Key Points
🔍 Check Shared Care Status:
Verify if testosterone replacement is a shared care drug in your area. Typically initiated by menopause clinics.
💼 Primary Care Responsibilities:
Refer patients to menopause clinic for assessment.
Contact specialists if concerns arise about shared care arrangements.
Report serious adverse reactions to MHRA and the referring specialist.
Continue prescribing as advised by the specialist and monitor as required.
Inform the specialist if the patient discontinues treatment or if there are any concerns.
Patient Selection and Treatment
Indication: For menopausal women with loss of libido despite conventional HRT.
Contraindications: Pregnancy, breastfeeding, active liver disease, hormone-sensitive breast cancer, competitive athletes, high baseline testosterone levels, hypersensitivity.
Side Effects: May include increased body hair, acne, voice deepening, and clitoral enlargement. Contact the specialist if these occur.
Monitoring
Specialist: Monitor total serum testosterone before and during treatment, and adjust as necessary.
Primary Care: Annual monitoring of testosterone levels, symptoms, and side effects. Ensure levels remain within normal physiological range.
Additional Information
Application Instructions:
Apply testosterone with clean hands to clean, dry skin on the lower abdomen or upper thighs.
Wash hands immediately after application.
Do not cover the skin for 3-5 minutes until dry.
Testogel® Sachet: Do not wash the site for 1 hour.
Testim® Gel: Do not wash the site for at least 6 hours.
Testogel® Pump Dispenser: Do not wash the site for 2 hours.
Tostran® Pump: Do not wash the site for at least 2 hours.
Precautions:
Avoid skin-to-skin contact with the application site to prevent testosterone transfer, especially to pregnant women and children.
Reduce transfer risk by washing hands after application, covering the site with clothes, or washing the site with soap and water after the recommended time.
MHRA Drug Safety Update: Inform patients about the risk of transfer, possible adverse effects, and precautions to minimize risk (25 Jan 2023).
Note: The HRT prepayment certificate, introduced on 1 April 2023, does not apply to transdermal testosterone products. It only applies to products licensed for HRT.
Resources
NICE Guidance: NICE NG23
British Menopause Society: Testosterone Replacement
Achillli C et al. Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder; a systematic review and meta-analysis. Fertil Steril 2017; 107(2):475-482
Barber RJ, Panay N, Fenton A, International Menopause Society (IMS) writing group. 2016 IMS Recommendations on women’s midlife health and hormone therapy. Climacteric. 2016; 19(2):109-150
Islam RM et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of RCT data. Lancet 2019; 7 (10):754-766
NICE NG23: Menopause Diagnosis and management November 2015 updated December 2019 www.nice.org.uk/guidance/ng23
Full details of prescribing information on topical testosterone products is given in the manufacturers summary of product characteristics (SPCs), available from www.medicines.org.uk ; however, note these refer to the licensed use in male hypogonadism.
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