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Your doctor may have talked to you about whether testosterone therapy is right for you. Here’s some information about testosterone therapy, what it does and how to take it.
*This guideline covers women, trans men and non-binary people registered female at birth who have never taken cross-sex hormones as gender affirming therapy and who are currently going through the menopause transition.
What is testosterone therapy?
Testosterone is a hormone (or chemical messenger) made in your ovaries and your adrenal glands, which are small glands near your kidneys. Levels of testosterone in your body gradually reduce as you become older, and they reduce very abruptly in those who have had an oophorectomy (an operation in which their ovaries are removed). When levels of testosterone decrease, you may find that your desire for sex less often and, when you do have sex, it’s not as pleasurable as it used to be, even though you still desire your partner.
Loss of sexual desire (libido) can be caused by many different medical and psychological conditions and medications (including commonly prescribed antidepressants). Low levels of hormones of the type called androgens may be just one of the factors leading to your loss of libido. The menopause symptoms you are experiencing can also significantly impact on libido. Testosterone is an androgen and may be offered to help boost your libido if this has not improved with hormone replacement therapy (HRT). Other support may be recommended instead of testosterone, such as psychosexual or relationship counselling.
Many experience uncomfortable and painful intercourse as a result of menopause related vaginal and vulval changes such as increased dryness. It is important that these symptoms are addressed before testosterone is trialled. Your doctor can prescribe vaginal oestrogens in addition to hormone replacement therapy. Lubricants and vaginal moisturisers can be helpful also, and are available over the counter for example in pharmacies and supermarkets.
Not every woman with a low level of testosterone will have a low libido. A low level of testosterone does not mean that it needs replacing. There is no good evidence that taking testosterone will help improve low mood, cognitive function (such as brain fog) or low energy levels.
What are the benefits of testosterone therapy?
Replacing testosterone can increase sexual desire and pleasure for some, but not all women who use it.
Are there any risks to testosterone therapy?
Studies to date suggest that there’s no increased risk of heart disease, breast cancer or stroke in the short term, but we don’t have studies that tell us about the long-term risks and safety of testosterone therapy.
How to take testosterone therapy
Testosterone gel is available in the UK on NHS prescriptions for off license prescribing, or cream which is only available privately. Testosterone prescribing in many areas of the UK has to be initiated by a specialist.
In the UK testosterone gel isn’t licensed for use in women*, only men, but is often prescribed off-licence for those who are already taking HRT. Its use is also endorsed by the National Institute of Clinical Excellence Guidelines on the menopause NG 23 2015.
Testosterone gel or cream is applied to the skin so that it goes directly into your bloodstream. The doses used in women* are much lower than those used for men. The aim is to keep the testosterone at a level that’s not greater than those found in premenopausal women*.
It may take 3-6 months to feel any benefit from taking testosterone. If there has been no benefit in that time, we would advise you to stop using it.
What is off license prescribing?
Before a medicine can be used in the UK, it must be granted a licence. While all medicines and treatments have side-effects and risks, a licence tells you that all the proper checks have been done and the benefits of the medicine are believed to outweigh the risks. The licence states what conditions the medicine has been approved to treat.
When a treatment is used off-licence, it means that the medicine has a licence, but it’s not for the condition that you have. In other words, testosterone has not undergone the required, regulated clinical trials to see if it’s effective and safe in treating your condition. But that doesn’t mean it’s unsafe, and it doesn’t mean it won’t work.
There are a number of reasons why a medicine may be unlicensed in the UK. For example, it may be waiting for a licence to be granted, or the need for the medicine may be so small that it doesn’t make commercial sense for the manufacturer to pay for the relevant testing.
The different types of testosterone available off-licence in the UK, and how to use them, are outlined below:
TESTOGEL (Besins Healthcare Ltd UK) – 40.5mg per 2.5g sachet. Use a small, pea-sized amount and rub it into the front of the thigh every day, changing the site of application to avoid extra hair growth. The sachet should last around 8 days. You can fold over the open top and clip it with a bag clip.
