Experts have warned that the prescribing of testosterone for middle-aged women in the UK is "out of control" and could have long-term health implications.

They are particularly concerned about "testosterone evangelists" on social media, including some celebrities and GPs, who promote the hormone as a remedy for fatigue and low energy, and as protection for the heart, brain, muscles, and bones. However, experts assert that the evidence only supports its use in postmenopausal women with low libido, and only after psychosocial causes have been ruled out.

“I genuinely think testosterone prescribing is completely out of control in the UK,” said Dr Paula Briggs, a consultant in sexual and reproductive health at Liverpool Women’s Hospital and chair of the British Menopause Society.

“People are being led to believe that they must have this. But we have no idea what long-term testosterone supplementation does to women.”

Role of Testosterone in Women

Testosterone, primarily known as a male hormone, is also produced in the ovaries and female adrenal glands, playing a crucial role in female sexual development and maintenance. Levels peak in a woman’s 20s and 30s before declining, influenced by reduced production from the ovaries and adrenal glands, as well as by stress, surgical interventions, and certain medications or cancer treatments.

In the UK, NICE guidelines suggest considering testosterone supplementation for menopausal women with low sexual desire if standard hormone replacement therapies are ineffective. However, the British Menopause Society advises this approach only after ruling out other potential causes such as psychological factors or medications. Nonetheless, some private doctors reportedly prescribe testosterone as an initial treatment for libido issues and other symptoms.

Dr. Louise Newson, a GP specializing in menopause with private practices in the UK, has argued for women’s access to testosterone, citing its potential benefits for mood, energy, concentration, stamina, bone density, and overall muscular and cardiovascular health. She advocates for integrating testosterone alongside hormone replacement therapy early in treatment for women experiencing symptoms related to testosterone deficiency during perimenopause.

Newson also stresses that testosterone’s impact extends beyond libido enhancement, highlighting its significant role in brain function and processing.

Side effects and risks

Professor Annice Mukherjee, a consultant endocrinologist at Spire Manchester Hospital and a media ambassador for the Society for Endocrinology, stated that she had seen patients experiencing unpleasant side effects after being prescribed testosterone.

“Women come to me saying: ‘My hair’s falling out’ or ‘My voice has got deeper, and I’ve got new acne or hair growth on my body, why is that?’ So, I measure their testosterone, and it is sometimes equivalent to a man’s level,” she said.

One of her patients was a professional singer who had been prescribed testosterone by a private clinic. “Her doctor had said: ‘You need HRT, and by the way, you also need testosterone.’ She came to me because she was experiencing problems with her voice. When I tested her testosterone levels, they were more than double what is normal for a woman,” Mukherjee said.

“If we give women too much testosterone, it can affect their vocal cords. If you don’t mind your voice deepening a bit, that’s fine, but if you’re a singer, it can change your pitch.”

Safety concerns 

Briggs and Dr. Stephanie Faubion, medical director of the North American Menopause Society and director of the Mayo Clinic’s Women’s Health Research Center in the US, are also concerned about the lack of long-term safety data for testosterone use in women.

“There’s a reason that we should be concerned about long-term safety, and that’s because we don’t have any data to say that it is safe,” said Faubion. “We don’t have data to say that it’s unsafe either. But the lack of data proving safety is a real problem.”

Newson stated that long-term use of safely prescribed testosterone replacement was unlikely to be associated with any adverse health risks, “due to it being a natural hormone”.