Physiological patterns of testosterone in women
The menopausal transition is a common time for women to present with libido changes. However testosterone levels don’t fluctuate or drop as suddenly as oestrogen does in perimenopause, but peak in women’s 20s and then gradually reduce over the rest of their lifetime. Testosterone is produced by both the ovaries and the adrenal glands in women and continues to be produced by the adrenal glands after menopause.
Indication
There has recently been increasing interest in and discussion around the use of supplemental testosterone in women for menopausal symptoms. Studies support the use of testosterone replacement to improve libido for women over the menopausal transition but more studies are needed to understand if testosterone supplementation is helpful for other markers of quality of life for women. So currently the only recommended use for testosterone in women at this stage is for troublesome hypoactive sexual desire symptoms which persist despite standard MHT therapy and it
is usually given as an adjunct to standard MHT.
Availability
Testosterone preparations are not currently funded or registered for use in women in New Zealand. Androfeme is the only product currently available in Australasia designed to provide testosterone in doses suitable for women in a consistent way. This means that the dosage is consistent from day to day and effects of the product can be monitored.
Usage
To use androfeme place ½ ml of cream onto the outer thigh and rub it in before bed. Rotate sites of application. Apply to clean skin without moisturiser or any other product on the skin. Timing of therapeutic effect. Testosterone replacement in this way takes approximately 4 weeks of use to have a clinical effect and the efficacy peaks at around 3 months of use.
Cautions and monitoring
The same cautions and contraindications that apply for MHT apply for testosterone therapy, though there is less safety data available for testosterone in women compared with standard MHT. It is important to consider monitoring for changes in haematocrit, lipids and liver functions and to ensure that testosterone levels are not supraphysiological on treatment.
We suggest a blood test every 2 months with an aim of achieving levels of between 2-3 nmol/l on the Auckland assay. The Waikato assay is slightly different and so we would be aiming to achieve slightly higher on this assay up to 3-4 nmol/L. Whilst women sometimes find using the syringe cumbersome to use, it is important to use this for accurate dosage.
Adverse effects
Common side effects can include acne and an increase in body hair. If Androfeme is not well monitored and levels become supraphysiological, side effects can be more significant with clitoral enlargement, voice deepening and an increase in red blood cells for example.
Lifestyle approaches for optimal effect
Androfeme is much more likely to have a positive effect when other influences on the libido are also considered (link to our libido article). Studies show that about 60% of women will respond positively to testosterone supplementation (where a positive response is described as 1-2 more satisfying sexual experiences per month).
Overall, first line approaches are to treat (peri)menopausal symptoms with standard MHT in the first instance. In addition to systemic MHT, topical vaginal oestrogen can improve tissue sensitivity and therefore sexual symptoms. Sometimes stabilising oestrogen levels with standard MHT and improving sleep, flushes, mood and vaginal symptoms may be enough for libido to improve.
However if there is not much improvement in libido, Androfeme could be trialled.
Testosterone therapy in women will be covered in more depth in our App-based menopause courses
(for the public and for health professionals) -find out more here:
Menopause course for women* and couples here
Menopause courses for health professionals here
Bays Pharmacy in Auckland supplies Androfeme within New Zealand.
Note: we have no funded affilations with AndroFeme, other testosterone preparations or Bays Pharmacy. We have simply provided information that we think will be helpful.
Do you recommend HCG mono-therapy before starting full TRT ? Can I add 10 mg of Anavar ( Oxandrolone ) to improve overall wellbeing?
We use testosterone replacement for men in the setting of proven testosterone deficiency. There is no clinical indication to use HCG in men unless there is a requirement for achieving spermatogenesis (sperm production) in the setting of wanting a pregnancy.
Thanks ERH Associates
It’s a shame that a androfem can’t be used for other things such as fatigue ,low energy etc ,in menopausal woman .
I am taking hrt and it’s had good effects : estrogen and progesterone.
But I am still tired , so I’m hoping like overseas there will be a better understanding of testosterone,and
It’s use in women ,as we are only replacing what we have lost .
Thank you so much for your comment and for sharing your experience — we’re so glad to hear that MHT has been helpful for you.
We absolutely agree that fatigue and low energy are very real and frustrating symptoms for many women during the menopause transition. While testosterone may seem like a logical option, the reason it isn’t routinely recommended for those symptoms by current international guidelines is simply because the current evidence doesn’t yet support its widespread use for fatigue, mood, or general energy levels. This isn’t a local New Zealand approach — it’s consistent with international guidelines including those from the International Menopause Society and other expert bodies around the world. Testosterone is currently recommended by international guidelines for use in women only where low libido persists despite standard MHT. Research does show that testosterone does not decline for women over this transition like estrogen does. There is a slow steady decline for women since their early 20s and in fact testosterone levels then increase again in women’s 70s and we are not sure why this is.
Persisting fatigue on MHT might be due to a a number of different causes or a combination such as MHT regime not being optimised for your individual needs, sleep apnoea and other sleep disturbances, suboptimal fueling/nutrition whilst trying to lose weight and other causes (look out for our article on fatigue in the next few weeks).
That said, we absolutely support the ongoing research into testosterone and other options that may one day expand our toolkit for managing energy, mood, and overall quality of life in menopause. In the meantime, we encourage a broad approach to midlife fatigue, including evaluation of sleep quality, iron levels, thyroid function, stress load, and nutrition.
Thank you again for your thoughtful comment — this kind of dialogue is so important in raising awareness and helping women feel heard and supported.
Warmest wishes,
The ERH Associates Team