TOSTRAN™ GEL (Kyowa Kirin Ltd) – 20mg in 1g. One press delivers 10mg of testosterone. Use 1 press of gel 2 to 3 times a week. If you use it every day the dose will be too high. Don’t apply the gel to the same patch of skin every time. Change the site of application to avoid additional hair growth at application sites.
ANDROFEME™ (Lawley Pharm) - 1% testosterone cream in 50ml tube. Starting dose is 0.5mls per day (5mg testosterone a day). Only available privately, the cost of a 50g tube is around £100 and this will last approximately 100 days.
What are the side effects of testosterone therapy?
The most common side effects are skin changes, such as acne, increased greasiness of the hair and thicker body hair or excess hair.
Androgenic side effects include acne and, rarely, virilisation (voice deepening and an enlarged clitoris). Other rare side effects include hair loss, excessive hairiness, fluid retention, increase in muscle mass, weight gain, nausea, headaches, mood changes, jaundice, and an increase in cholesterol.
Side effects are generally only seen when high doses of testosterone are given. If you experience side effects. reducing the dose or else stopping treatment altogether may help. Please contact the clinic if you have any concerns.
Risk of testosterone transfer to others
During close and relatively long periods of skin contact testosterone may be transferred to another person unless you cover the treated area. Transfer can potentially result in the other person showing signs of increased testosterone – masculinisation effects as described in the side effects above.
To prevent such transfer, make sure you wear clothes that cover the area of application or wash the application area before contact. The following precautions are recommended:
For the patient:
- wash your hands with soap and water after applying the gel,
- cover the application area with clothing once the gel has dried,
- wash the application area before making close contact with another person.
If you believe testosterone has been transferred to another person (man, woman or child), that person should:
- wash the area of skin onto which may have been affected immediately with soap and water and report any signs such as acne or changes in the growth or pattern of hair on the body or face to their doctor.
You should preferably wait at least one hour before showering or bathing after applying the testosterone gel to ensure that it has been absorbed.
For more information please see:
www.menopausematters.co.uk and www.womens-health-concern.org have further information as well as https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/
Overview | Menopause: diagnosis and management | Guidance | NICE
Dr Clare Spencer, GP and registered Menopause Specialist
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We have noticed a significant increase in the number of patients requesting that our GPs prescribe weight loss medications such as Mounjaro, Ozempic or Wegovy.
These medications are available on the NHS to some patients to support weight loss.
They are prescribed by specialist weight management services and require a referral to these services prior to any prescription.
Weight loss injections in Leeds are provided by Leeds Tier 3 Weight loss services.
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Current criteria for referrals are patients with: A BMI 50 or over. A BMI 40 or over, who have engaged with a recognised weight loss service (e.g. weight watchers or slimming world) for at least 12 weeks in the last 12 months (and have evidence of this). A BMI 35-40 plus 1 or more of the following conditions: Cardio vascular disease (angina, previous MI), Pre-diabetes, Type 1 or 2 diabetes, fatty liver disease, sleep apnoea (on CPAP), high blood pressure on medication, established depression/anxiety (for 6 months or more and/or on treatment), moderate to severe osteoarthritis, and polycystic ovaries. |
If you meet these criteria, then please submit a triage form with your weight and height, included to arrange a GP appointment. There are also specific blood tests that are required to make the referral, which we can arrange at the surgery to support your referral.
If you do not meet these criteria, we will be unable to refer to this service to support your weight loss. However, there are still other services that may help:
- The NHS digital weight management Programme: supports adults living with obesity (BMI >30) who also have a diagnosis of diabetes, hypertension or both, to manage their weight and improve their health. It is a 12-week online behavioural and lifestyle programme that people can access via a smartphone or computer with internet access.NHS England » The NHS Digital Weight Management Programme
- Alternatively Weight Management - Leeds Community Healthcare has more details of other useful links to support your weight loss journey.
Weight loss injections and contraception
For those patients who are buying weight loss injections there are potential issues if you are taking an oral contraceptive and oral HRT (progestogens and oestrogens) due to the way the medication works.
This could potentially make your contraceptive pill ineffective or in the case of HRT put you at an increased risk of endometrial cancer.
Please contact the surgery and request an appointment with one of our pharmacist to discuss the implications for you an how to safely manage your menopause and contraceptive needs.
