Testosterone Q&A | Dr Louise Newson- Women's HRT Doctor in the UK

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In her latest Instagram Live, Dr Louise Newson answers questions about testosterone.

Introduction​

Today, I’ll be discussing testosterone. Although I’ve already covered this topic in a previous Instagram Live, which is available on my YouTube channel, I’ve decided to approach it differently today. I’ve received many questions about testosterone, so I’ve compiled them on my laptop and will try to answer as many as possible within 30 minutes. I hope this will be useful for you.

Overview of Testosterone​

Testosterone is one of the hundreds of hormones in our body. Hormones are chemical messengers that travel through our bloodstream and instruct cells on how to function. Testosterone, often misunderstood, is produced by both men and women. In women, it is made in the ovaries, adrenal glands, muscles, and even the brain. Interestingly, younger women have more testosterone than estrogen. Testosterone levels typically peak in the mid-20s and decline with age, unrelated to menopause. Women who have had their ovaries removed experience a significant drop in testosterone, which can lead to noticeable changes.

Testosterone is involved in various metabolic processes, including brain function, bone health, heart health, and mitochondrial activity. Although we can survive without testosterone, its absence can lead to symptoms.

Questions and Answers​

Does Testosterone Help with Mood?​

Yes, it can. Guidelines state that testosterone can be considered if women have reduced sexual desire despite being on HRT. Many women also report improvements in mood and memory when testosterone is added. In clinical practice, women who have not responded well to psychiatric medications or even ECT have found relief when testosterone is added to their treatment.

When Should We Ask About Testosterone and Is It Only for Low Libido?​

Guidelines suggest testosterone primarily for low libido, but it can help with other symptoms as well. It’s difficult to predict who will benefit, so we often start with a baseline blood test. If levels are low and symptoms match, a therapeutic trial is conducted.

Are All Testosterone Replacements Body-Identical?​

No, there are synthetic forms as well. Over 300 synthetic testosterone variants exist, often found in gyms. However, these are chemically altered and lack the biological benefits of natural testosterone. In our clinic, we use testosterone cream or gel that matches the body’s natural structure.

What Are Normal Testosterone Levels in Women?​

Normal levels vary greatly and depend on the laboratory. We usually measure testosterone and SHBG to calculate the free androgen index. NHS labs often mark low levels as “normal” due to automated systems. It's important to ask for the actual figure to interpret it in context.

Testosterone and Parkinson’s Disease​

Parkinson’s is a neurodegenerative disease, and research shows that women with early menopause have a higher risk. While there are no large studies on testosterone use in women with Parkinson’s, it has shown promise in clinical observations, improving muscle strength and nerve conduction. It’s safe to try it alongside Parkinson’s medication.

Availability of Testosterone in the UK​

Testosterone is not licensed for women in the UK. The only licensed product was Intrinsa, which was discontinued. Testosterone for men can be prescribed off-label at lower doses for women. Private clinics can prescribe AndroFeme cream, which is licensed in Australia. Not all GPs can prescribe it due to local formularies, but many become confident after seeing initial clinical success.

Application of Testosterone Gel​

Absorption varies by site. If it’s not well-absorbed on the thigh or bottom, try areas with less subcutaneous fat. It’s best applied daily for consistent levels. The sachet can last 5-8 days, depending on usage.

Should Estrogen Levels Be Adequate Before Starting Testosterone?​

The idea that estrogen must be at an adequate level before starting testosterone is outdated. Testosterone can be started alongside HRT based on individual needs and preferences.

Does Testosterone Cause Weight Gain?​

Usually, it doesn’t. It can help convert fat to muscle, leading to weight loss due to improved activity and reduced sugar cravings. Clinical studies haven’t confirmed direct weight loss effects, but improved energy often leads to better exercise routines.

Side Effects of Testosterone​

Common side effects include hair growth at the application site. Rare side effects include voice changes and clitoral enlargement, which usually resolve if treatment stops. Acne may recur in those predisposed to it. Significant side effects are rare when using the correct dose.

How Long Does It Take to See Effects?​

It can take 3-6 months to see significant improvements. Blood levels are reviewed after 3-4 months to ensure proper absorption and dosing. If absorption is an issue, switching to a different formulation or application site can help.

Does Testosterone Help with Sleep?​

Yes, many patients report improved sleep quality. Testosterone, alongside estrogen and progesterone, contributes to restful sleep.

Can Testosterone Help with Anxiety?​

Yes, especially if anxiety is linked to low testosterone levels. It can help with general anxiety, driving anxiety, and social fears. However, results vary.

Use in Conditions Like Sjögren’s Syndrome​

Testosterone may improve symptoms like dry eyes and mouth, common in autoimmune conditions. Optimizing all three hormones—estrogen, progesterone, and testosterone—is important for symptom relief.

Does It Help with Vaginal and Urinary Symptoms?​

Yes, testosterone can improve vaginal and urinary symptoms due to its effect on the vulva, bladder, and pelvic floor. Localized DHEA, which converts to testosterone, is another treatment option.

Safety and Cancer Risk​

There’s no evidence that natural testosterone causes cancer. Young women with naturally high testosterone do not show an increased risk. It’s anti-inflammatory and promotes cell health.

Driving Fatigue and Lack of Improvement​

If you’re using testosterone but not seeing results, it may not be absorbing well. Try changing the application site or switching between gel and cream. Blood tests can confirm absorption.

Conclusion​

Thank you for joining this session. If you found this Q&A format useful, please let me know in the comments so I can plan more sessions. I’m passionate about sharing knowledge to help women make informed choices about their health. For more information, visit my website and check out my tour dates. Hope to see you there!

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