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.