In this edition
- Testosterone use in women
- Menopausal Hormone Therapy (MHT) patch shortages July 2024
- IMS World Congress on Menopause in Melbourne 2024
Health Professionals - join AMS for Members-only content
- Menopause Matters
- Menopausal age and the risk of cardiovascular disease in American women
- Skin Ageing and Menopause - IMS Webinar online now
- European Menopause and Andropause Society (EMAS) Online School 2024
- European Menopause and Andropause Society (EMAS) Newsletter
In this edition
Testosterone use in women
By Dr Karen Magraith
With increasing interest in the use of testosterone for women, fuelled by anecdotal reports on social media, patients may present requesting prescriptions for testosterone for a range of reasons. It is timely to reconsider the evidence base for efficacy of testosterone, and the guidelines for safe use.
The context of this discussion is for post-menopausal cis-gender women, and is separate from any consideration of gender affirming hormone therapy for trans or gender diverse people.
The closest we have to an Australian or international guideline is the Global Consensus Position Statement on the Use of Testosterone Therapy for Women endorsed by RANZCOG and the Endocrine Society of Australia. Clinicians are encouraged to read the Statement to obtain detailed information.
Testosterone is not a routine component of menopausal hormone therapy. The only evidence-based indication for the use of testosterone in women is for the treatment of postmenopausal women who have hypoactive sexual desire disorder (HSDD).
Some points about testosterone prescribing in women include:
- There is no statistically significant association between endogenous testosterone levels and sexual function in premenopausal women and available data for postmenopausal women also show no association. Testosterone levels peak in early adulthood and decline during the reproductive years. Menopause (unless surgical) does not itself cause a sudden drop in testosterone levels.
- Libido and other elements of sexual function are multifactorial. Hormones are just one factor.
- When assessing patients, consider general physical and mental health, medications (including SSRIs and SNRIs), lifestyle, relationship issues, and previous history of trauma or abuse. Offer treatment for vaginal dryness if present.
- There are anecdotal reports that treatment with testosterone may improve mood, cognition and general well-being. However, this is not supported by RCT evidence. Testosterone has not been shown to be effective for treatment of mood disorders, ‘brain fog’ or fatigue.
- The only evidence-based indication for prescribing testosterone is for treatment of low libido, specifically hypoactive sexual desire disorder in postmenopausal women. In practice this means very low libido which distresses the woman, when other contributing factors have been considered and treated as appropriate.
- Testosterone is not currently indicated for bone or muscle health. Research is ongoing in this area.
- Transdermal testosterone has a modest beneficial effect on libido in the majority of postmenopausal women treated for this indication.
- Measurement of baseline total testosterone levels is recommended. This is usually only available by immunoassay which provides a rough estimate but not a precise level for women. Therefore, blood testing is not to diagnose ‘testosterone deficiency’, but to ensure levels are not above the upper reference range before starting therapy.
- “Free” testosterone should not be used to make a diagnosis or to monitor blood levels during treatment.
- Once on treatment, periodic measurement of testosterone levels is needed to ensure that levels stay in the physiological female reference range.
- Patients should be counselled about side effects, which are uncommon if levels remain in the normal range. Side effects include hirsutism, acne, vocal changes and clitoromegaly.
- When levels remain in the physiological reference range, testosterone appears to be safe for the breast and cardiovascular health. However, data are only available up to 48 months of follow up, and long-term safety is uncertain. Clinical trials of testosterone have generally excluded women with pre-existing cardiovascular disease or breast cancer.
- There is a TGA registered female-specific formulation available in Australia, and following TGA Guidance, this should be prescribed, not products designed for males. Products designed for males have a high potential for inadvertent application of high doses. For clinicians outside of Australia, the Consensus Statement indicates that transdermal male formulations can be used ‘off label’ judiciously, with regular monitoring of blood testosterone concentrations.
Clinicians considering offering testosterone to their patients are advised to read the Global Consensus Position Statement. Other resources include the AMS webinar featuring Prof Susan Davis, and a podcast for patients presented by Jean Hailes.
