With all the hype around testosterone for menopause symptoms, is any of the hype justified? Why are menopause influencers so insistent that more women "need" this treatment when the science behind it is so weak?
In most of the world, testosterone for menopause symptoms can only be prescribed off-label, which means that medical regulators have yet to be convinced of the efficacy and/or safety of testosterone products. Australia is one of two countries where testosterone is licensed for menopausal women.
Professor Susan Davis (former president of the International Menopause Society and a professor of women’s health at Monash University, Australia) has been prescribing testosterone cream to women for the past twenty years. Her research around testosterone for women goes back even further, to the 1980s. She’s considered a leading expert in the field.
In a fascinating interview with Ann Marie McQueen, host of The HotFlash Inc podcast, Professor Davis explains there’s robust evidence from numerous studies, which show that testosterone will “moderately improve sexual desire in most women but not in all.”
Yet, from her experience treating women, she also shares the following:
“I would say more women than not, after trialing it, come back and say, it hasn't really helped. I give them six months to trial it and they say I'm not going to bother continuing. It is the minority that continue in terms of sexual function. And so, if you are really honest with women and don't try and you know, be charismatic and over embellish the potential benefits, you get much less of a placebo effect. But in all our research, there was a very, very high placebo effect, and there is with testosterone. And if you pay a lot of money for it and you're treated by a charismatic doctor, you probably think it works.”
Oops! This is not what charismatic menopause influencers with huge numbers of social media followers want you to know.
Let’s break down what Professor Davis said:
Even though clinical trials have shown a moderate improvement in sexual function in “most women,” from her decades of experience, a majority of women don’t experience a change significant enough to convince them to carry on taking testosterone beyond six months.
Over-marketing testosterone significantly increases the placebo effect.
But if women start feeling better because of a placebo effect, does it matter?
All medicines come with risks. Relying on a placebo effect to help women, needlessly exposes them to risks, which could be small or more serious.
Since testosterone has not been tested in any clinical trial for more than a year, we simply don’t know what the long-term risks are.
When estrogen-only therapy started to be aggressively marketed to all menopausal and post-menopausal women in the mid 1960’s, it took a decade until research was published on the increased risk of endometrial cancer found in women who were taking estrogen-only therapy but had not undergone a hysterectomy.
Similarly, when estrogen was combined with progestin (the latter to protect the uterus from endometrial cancer) and was aggressively marketed as combined HRT in the 1980s, it would be over a decade until research revealed the increased risks of heart disease, breast cancer, stroke, blood clots, and urinary incontinence that came with long-term use of combined HRT, particularly in women who are more than 10 years post menopause.
Without the existence of data on long-term safety, is the current aggressive marketing of testosterone to menopausal women going to repeat these unfortunate patterns of harm that we’ve seen throughout the history of hormone therapy?
In recent years, with a growing hype around testosterone therapy, lots of perimenopausal and menopausal women have been convinced that the treatment can help ease a large range of symptoms associated with midlife change, and prevent disease. As Professor Davis points out, this is not because there’s clinical data to back such claims. Research has been carried out to test if testosterone could positively impact mood, cognitive function, bone health and more in women post-menopause, and in all cases apart from sexual function, the results were inconclusive.
We can only speculate, therefore, why meno celebs insist on promoting testosterone as the latest panacea for women.
In a recent article in The Times (UK), entitled Testosterone for women? Ten things you need to know, readers were told that testosterone:
“Can protect against urinary tract infections.”
“May help prevent osteoporosis.”
“May increase resistance to Alzheimer’s disease”
And more.
Without digging deeper into the scientific research referenced in the article, a reader could easily conclude that these claims were true rather than unproven. In the HotFlash Inc interview, Professor Davis stated about The Times article that “people are just cherry-picking the data [and] misquoting the publications.”
Specifically, around the claim concerning bone health, Professor Davis pointed out that The Times article referred to a study carried out in 1999 with a testosterone product that is no longer available because it’s considered unsafe. Furthermore, the impact on bone health in the study was only witnessed with high doses given to 50 women, who experienced side-effects such as the onset of body hair, acne and baldness. Which women are willing to pay that price for an unproven promise of bone health?
Why wouldn’t The Times promote all-round health boosters such as a clean diet, sunshine and exercise, all of which can have a positive impact on bone health and much more?
Why would The Times even publish an article promoting testosterone for menopausal women, when promoting prescription-only medicines to consumers is prohibited under UK law?
And where are the UK regulators who are supposed to protect the public from pharmaceutical brainwashing?
On the day that The Times article was published, The British Menopause Society (BMS) was compelled to issue a statement to protect women from harms caused by the unethical practice of testosterone promotion. The Times article was just one of a long list of media promotions that have disrupted women’s basic right to informed consent.
The BMS statement said:
In the past few weeks, there has been a significant increase in media attention for more women to be prescribed testosterone. Some of these articles have been written by lay people and it appears that the information provided has been misrepresented to support personal opinion.
Misinformation risks medicalising a normal life stage and render women dependent upon clinicians, some of whom may also be overly promoting treatment with testosterone, which is associated with a high placebo response. Testosterone is not an “essential” hormone for women, as women who have effectively no testosterone production, such as women with no functioning adrenals or ovaries, do not have to have testosterone treatment to be well. Women in whom the ovaries have been removed surgically, still have some testosterone produced by their adrenal glands. So, the frequently used descriptive term, “deficiency state” is incorrect and alarmist.
...
The only current evidence-based factual indication for the addition of testosterone to standard HRT, is for persistent low libido in postmenopausal women, after all other contributory factors have been addressed. There is no evidence to support claims that testosterone will help with other symptoms associated with menopause or prevent bone loss or dementia.
Having supported women in perimenopause and menopause for almost a decade, I know how tough it can be to find help. There’s a lot of confusion around the most effective and safest routes to reach symptom relief. When you feel overwhelmed and desperate to feel better, it’s certainly attractive when the familiar face of a celeb assures you that help is at hand from a supposedly simple product. When you hear about that product on social media, on the TV, in a newspaper that you may have subscribed to for decades, you want to believe that what you’re being told is true.
However, it seems by design, perimenopause and menopause are supposed to teach us about health, sovereignty and discernment. We’re evolving into wiser women and it’s time to take an honest look at influencers who rather than serving women’s health, are promoting unproven benefits of medicines to serve other interests.
I encourage you to listen to the whole interview with Professor Davis on The HotFlash Inc podcast. Ann-Marie and Professor Davis cover a lot of ground, and you’ll hear information about testosterone and HRT, which may not be popular to share, but is crucial to help women make informed choices for their health.
In this day and age, when ethical journalism is a rarity, Ann Marie, with her podcast and Substack dedicated to researching all areas of menopause, is a shining example of what good journalism should look like.
If you have any questions about the above, feel free to contact me.
And if you’d like to listen to my interview with Ann Marie on The HotFlash Inc podcast, you can catch it here.
I had no idea of any of this in relation to testosterone use and have just had a blood test prior to an appointment to request testosterone for low libido. I am 66 and post menopausal. Thank you so much - I now feel much better informed to have the conversation. I’ll probably give it 6 months and see if it works.