Testosterone Prescribing

For perimenopausal and menopausal women

Hormonal changes associated with the perimenopause and menopause may result in lower testosterone levels. For some women, this can be associated with a reduction in sexual desire (libido).

Testosterone is not licensed in the UK for the management of menopausal symptoms. In limited circumstances, an NHS specialist may recommend testosterone for postmenopausal women with ongoing low libido where standard hormone replacement therapy (HRT) has been fully optimised and found to be ineffective. In such cases, the specialist is responsible for initiating treatment, arranging any necessary investigations, and providing ongoing monitoring and prescriptions.

The practice can, however, offer assessment and support to help identify or exclude other medical, psychological, or social factors that may contribute to reduced libido, and to support patients with broader menopause care.

Background

National guidance indicates that testosterone may be considered as an additional treatment alongside topical oestrogen in women with persistent low sexual desire once oestrogen therapy has been fully optimised. This approach is supported by NICE menopause guidance and the British Menopause Society.

As oestrogen is a licensed treatment for menopausal symptoms and may itself improve genital sensitivity and libido, it should be optimised before testosterone is considered.

At present, there are no licensed testosterone preparations for women in the UK, and published guidance highlights the absence of long-term safety data beyond approximately two years of use.

Prescribing and monitoring

When testosterone is prescribed, appropriate baseline investigations and ongoing monitoring are required. Responsibility for arranging and reviewing monitoring rests with the prescribing clinician and does not fall within the routine remit of primary care.

Prescribing unlicensed medicines

General Medical Council (GMC) guidance states that clinicians prescribing unlicensed medicines must be satisfied that there is sufficient evidence to support their use and must retain responsibility for patient care, including monitoring and follow-up. Patients should be provided with clear information to enable informed decision-making.

Practice policy

After reviewing current national guidance and the available safety data, the GP partners at Orchard Surgery do not consider that off-licence testosterone prescribing can be safely undertaken within primary care.

Accordingly, the practice:

• does not initiate testosterone therapy
• does not continue prescriptions initiated by private providers
• does not provide monitoring blood tests for testosterone treatment

Review

This policy will be reviewed should new evidence become available regarding the long-term safety of testosterone use in women.