Read more here
Menopausal Hormone Therapy (MHT) patch shortages July 2024
Australia
Patch Shortages
There are a number of MHTs that are currently unavailable. Please note that the TGA has approved some unregistered products under Section 19A and some substitute doses are currently in supply in Australia.
Pharmacists are encouraged to contact suppliers Medsurge Healthcare Pty Ltd on 1300 788 261 for orders of Estramon and Sandoz on 1800 726 369 for orders of Estradiol Transdermal System.
Oestradiol patches
| |
Expected supply due
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Alternative supply under Section 19A
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|
Dose
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Estradot
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Estraderm
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Estramon
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Estradiol Transdermal System
|
|
25 mcg
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29 Jul 2024
|
19 Aug 2024
|
Available
|
|
|
37.5 mcg
|
20 Sep 2024
|
|
Available
|
Available
|
|
50 mcg
|
7 Sep 2024
|
19 Aug 2024
|
Available
|
Available
|
|
75 mcg
|
22 Aug 2024
|
30 Sep 2024
|
Available
|
Available
|
|
100 mcg
|
15 Sep 2024
|
19 Aug 2024
|
Available
|
Available
|
Combined patches
|
Dose
|
Estalis Sequi
|
Estalis Conti
|
|
50/140
|
Available
|
30 Jul 2024
|
|
50/250
|
Available
|
3 Aug 2024
|
All doses of Climara have been deleted from the market and there will be a reduction in supply until supply is exhausted.
The AMS Guide to MHT Doses (Australia only) provides a guideline to approximately equivalent doses of the different MHT/HRT products in Australia.
New Zealand
As at 15 May 2024, patch availability is provided below.
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Dose
|
Estradot
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Viatris
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Estraderm MX
|
|
25mcg
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Low
|
Available
|
Available
|
|
50mcg
|
Low
|
Available
|
|
|
75mcg
|
Low
|
Available
|
|
|
100mcg
|
Low
|
Available
|
|
More information can be found here
The AMS Guide to MHT Doses (New Zealand only) provides a guideline to approximately equivalent doses of the different MHT/HRT products in New Zealand.
IMS World Congress on Menopause in Melbourne 2024
The the 19th World Congress on Menopause is fast approaching. There are around 800 attendees from Australia and New Zealand of which 256 are AMS members, with 80 of those from New Zealand.
Registration for Australian and New Zealand trainees is still FREE until 23 September 2024. Simply go here to register.
Menopause Essentials Update
Want to refresh your understanding of the basic physiology of menopause, its health implications and implement effective treatment strategies? Join us in Room 203 at the Melbourne Convention and Exhibition Centre on Friday the 18th of October for the Menopause Essentials Update. This Update is designed to be globally applicable and clinically practical for specialists and non-specialists alike. It is also a fantastic opportunity to earn valuable CPD points while enhancing your expertise. Book your place here!
Health Professionals - join AMS for Members-only content
Menopause Matters: Professor Athol Kent has reviewes and comments on recent journal articles.
IMS Live 15 July 2024: Menopausal age and the risk of cardiovascular disease in American women: evidence from the National Health and Nutrition Examination Survey
Cardiovascular disease (CVD) is a significant contributor of female deaths, and in this sense premature menopause contributes in increasing this risk. Bearing this in mind, recently Zhang et al.[1] aimed to investigate the age of menopause and the incidence of CVD in American females using data from the National Health and Nutrition Examination Survey (NHANES). The authors analyzed using multivariate logistic regression data from 6,347 women to investigate the association between the age at menopause and the risk of CVD. They found that a later age at menopause onset reduces the risk of developing CVD...
Skin Ageing and Menopause - IMS Webinar online now
Moderator: Dr Jennifer Allen
Speaker: Professor Mark Brincat
European Menopause and Andropause Society (EMAS) Online School 2024: Details here.
European Menopause and Andropause Society (EMAS) Newsletter AMS is an affiliate of EMAS. See latest copy.
