Perimenopause can lead to poor concentration, crushing tiredness, and low libido. Sharon Ní Chonchúir talks to medics about the restorative power of testosterone replacement therapy
WOMEN are often told they should feel fabulous during their 40s but for many, it’s a decade when there is far too much going on. Ageing parents, growing children, and work commitments mean endless demands on our time and energy.
As a result, they’re exhausted. Concentration levels are pitiful and libidos are practically non-existent.
With all that has to be done, how could they feel any different? However, a growing body of medical research is showing that it is indeed possible to feel fabulous at 40-plus, but first you’ll need to address the perimenopause, which can last from four to eight years.
The perimenopause is the name for the years before the menopause, when the ovaries gradually start to make less oestrogen, an influential sex hormone that regulates many aspects of our lives. It continues until the ovaries stop releasing eggs.
The average age of menopause in Ireland is 50, says Dr Cliona Murphy, a consultant obstetrician and gynaecologist in the Coombe Hospital and the Adelaide and Meath Children’s Hospital.
“For a number of years before this, women experience symptoms ranging from heavy periods to hot flushes, sweats, mood disturbance, poor sleep, lack of concentration, low energy levels, and low libido,” she says. “These symptoms are due to varying levels of hormones in the body.”
Traditional hormone replacement therapy (HRT) has sought to replace lost oestrogen but increasingly doctors believe that testosterone — the so-called male hormone — could also have a role to play in helping women through the perimenopause by alleviating many of the symptoms mentioned above.
Dr Martin Galy is one of the most prominent hormone doctors in Britain. He did his medical training at the Royal College of Surgeons in Dublin and now has a clinic in London. He has offered testosterone replacement therapy (TRT) to women since 1998.
“I see lots of Irish patients and like all my female patients, their symptoms include fatigue, bone loss, muscle weakness, increased fat, chronic aches and pains, stiffness, low libido, low mood, anxiety, irritability, insomnia, decreased mental sharpness and decreased memory,” he says.
“Most commonly, it’s low libido, poor concentration, and irritability.”
Decades ago, women might have had no choice but to put up with this but these days try to stay as fit as possible for as long as possible. Dr Galy believes this is where HRT, and testosterone in particular, can help.
UCC graduate Dr Hind Abu Ella Al Hussain works at the Marion Gluck Clinic, another London clinic that is pioneering in its approach to hormones. She is convinced testosterone can be of benefit to women experiencing perimenopause.
“Testosterone — like oestrogen and progesterone — is produced in the ovaries,” she says. “It works in synergy with these hormones to enable us to feel fulfilled in our lives; motivated and competitive in our jobs and sexually aroused and actively engaged in a fulfilling sexual relationship with a partner.”
Many of her patients don’t feel this fulfilment. “15% of all perimenopausal women have hypoactive sexual desire disorder, which is a lack of receptivity to sexual thoughts or activity.
“A significant proportion also present with feelings of being demotivated towards life or work, a lack of energy or feelings of being overwhelmed and unable to cope.”
After TRT, they change dramatically. “One of my patients described her renewed vigour with delight as ‘being able to run with the boys again’ in her highly male-dominated and challenging career,” she says.
Several female celebrities have testified to the life-changing power of testosterone. At 76, Jane Fonda announced it had transformed her sex life. At 54, Trinny Woodall ascribed her youthful looks to a combination of progesterone, oestrogen, and testosterone, and 52-year-old Meg Mathews from ITV’s Loose Women raves about the benefits of testosterone on her website, megsmenopause.com.
Here in Ireland, Dr Patrick Macgovern of the Drummartin Clinic in Dublin has been offering testosterone as part of compounded hormone treatment for over a decade.
He regularly sees its benefits. “A 42-year-old patient told me today that she now has more energy and strength than the 22-year-old she lives with,” he says. “She goes out dancing and is able to exercise more and puts this change down to her restored hormone levels.”
Some myths need to be busted in order to change awareness of the potential offered by testosterone, say medics who prescribe TRT.
