It’s been a bit of a Girl Power month, with International Women’s day, Mothering Sunday and Mother Nature’s recent spring into action; so far be it from me to suggest that women are not complete without a man ... although I will concede, they have their uses.
I am referring to the hormone we associate with masculinity but in actual fact, sisters produce it for themselves. Testosterone is made by the ovaries and adrenals (glands that sit above the kidneys, best known for their adrenaline and cortisol contributions).
Most ovarian testosterone is converted to oestrogen but small amounts remain unchanged and it’s even possible to have too much floating around. The effects of hypertestosteronism can result in Polycystic Ovarian Syndrome (PCOS) presenting as reduced fertility, central obesity, acne, and hair growth abnormalities such as male pattern balding and/or increased body hair.
As ovarian function declines towards menopause, testosterone production slows down in tandem with oestrogen and progesterone. In fact, it’s now widely acknowledged that some menopausal symptoms can be attributed to testosterone deficiency and not exclusively to that of oestrogen.
Poor libido, fatigue, sleep disturbance, anxiety and reduced concentration, drive and confidence may all be caused by testosterone decline. The good news is that it can also be replaced in the same way as other sex hormones. Unfortunately, despite the evidence, the current guidelines from NICE (the National Institute of Clinical Excellence that NHS doctors are encouraged to follow) only state reduced libido as an indication for supplementation and then, only if HRT alone (i.e. oestrogen/progesterone replacement) is not effective.
I have spoken to countless women around my age, and many have confided that they are struggling to access good menopausal support within the NHS and some (like me) have had to resort to seeking specialist help privately.
Having experienced literally life-changing benefits of standard HRT (hello sleep!), my menopause doctor suggested I introduce testosterone for a few months and see if I noticed any further beneficial effects. I started applying a gel to my skin below the waist every day, rotating the site (to avoid local hair growth) and I have to admit, there were no immediate noticeable effects.
However, about two months later, whilst getting dressed one morning, I suddenly realised that the usual discordant cacophony of chatter in my brain of to-do lists, automatic negative thoughts and anxieties about the day ahead, weren’t there. Instead, I felt calm and serene, with a deep conviction that everything was going to work out. I had never had such a feeling before and it literally stopped me in my pants.
It may seem strange to say but I didn’t make the connection with TRT until I ran out and requested a repeat prescription from my NHS GP. This was immediately declined and I then had a period of several weeks without it. As I plunged into testosterone cold turkey, my backchatting brain sidled back into action and there were those niggly thoughts again.
There was nothing for it but to pay privately for my prescription until I had been taking it for six months, as only then would I be allowed to have my GP consider prescribing it. When I did finally have that consultation and explained the benefits I had experienced, the positive impact on my sense of wellbeing and improved focus and performance at work, I was shocked when she asked me if I was in a relationship. The implication was my hypothetical partner’s sexual satisfaction was an appropriate indication for me to receive a prescription drug but not my own personal feeling of wellbeing and improved performance. How un-Girl Power is that?
I’m pleased to report that I now have TRT on NHS repeat prescription. I recognise that being a doctor gave me the confidence to fight my case and that many GPs may be less reticent about prescribing TRT; but I also know of many women who are struggling to access even conventional HRT through the NHS. This has to change if we are going to improve women’s wellbeing, their ability to perform optimally in the workplace and reduce the incidence of chronic conditions such as osteoporosis, cardiovascular disease and dementia.
We have come a long way in our fight to have menopause recognised as the important issue it is. Thank you from the bottom of my heart to the fabulous Mariella Frostrup and Davina McCall for the work they have done in raising awareness and even making it a little less un-sexy; and to the Newson Clinic who have helped me on my own personal menopause journey.
I’m very grateful that I belong to a generation of women in a part of the world that can benefit from HRT and having just opened my first independent clinic at the tender age of 52, I attribute much of the drive, determination, stamina and confidence in my abilities to the hormonal support I lovingly apply to my skin every day.