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Eligible patients have started receiving letters from the NHS inviting them for their Spring Covid Booster.
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If you considering a steroid joint injection, please make an appointment with one of our clinicians to discuss and, if appropriate for you, we will place you on the waiting list. Then one of our team will contact you to arrange an appointment in our Steroid Injection Clinic.
The Joint Injection Procedure
A quick steroid injection given under aseptic technique into the joint space (shoulder/elbow/wrist/thumb/knee/hip/hand/feet) by a trained practitioner.
In addition to the information below, the NHS website provides more information as well: Steroid injections - NHS
Common reasons to have the steroid injection at our practice
Joint injections are commonly used to treat various joint-related conditions, particularly when other, more conservative treatments (like rest, physical therapy, oral medications, or over-the-counter pain relievers) have failed to provide sufficient relief, or when the symptoms are severe enough to interfere with daily activities.
Here are some common reasons why someone might receive a joint injection:
Osteoarthritis
One of the most common reasons for joint injections is to treat osteoarthritis, especially when it causes significant pain and inflammation. The injection can help reduce pain, inflammation, and improve joint function.
Bursitis
Bursitis, which is the inflammation of the fluid-filled sacs (bursae) that cushion the joints, can be treated with joint injections to relieve pain and inflammation in the affected joint.
Tendinitis
Tendon inflammation, or tendinitis, can be treated with injections, particularly if other treatments like rest or physical therapy haven't worked. The injection can reduce inflammation and provide pain relief.
Frozen Shoulder (Adhesive Capsulitis)
Joint injections are often used for treating frozen shoulder, a condition where the shoulder becomes stiff and painful. The injection can help reduce inflammation and improve range of motion.
Some possible side effects of a steroid joint injection
While these injections can be highly effective for providing relief, they do come with potential side effects, which can vary depending on the substance used and the individual’s response. The risks can be quantified in terms of their occurrence.
Common (Likely to Occur in Many Patients- 1 in 100 to 1 in 10)
- Pain or Swelling at the Injection Site: Occurs in many patients, typically within the first few days post-injection. This is a common side effect.
- Flare-up of Pain ("Steroid Flare"): Temporary increase in pain within a few hours to a day after the injection. This is relatively common, especially in the first 24-48 hours.
Uncommon (May Occur in Some Patients, but Not Likely- 1 in 1000 to 1 in 100)
- Increased Blood Sugar: Occurs in some patients, particularly those with diabetes. It is uncommon for healthy individuals, but monitoring is important for diabetics.
- Skin Thinning or Discoloration: More common with repeated injections but may occur in some patients who have frequent corticosteroid injections at the same site.
- Infection: While the risk is generally low, it’s an uncommon side effect when proper sterilization is followed. However, it can be more common for those with weakened immune systems. Infection can be of the overlying skin or of the joint injected.
Rare (Infrequent, Occurs in a Small Number of Patients- 1 in 10 000 to 1 in 1000)
- Tendon or Ligament Weakening: Occurs with frequent or repeated corticosteroid injections near tendons or ligaments. This is a rare long-term risk after multiple injections.
- Joint Damage: This typically occurs only after long-term use or frequent injections. It is a rare but possible long-term risk.
- Nerve Damage: This is a rare complication, occurring if the needle damages a nearby nerve. Nerve damage can cause numbness, tingling, or weakness.
- Unwanted Side Effects (Corticosteroids): Side effects like mood changes, insomnia, weight gain, or gastrointestinal issues are rare, especially with a single injection. These are more likely with long-term or repeated steroid use.
- Allergic Reactions: Extremely rare, but possible, especially to the corticosteroid or numbing solution used in the injection.
Extremely Rare (Very Unlikely to Occur- less than 1 in 10 000)
- Severe Allergic Reactions: Anaphylactic reactions to the substances used in the injection are extremely rare, occurring in less than 1% of cases.
This classification helps to understand the general frequency of these side effects, though individual risk can vary depending on factors like medical history, the specific substance injected, and the skill of the practitioner.
Some of these risks are low risk, mild and temporary such as pain or swelling at the injection site. They tend to resolve quickly with minimal intervention needed.
