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More women could be treated with testosterone gel for a low sex drive after menopause, according to new research. The hormone in men, controls sex drive and adult male characteristics such as facial hair and muscle mass has increasingly been prescribed to post-menopausal women for low sex drive, tiredness and low mood.
However, concerns have been raised about whether the hormone increases their risk of breast cancer. That’s because testosterone is converted into oestrogen in the blood and in some women, oestrogen can stimulate breast cancer cells.
Now, a review, to be published next month in the journal Anticancer Research, has found there is no evidence that testosterone significantly increases the risk of breast cancer in these women and it does improve their sex drive.
Professor Kefah Mokbel, a consultant breast surgeon at The Princess Grace Hospital in London, who led the study, says the use of testosterone gels in post-menopausal women has been increasing rapidly in the UK.
‘However, there’s a theoretical concern about a link with breast cancer that has stopped some doctors prescribing it,’ he says.‘We carried out this research to address the question.’ Women produce testosterone in the ovaries and in the adrenal glands (small glands near the kidneys), although they make five times less of the hormone than men.
In women, testosterone affects sex drive, muscle mass, fat distribution and the production of red blood cells (which supply the body’s tissue with oxygen).From around age 30, women’s testosterone levels fall as their ovaries’ production of hormones gradually declines. One theory is that the reduced sex drive, low mood and sluggishness that affect some women after the menopause are as a result of low testosterone, although this is unproven.
These symptoms could also be caused by the natural decline in oestrogen as women come to the end of their reproductive lives. This — in addition to concerns over the breast cancer risk — has made treating women with testosterone controversial Around 15 per cent of women will experience a low sex drive post-menopause. Currently, NICE (the National Institute for Health and Care Excellence) recommends that women should only receive testosterone treatment if hormone replacement therapy (HRT), a combination of the female hormones oestrogen and progestogen, is not effective.
The treatment is given as a cream — a pea-sized blob has to be applied daily. It can lead to side-effects such as acne and excessive hair growth. The new review analysed three trials involving almost 2,000 post-menopausal women who were all using testosterone patches. Professor Mokbel says the results they examined suggest ‘no link with breast cancer’.
However, the review does have limitations — the follow-up of the women was short (the longest study was for four years) and the possible link with breast cancer was not the main focus of the studies analysed.
Dr Channa Jayasena, of the Society for Endocrinology, who is also a clinical senior lecturer in endocrinology at Imperial College London, says only a small number of studies were used in the review and, while it establishes that there is no risk of breast cancer, ‘more research is needed to ensure testosterone does not increase the risk of heart disease and stroke in women’. It is thought that testosterone may increase cholesterol and the risk of blood clots.