Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care

Testosterone is one of the sex hormones that women produce, yet it is often overlooked. Women actually produce three times as much testosterone as oestrogen before the menopause. Levels of testosterone gradually decline because of increasing age or they reduce abruptly following oophorectomy. The most commonly described symptoms of androgen insufficiency include dysphoric mood, unexplained fatigue, change in sexual function including reduced libido, changes in cognition, vasomotor symptoms, bone loss, and decreased muscle strength.1 Reduced or lack of libido is very common in menopausal women. The National Institute for Health and Care Excellence (NICE) guidelines state that testosterone supplementation can be considered for menopausal women with low sexual desire if hormone replacement therapy (HRT) alone is not effective.2 The British Menopause Society (BMS) 2016 recommendations advise that this indication could be extended to include menopausal women with low sexual desire and tiredness.3 Testosterone can be important in women for bone density and muscle mass, cognitive function, mood, sexual function, and energy.1 Adequate levels of testosterone are important for the maintenance of musculoskeletal health and possibly vascular and brain function. Numerous studies have shown that adding testosterone to hormonal therapy can improve sexual function and general wellbeing among women during their menopause. A recent systematic review and meta-analysis of testosterone treatment in women has provided robust support for a trial of testosterone in women when clinically indicated. In postmenopausal women, testosterone supplementation improved several domains of …