healthcare-profeesioanls

Quick Update for Healthcare Professionals on Topical Testosterone Replacement Therapy for Menopausal Women

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.

Author

  • Director, The Medicines Management Team

    Mohammed Rashad is a pharmacist and Director at The Medicines Management Team (TMMT), an award-winning provider of pharmacy services supporting over 85 Primary Care Networks (PCNs) and 250 GP practices across the UK. He works at scale with practices and PCNs to reduce workload, improve access, and deliver key targets such as QOF. Mohammed combines clinical expertise with strategic leadership to redesign how primary care operates. He leads on digital innovation, implementing performance dashboards, optimising workflows, and using data to drive smarter decisions. His work focuses on building scalable, high-performing models that deliver measurable impact. He regularly shares practical insights on improving efficiency, workforce productivity, and patient outcomes across primary care.

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