Testosterone's Role in Menopause Management

Summary

Join Dr. Vikram Talaulikar, a certified menopause specialist, in this on-demand teaching session as he delves into the often overlooked role of testosterone in Hormone Replacement Therapy (HRT). He provides a comprehensive look at testosterone levels in women and how they decline with age, especially during menopause. In this informative session, you will learn about the key functions of testosterone, including its impact on brain function, metabolism, urogenital health, bone strength, lean muscle mass and strength, and most significantly, a woman's libido/sex drive. Added to this, he discusses potential symptoms linked to low testosterone, how to assess testosterone levels, and currently available testosterone treatments. Dr. Talaulikar tackles potential side effects and risks and offers critical insights into DHEA during perimenopause and menopause. Imbibe knowledge from the studies and research he shares extensively. This session is a goldmine of information for professionals delving into the shift in understanding towards testosterone and HRT.

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Description

About the MedAll Primary Care CPD Programme

We are passionate about making medical education free and more accessible. In light of the increasing financial pressures faced by healthcare professionals, including the rising cost of living and strained practice finances, we felt compelled to do something. It's why we have introduced a no-cost CPD programme for doctors, nurses and other healthcare professionals working in primary care. We recognise that the high expense of traditional CPD update courses is a significant barrier, and by collaborating as an entire primary care community we hope we can offer a practical, accessible alternative.

About our speaker: Dr Vikram Talaulikar MD, FRCOG, PhD

Dr. Talaulikar is an Honorary Associate Professor in Women's Health at University College London. As a British Menopause Society Menopause Specialist, Dr. Talaulikar brings a wealth of expertise in menopause care. He is recognized as a Principal Trainer for the Menopause Special Skills Module at the Faculty of Sexual and Reproductive Healthcare at the Royal College of Obstetricians and Gynaecologists. He is a Trainer for the BMS Principles and Practice of Menopause Care course.

Further teaching from Dr Talaulikar can be found here

Who Should Join?

✅ GPs

✅ Primary care and practice nurses

✅ Practice pharmacists

✅ Other allied healthcare professionals in primary care

Note: this event is not formally accredited by an external organisation for CPD points. The current guidance for GP CPD is that it is appropriate that the credits you self-allocate should equal however many hours you spent on learning activities, as long as they are demonstrated by a reflective note on lessons learned and any changes made or planned (if applicable).

Learning objectives

Gain an understanding of the role of testosterone in Hormone Replacement Therapy (HRT), particularly in relation to the menopause.
To familiarize yourself with the impact of testosterone levels on women's health, specifically understanding the functions and symptoms linked to low levels of testosterone.
Learn how testosterone levels are assessed and monitored as part of the HRT treatment plan for menopausal women.
Gain knowledge of the current UK prescribing guidelines and parameters related to testosterone for women.
Understand the potential risks, side effects, and benefits of testosterone use in menopausal women, with an emphasis on the available clinical trial data and the uncertainty surrounding long-term efficacy and safety.

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RDPI and the Menopause Clinic, London Testosterone as part of HRT – where are we? Dr Vikram Talaulikar MD, FRCOG, PhD Associate Specialist in Reproductive Medicine, UCLH Hon. Associate Prof in Women’s Health, UCL BMS certified Menopause Specialist Principal trainer for FSRH Menopause Special Skills Module What is HRT? Hormone Replacement Therapy (HRT) is … the replacement of oestrogen, progestogen and for some women testosterone hormone Testosterone has often been overlooked and traditionally not considered part of HRT Testosterone – levels decline with age • Healthy young women produce approximately 100 – 400 mcg per day • Three to four times the amount of oestrogen is produced by the ovaries • Both ovaries and adrenals contribute • Levels of testosterone in women decline between the ages of 20 and 40. By menopause the levels have plateaued out. • Profound and sudden loss after iatrogenic menopause (brought about by surgery to remove the ovaries or medical treatments that damage ovaries) Testosterone functions • For all women, testosterone plays a vital role in brain function, metabolism, urogenital health, bone strength and the overall development of lean muscle mass and strength • And perhaps most crucial is its effect on a woman’s libido/sex drive (desire, arousal or orgasm) Symptoms linked to low testosterone – not well characterised Besides impact on sexual health, lack of testosterone could cause: • Reduction in general quality of life • Tiredness • Low mood • Headaches • Brain fogging • Low bone density and sarcopenia (loss of muscle mass) Assessment • The assessment and interpretation of testosterone blood levels is not straightforward – assays/techniques differ • Not mandatory but useful to perform total testosterone level estimation prior to treatment • Testosterone levels advised for monitoring treatment (avoid high levels) UK prescribing There are no testosterone products for female use licensed in the UK Mostly gels on the NHS and gels/cream/implants in the private sector What do guidelines say? • NICE guideline recommends that systemic HRT should be prescribed before a trial of testosterone and testosterone be considered for low libido • But there are trial data which indicate that testosterone used without systemic oestrogen is effective and safe • IMS has published a paper on testosterone as treatment for persistent low sexual desire (when other causes such as relationship issues, medications, medical problems, urogenital atrophy have been ruled out)Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data Islam RM, Bell RJ, Green S, Page MJ, Davis SR. The lancet Diabetes & endocrinology. 2019 Oct 1;7(10):754-66. What is available? • Testogel • Tostran • Testavan • Testim • AndroFeme • Testosterone Implants • Aim – 5 mg daily • Treatment - a minimum of 3-4 months before review, then 6 months and annually Possible side effects • Increased body hair • Generalised Hirsutism (uncommon) • Male pattern hair loss (uncommon) • Acne and greasy skin (uncommon) • Deepening of voice (rare) • Enlarged clitoris (rare) Potential risks • Randomised controlled trials and observational data have so far have not shown an increased risk of cardiovascular disease or breast cancer although longer-term trials are needed • Evidence about long term efficacy and safety remains limited – we need RCT evidence about non-libido effects of testosterone DHEA during perimenopause and menopause • Main precursors of androgens, which in turn is converted to testosterone and oestrogens • Twenty-eight trials with 1273 menopausal women included • Data extracted from 16 trials to conduct the meta-analysis • Overall quality of the studies - moderate to low DHEA - evidence • There is no evidence that DHEA improves quality of life but there is some evidence that it is associated with androgenic side effects. • There is uncertainty whether DHEA decreases menopausal symptoms, but DHEA may slightly improve sexual function compared with placebo • Good practice recommendations on add-ons in reproductive medicine • ESHRE Add-ons working group