It’s the drug that midlife women increasingly claim is the key to finally overcoming menopause symptoms, banishing fatigue and reviving their libido.
No wonder, then, that NHS prescriptions for testosterone HRT have surged eight-fold in five years – with the therapy championed by celebrities from broadcaster Davina McCall to celebrity chef Dame Prue Leith.
But, for some, the effect of testosterone therapy can be underwhelming. Or its benefits can quickly fade – often within weeks or months.
This was the case for Daily Mail columnist Nadine Dorries, who last week revealed how, just three months after beginning testosterone therapy to tackle brain fog and exhaustion, ‘the positives have begun to subside’. Nadine previously detailed the remarkable turnaround she had experienced when she began treatment. ‘I could once again think clearly, and the relief was immense,’ she wrote. ‘I had honestly forgotten how good life can be.’
In response to the drop-off, her GP chose to double the dose and, thankfully, she says she can once again ‘feel the difference already and I’m back on form’.
However, experts say that, for many patients for whom the effects of testosterone fade, increasing the dose is not always necessary. Instead, they argue that many patients can ‘turbocharge’ their testosterone therapy by making other changes.
These include changing sleeping patterns, cutting out certain food and drink, as well as following a particular exercise routine.
Last week, Daily Mail columnist Nadine Dorries revealed the the positive effects of her testosterone therapy were beginning to wear off after just three months
NHS prescriptions for testosterone HRT have surged eight-fold in the last five years
Crucially, experts also say that many patients are making common mistakes when applying their testosterone that could be impacting its efficacy.
‘It’s very normal for the effects of drugs to lessen over time,’ says Dr Naomi Potter, co-author of Davina McCall’s book Menopausing. ‘But there are things you can do to maximise your body’s response.’
While testosterone is often seen as a male hormone, women also produce it in smaller amounts in the ovaries and adrenal glands.
It plays a key role in sexual desire by boosting dopamine – the ‘feel-good’ chemical linked to pleasure, decision-making, mood and focus.
Levels peak in the mid-to-late 20s, then gradually decline with age. However, experts say this does not mean all women will need to take it. Most women who develop menopause symptoms in midlife will respond well to standard hormone replacement therapy, which usually comprises the two female sex hormones oestrogen and progesterone.
But, for some, particularly those with persistently low libido, testosterone might be recommended.
Almost all women prescribed testosterone therapy in the UK will typically take it as a gel that is rubbed into the skin every day.
But the treatment won’t be effective for everyone. Dr Paula Briggs, a reproductive and sexual health consultant at Liverpool Women’s Hospital, believes that only one in ten women experience a benefit.
It is also still unclear whether it improves menopause symptoms beyond libido, as there is no data that it combats other common issues such as brain fog or poor sleep – but studies looking into this are ongoing.
However, the way to get the best results from testosterone therapy is to also focus on boosting natural testosterone levels.
‘Medication isn’t the only way to get your levels up,’ says Dr Potter.
‘You can’t just take the drug and hope that all your symptoms go away. It’s important to look after your body too.’
One of the most important factors is getting enough sleep. Studies show that most people need between seven and eight hours a night – however, it is important not to get too much sleep, either.
A 2023 study, published in the journal Andrology, found middle-aged women who slept for less than six hours tended to have low testosterone – but so too did those who slept for more than nine hours.
Davina McCall holding a tube of testosterone. The broadcaster is a vocal supporter of the therapy
Dr Naomi Potter, co-author of Davina’s book Menopausing, says that excercise is crucial for boosting testosterone. Twice-weekly resistance training could boost levels in two months
‘One of the best ways to ensure you are getting the right amount of sleep is to go to bed and wake up at the same times,’ says Dr Potter. ‘This will help regulate your hormones, so they are not spiking or dropping.’
Another way to boost testosterone levels is to avoid caffeine and alcohol.
‘During the menopause the body becomes more sensitive to caffeine,’ she adds. ‘So you are more likely to feel more anxious and sleep less, both of which will worsen your testosterone levels. The same is true for alcohol.’
Dr Potter also argues that exercise is crucial for boosting testosterone. One 1998 US study found that twice-weekly resistance training – muscle-strengthening exercises that involve weights or bands – could boost female testosterone levels in two months.
Any exercise is helpful – provided you don’t multi-task while doing it.
‘One of the most important parts of exercise is that it tackles stress levels,’ says Dr Potter. ‘And all exercise has this effect, whether it’s running or weight-lifting.
‘But if you are watching something on your phone or responding to emails at the same time as exercising, this is going to keep your stress levels up and reduce its positive effects.’
Another reason many women find their testosterone therapy stops working – or is not as effective as they expected – is because they are not using it correctly.
Testosterone medication typically comes in a pump dispenser or sachet. But Dr Potter says that many patients do not use enough of it.
‘It’s common for patients to not get all the gel out of the packet,’ she says. ‘And if you underdose like this over several weeks you will start to feel a difference.’
She adds that many patients do not realise they need to wait for it to absorb into the skin. ‘If you wear clothing over the top of the area where the gel has been applied, this can rub it off,’ she says.
‘Likewise, if you go in the sea, apply sunscreen to the area or even just sweat in the sun, this can all reduce its effect.
‘I’ve even had patients who were getting into hot tubs or saunas straight after applying it, who didn’t realise this would lessen its impact.’
Dr Potter says that anyone who believes their testosterone therapy is no longer working should speak to their GP.
‘It’s possible that a larger dose might be necessary,’ she says. ‘But, often, it’s worth checking whether you are taking the drug correctly and that you are doing everything possible to keep your body healthy.’
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