What is the Role of Testosterone in Women’s Health and Menopause?
This International Women’s Day offers an important moment to reflect on how women’s health, including menopause, has historically received limited research and attention. Approximately 13 million people in the UK are peri- or postmenopausal, underscoring the significant demand for menopause-related care and support.[1] While oestrogen often dominates the menopause conversation, testosterone also plays an important, yet under-recognised role in women’s health and wellbeing. Other than influencing libido, testosterone contributes to energy levels, mood, cognitive function and physical wellbeing. Although women produce testosterone in lower quantities than men, it remains biologically important throughout life. Recognising its role is key to building a more complete, informed and supportive understanding of women’s health.
Testosterone and its impact on women’s wellbeing
Testosterone plays an essential role in women’s physiology. As part of the androgen hormone group, testosterone contributes to the development and maintenance of female sexual anatomy, sexual psychology and the modulation of sexual behaviour. However, the impact of this hormone often becomes more apparent when levels decline during aging and menopause.
On average, testosterone levels decrease by around 50% between early adulthood (age 20) and age 60.[2] This reduction can be more pronounced following surgical menopause due to the removal of ovaries and iatrogenic menopause, which is medical or surgical menopause induced by treatment. The drop in testosterone, along with other hormonal changes during menopause, can contribute to symptoms that many women experience, including low libido, sexual dissatisfaction, fatigue, low mood, anxiety and brain fog, all of which can negatively impact physical and psychological well-being.
The most clearly established role of testosterone for women is sexual function. While persistent reductions in sexual desire during menopause are influenced by multiple hormonal factors, testosterone therapy can help address this in some women. Hypoactive Sexual Desire Disorder (HSDD) is characterised by a sustained loss of sexual desire that causes personal distress. HSDD is estimated to affect more than 1 in 3 menopausal women and can significantly affect relationships, emotional wellbeing and the overall quality of life.[3]
In the UK, the National Institute for Health and Care Excellence (NICE) recommends testosterone therapy for HSDD in postmenopausal women if oestrogen-based HRT alone is not effective. This guidance reflects increasing recognition that declining testosterone can be a treatable factor contributing to symptoms in some women.
Limitations and innovations in testosterone therapy
However, significant limitations remain in meeting women’s needs for appropriate hormonal therapy. Most currently available testosterone creams and gels are formulated for male dosing rather than female physiological requirements, creating challenges in achieving accurate dosing for women. In addition, the need for frequent application can be inconvenient and difficult to maintain, while concerns around accidental dermal transfer may further affect adherence. As a result, there remains a clear unmet need for convenient, discreet and accurately dosed testosterone therapies designed specifically for women.
Medherant’s testosterone TEPI® patch represents a delivery-led approach to addressing this unmet need. Designed to deliver low-dose testosterone within the physiological female range, the patch’s drug-in-adhesive technology provides controlled and reproducible transdermal delivery over the wear period. Unlike other patches, the adhesive matrix on the TEPI® patch does not lead to cold flow, therefore avoiding the dark adhesive marks left on the skin that most women experience with existing HRT patches. These design features have been supported by early clinical evaluation, which has demonstrated predictable pharmacokinetic profiles with testosterone levels maintained within the normal premenopausal range. Other benefits include positive skin tolerability and patch adhesion, offering potential for improved convenience and adherence compared with daily creams and gels.
Testosterone plays an important, yet often overlooked, role in women’s health during menopause. Testosterone therapy may be an effective option for women experiencing distress from low libido during menopause, particularly when conventional hormone replacement therapy is insufficient. Advances in treatment formulation and delivery, such as transdermal patch technologies, may help translate clinical recommendations into practical, real-world treatment options for this underserved population.
References:
[1] https://www.engage.england.nhs.uk/safety-and-innovation/menopause-in-the-workplace/