Some of these side effects are more significant and may require attention or monitoring but are not usually long-lasting for example increased blood sugar or infection.
High risks side effects are more severe and require close monitoring, possible adjustment of treatment or a higher level of caution for example joint damage or nerve damage, tendon or ligament weakening.
Joint injections can be very effective for pain relief and inflammation reduction, but there are several contraindications (situations where the procedure should be avoided or used with caution) due to potential risks. These include:
1. Active Infection or Skin Infection at the Injection Site
Example: If the skin around the joint is infected, or if there's an existing joint infection (septic arthritis), injections should be avoided.
2. Allergy to Components of the Injection
Example: If a patient has a known allergy to corticosteroids or a specific numbing agent, the injection should not be performed.
3. Uncontrolled Diabetes
Corticosteroid injections can raise blood sugar levels, which can be risky for people with poorly controlled diabetes.
Example: If a patient’s blood sugar is difficult to manage, the risks of using corticosteroids might outweigh the benefits.
4. Severe Osteoporosis
Injections, particularly those with corticosteroids, can weaken bones, making them more susceptible to fractures, especially in patients with osteoporosis.
Example: If the patient has severe bone thinning, corticosteroid injections may worsen bone density.
5. Active Bleeding Disorders or Anticoagulant Therapy
Joint injections can cause bleeding or bruising. In patients with bleeding disorders or those on blood thinners (e.g., warfarin, aspirin), there is a higher risk of significant bleeding complications.
Example: If a patient has hemophilia or is on anticoagulant therapy, joint injections should be carefully considered or avoided.
6. Pregnancy (For Corticosteroid Injections)
The safety of corticosteroid injections during pregnancy is not fully established, so they should generally be avoided unless the benefits clearly outweigh the risks.
7. Joint Instability
If the joint is unstable (e.g., due to ligament or tendon injury), injecting into the joint might worsen the instability or cause further damage.
Example: If there is significant ligament damage, the injection might not provide the expected benefits and could risk aggravating the instability.
8. Recent Joint Surgery
If a patient has recently undergone joint surgery, introducing an injection could interfere with the healing process or increase the risk of infection.
Example: Patients who have had recent joint replacement or arthroscopy should generally avoid injections until healing is complete.
9. Advanced or Severe Joint Degeneration (End-Stage Arthritis)
In patients with end-stage arthritis, injections may not be effective, and the joint may no longer respond to the treatment. Surgical options might be more appropriate.
Example: A patient with advanced osteoarthritis or joint deformity may not experience significant relief from injections.
At Crossley Street Surgery, we strive to provide the best care possible. However, there are certain procedures, such as injections into the feet or the elbow, that may not be standard practice for all clinicians. It’s important to note that not all injecting clinicians may provide these treatments, and we want to ensure that any decision made about your care is in line with current best practices. If you have any specific requests or concerns, please feel free to discuss them with us so we can determine the most appropriate treatment for you.
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As part of the national bowel screening programme, eligible patients are sent a letter and a bowel screening kit; however some patients are reluctant to send samples off for testing.
It is important that invited patients participate in the bowel screening programme for a number of reasons:
- Bowel cancer affects 1 in 20 people in the UK during their lifetime
- 80% of people who develop bowel cancer are 60 years of age or older
- It is the third most common cancer in the UK, and the second leading cause of cancer deaths
- Regular bowel screening has been shown to reduce the risk of dying from bowel cancer
We recognise that obtaining the samples is not pleasant however, as your GP practice, we would strongly encourage invited patients to submit their samples as soon as possible. The kit you are sent originally can still be used if it is unopened; however the samples need to be submitted within 14 days of taking the first sample. If you require an additional kit please contact the Bowel Screening Helpline on 0800 707 6060
Once you have submitted your samples, you will be notified in writing of the results within 14 days. Please remember that abnormal results can be due to other conditions, it does not mean that you have cancer. You will be offered further investigations if you have an abnormal result.
If you have any question about the screening programme please contact the surgery. Further information can also be obtained from the website: http://www.cancerscreening.nhs.uk/bowel/
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