British Menopause Society Tools for Clinicians: Testosterone Replacement in Menopause

The document from the British Menopause Society provides guidance on testosterone replacement in menopausal women, highlighting its role in libido, sexual arousal, orgasm, metabolic function, muscle and bone strength, urogenital health, mood, and cognitive function. It notes that testosterone levels decline naturally with age and more significantly after surgical or medical menopause. The diagnosis of Female Androgen Deficiency Syndrome (FADS) should be based on symptoms rather than solely on testosterone levels. While there are no UK-licensed testosterone products for women, off-label prescribing of male testosterone products in female doses is deemed acceptable. The document outlines the use of testosterone gels/creams and implants, with a starting dose provided for each. It advises a trial of at least 3 months, up to 6 months, before discontinuing due to lack of efficacy, and annual evaluation thereafter. Possible adverse effects include increased body hair, alopecia, acne, and voice deepening, but these are not problematic if female physiological doses are prescribed. Testosterone therapy should be avoided or used with caution in certain conditions, such as pregnancy, liver disease, or hormone-sensitive breast cancer. The document also references further reading for more detailed information on the topic.