The first is that testosterone is a male hormone. Testosterone is made in the testes of males and in the ovaries of females as well as in the adrenal glands of both sexes. In fact, there is no oestrogen without testosterone. “Most of the testosterone in a woman’s body is converted to oestrogen,” says Dr Galy.
The second is that testosterone is essential for physical and mental health in women. It helps to build motivation and emotional stamina, which is why a lack of it can leave us feeling listless.
It boosts the brain’s neurotransmitters, which is why we become forgetful when it’s in short supply. It’s instrumental in the production of serotonin and dopamine, influencing sex drive. It also keeps bones, hair, and muscles strong and helps to relieve joint pain.
Women’s testosterone levels are highest in their 20s and have usually halved by age 40. It’s no wonder they then experience such debilitating symptoms.
There are misconceptions surrounding the side-effects of TRT too. They potentially include acne, irritability, excessive hair growth or hair loss, changes in the menstrual cycle, deepening of the voice, irritability, an abnormal enlargement of the clitoris, and an unacceptably high libido.
“I don’t believe in side-effects with HRT but rather in dose-dependent effects,” says Dr Al Hussein.
Dr Macgovern agrees. “There’s always a risk, especially of acne and hair loss, but I’ve hardly ever seen it and I’ve prescribed testosterone hundreds, if not thousands, of times,” he says.
Cancer is a serious concern with HRT. In the 1990s, the Women’s Health Initiative in the US looked at HRT’s effects on more than 16,000 women aged between 50 and 79. It found that a specific oestrogen-based menopausal treatment increased the risk of breast cancer in women who took it over a long period. Suddenly all HRT was under suspicion.
Studies since then have shown the science to be more complicated. Oestrogen-only HRT and a combination of oestrogen and progesterone may elevate the risk of breast cancer but testosterone has been shown to be breast protective.
In 2013, a 10-year, US study carried out at Wright State University found that being treated with testosterone improved symptoms of menopause in women and reduced their risk of breast cancer. (Testosterone for women has yet to be approved by the US Food and Drug Administration.)
Other studies have shown the impact TRT can have on women’s overall wellbeing, especially on their sex lives.
In 2012, a review of all of the studies carried out into the effects of testosterone on hypoactive sexual desire disorder was published in the Journal of Sexual Medicine. It found transdermal testosterone was an effective and safe therapy for women with the disorder.
The hormone therapy doctors interviewed for this article have been convinced of this for decades and follow a careful protocol when prescribing testosterone to their patients.
Firstly, they get as full a history as possible. “I take a comprehensive medical, surgical, and gynaecological history and test the blood for hormone levels,” says Dr Al Hussein. “I then put the history and blood hormone profile together. Women with exactly the same blood hormone profile can present with very different symptoms and their hormonal needs can be hugely different.”
Dr Macgovern takes an even wider view. “I’ll ask them about gut health and take magnesium levels as well as hormone levels,” he says. “Hormones are one thing but nutrition is another and there are plenty of other factors too.”
When prescribing testosterone, the doctors start with the lowest dose they believe will benefit the patient. The duration of treatment varies. “When a patient comes off their HRT, their symptoms may return, so it remains a decision that is individual to each patient,” says Dr Galy.
“Women in America can be on hormones forever,” says Dr Macgovern.
There are many reasons why testosterone is not widely prescribed to women going through perimenopause and menopause. It could be because it’s largely seen as male hormone. Or it could be because most of the medical products on the market are designed for men and the dosages are too high for women.
“When big pharmaceutical companies don’t provide a testosterone replacement for women, then the benefits of testosterone for women are not even up for discussion in many medical circles,” says Dr Al Hussein.
Dr Galy suggests it might be because doctors are reluctant to discuss sexual matters with female patients. “We need to move past this. A female patient complaining of a low libido needs to be treated as seriously as the same complaint from a male patient.”
Whatever the case, many women in their 40s need help. “Compared to previous generations, women experiencing perimenopause today are likely to be in full-time employment,” says Dr Cliona Murphy.
There are options available to them when it comes to dealing with the challenges they face as they approach menopause. Testosterone treatment is one that could offer real results. With its help, they might begin to feel fabulous during their 40s.