Testosterone helps libido in menopause – can it deal with different signs?

Temper swings, mind fog, plummeting libido – menopausal signs could be debilitating. Many ladies flip to hormone substitute remedy for aid. These therapies virtually solely deal with restoring the plummeting oestrogen and progesterone ranges girls expertise in mid-life. But research now counsel one other hormone may have advantages too: testosterone. Whereas most analysis has checked out its impact on libido and sexual well being, preliminary proof signifies testosterone may assist with a variety of menopause signs, from temper modifications to muscle loss.

We frequently consider testosterone as a male hormone, however it is usually present in girls, simply often at a tenth of the extent as in most males, says Sarah Glynne on the Portland Hospital in London, who has labored as an adviser on menopause therapy pointers for the British Society of Sexual Drugs. Due to this false impression, analysis on the way it influences girls’s well being has been restricted, she says. However that’s beginning to change. Extra proof is revealing the hormone’s essential function within the feminine intercourse drive, and a few early research point out it’s even necessary for mind, muscle, bone and bladder well being.

Roughly half of testosterone in girls comes from the ovaries. The remainder is made within the adrenal gland, situated atop the kidneys. Ranges are inclined to peak throughout a girl’s 20s after which regularly decline beginning of their 30s. By center age, ovarian manufacturing of testosterone is about half what it was once, says Sharon Parish at Cornell College in New York. Whereas this tends to happen round menopause, it in all probability isn’t a direct results of it, she says.

Little is understood about how this drop-off impacts well being, however what is obvious is it might result in low libido. “[Testosterone] has an important profit for sexual operate,” says JoAnn Pinkerton at UVA Well being in Virginia. It performs a job in sexual arousal, want and vaginal lubrication. So it is smart that almost half of menopausal and postmenopausal girls within the US report combating libido and ache throughout intercourse, largely because of hypoactive sexual want dysfunction (HSDD), a situation wherein an absence of sexual fantasies or want for at the least six months causes misery. In the meantime, a survey of greater than 1800 postmenopausal girls in Europe discovered greater than a 3rd reported diminished intercourse drive and greater than half had been much less fascinated by intercourse.

The concept that declines in testosterone ranges drive lack of libido dates again to the Nineteen Forties. Since then, research after research has proven testosterone substitute remedy improves sexual operate in menopausal and postmenopausal girls. For example, a 2005 research of 533 girls with HSDD as a result of surgical removing of their uterus and ovaries discovered these handled with a twice-weekly testosterone patch alongside oestrogen remedy reported extra satisfying sexual experiences than these on oestrogen alone. A 2010 research confirmed comparable outcomes amongst 272 menopausal girls.

In 2019, a meta-analysis of greater than 80 research comprising 8480 girls discovered treating postmenopausal girls with testosterone considerably elevated sexual want, the frequency of satisfying sexual actions, pleasure, arousal, orgasm and self-image. Because of this, a few dozen skilled medical organisations, together with the Worldwide Menopause Society, the Royal School of Obstetricians and Gynaecologists and the North American Menopause Society endorsed using testosterone for HSDD.

One cause testosterone heightens libido is as a result of it interacts with mind receptors that activate neural pathways governing want, says Parish. To date, solely 4 nations have permitted a testosterone product designed for girls: Australia, New Zealand, South Africa and, as of July, the UK. The US Meals and Drug Administration (FDA) hasn’t adopted go well with as a result of issues there isn’t sufficient information monitoring potential long-term uncomfortable side effects. However Parish believes that is misplaced, noting some research have adopted individuals for years and located no elevated threat of coronary heart, breast or uterine points.

“Most suppliers who maintain menopausal girls would like to have an FDA-approved, protected and efficient transdermal [testosterone] remedy for girls,” says Pinkerton. “We actually suppose there’s a want for it, significantly within the libido house.”

The precise mix

Some docs counsel the remedy may have advantages past the bed room, too. A 2023 evaluation of seven research on testosterone in postmenopausal girls discovered it might improve muscle mass, decrease physique fats and enhance insulin sensitivity and ldl cholesterol. In 2024, Glynne and her colleagues evaluated use of the hormone in 510 perimenopausal and postmenopausal girls additionally utilizing oestrogen. After 4 months of therapy, about half the individuals reported fewer anxiousness assaults and crying spells. About 40 per cent additionally reported enhancements in melancholy, focus and fatigue, and greater than a 3rd noticed reminiscence enhance and irritability lower. “What I hear most frequently is girls saying they really feel extra like themselves. They really feel stronger. They really feel extra sturdy,” says Glynne.

However others are sceptical. Pinkerton notes these research don’t embrace a management group and depend on self-reported enhancements, elevating doubts about whether or not it’s testosterone or the placebo impact driving them. “Principally, there’s some analysis on cognition, temper, muscle power and cardiovascular and bone [health],” says Parish. “Whereas these present promising outcomes, we don’t have efficacy or security information in any substantial randomised managed trial to warrant suggestions for these indications.”

Most research use testosterone remedy along side oestrogen, however some have discovered testosterone alone nonetheless meaningfully improves sexual operate. Nevertheless, there’s a larger incidence of uncomfortable side effects comparable to pimples and extra hair development, so it isn’t often really helpful. Glynne says she often treats her sufferers with oestrogen first after which tacks on testosterone if signs nonetheless persist.

Researchers agree that scientific trials investigating testosterone’s results past libido are desperately wanted. Plus, there are nonetheless questions in regards to the impression of timing, dose and length, says Pinkerton.

What is obvious is present menopause therapies aren’t ample for many individuals, particularly these with a historical past of hormone-sensitive breast most cancers who can’t or don’t wish to threat oestrogen remedy, as it might spur the expansion or recurrence of those most cancers cells. “It’s a huge black gap in the meanwhile that we’d like heaps extra information on,” says Glynne.