{"id":230457,"date":"2025-12-13T06:30:20","date_gmt":"2025-12-13T06:30:20","guid":{"rendered":"https:\/\/www.europesays.com\/ie\/230457\/"},"modified":"2025-12-13T06:30:20","modified_gmt":"2025-12-13T06:30:20","slug":"mood-swings-low-libido-fatigue-is-testosterone-the-quick-fix-for-women-in-midlife-the-irish-times","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/ie\/230457\/","title":{"rendered":"Mood swings, low libido, fatigue … Is testosterone the quick fix for women in midlife? \u2013 The Irish Times"},"content":{"rendered":"

Humanity has always chased the promise of renewed youth<\/a>. From ancient myths about the fountain of life to modern Silicon Valley regimes of supplements, sensors and self-tacking biohackers, the supposed elixir may change over time, but the desire for eternal youth remains the same. <\/p>\n

Today it appears everywhere, and it is often split along gendered lines. For women, the pursuit tends to be aesthetic, shaped by a culture that treats ageing as a flaw to be corrected via Botox, fillers, or \u2013 increasingly among actresses barely in their mid-30s \u2013 a facelift. Men, meanwhile, are urged to optimise. An entire industry of podcasts, tech devices and protocols encourages them to track their biomarkers, adapt their sleep cycles, and follow elaborate nutritional codes. It\u2019s a thriving market built on the belief the body, ageing, time itself can all be mastered and controlled with enough science, discipline and money.<\/p>\n

Into this landscape enters a new supposed miracle tonic for women: testosterone<\/a>. It may be a hormone as old as time, but it\u2019s being worshipped with a new fervour. Influencers and wellness clinics are peddling unregulated, high-dose testosterone to women, promising not just heightened libido but sharper focus, renewed purpose and a vitality dormant for years. Some of the stories sound almost mythic<\/a>. Women describe bounding out of bed, lifting heavier weights, rediscovering sexual desire<\/a>, and feeling newly energised at work and at home. In one recent New York Times piece, women described sex going from \u201cHow about never?\u201d to six times a week; marriages transformed, energy levels electrified, all apparently down to testosterone.<\/p>\n

The problem is, most of the claims about testosterone <\/a>are simply not borne out by evidence. Step away from the viral testimonies and influencer marketing spiels and into the consulting rooms of clinicians who specialise in hormonal care, and the story of testosterone becomes far more measured, more grounded, more wary. This research-backed, evidence-based medical view is not anti-testosterone; it\u2019s just anti-magic.<\/p>\n

What is testosterone? <\/b><\/p>\n

Though long framed as the defining male hormone, testosterone is no more exclusively masculine than oestrogen is exclusively feminine; both circulate in all bodies, and both matter profoundly. \u201cTestosterone is the third hormone that your ovaries make, along with oestrogen and progesterone,\u201d explains Dr Caoimhe Hartley, the clinical lead in women\u2019s medicine at the newly opened Blackrock Health Women\u2019s Health Centre. \u201cIt has an impact on bone density, muscles, probably cognition and sexual function, and that is where libido comes in. All these hormones do multiple things; they are not isolated to one usefulness.\u201d<\/p>\n

What testosterone does not do is plummet dramatically at menopause, despite the common misconception. \u201cThere is no study that has shown any change over natural menopause,\u201d says Prof Susan Davis, an endocrinologist at Monash University whose work has shaped global understanding of female testosterone. \u201cTestosterone blood levels decline slowly from the age of about 20 through to the age of about 60,\u201d she explains. Over those 40 years, she says, \u201con average, normal women will have about a 50 per cent decline.\u201d Then, unexpectedly, levels start to creep up again from about 60. \u201cIt is changing with age, not menopause.\u201d<\/p>\n

This distinction matters because it reframes midlife experiences. Changes that women may experience in metabolism, energy and mood are often misattributed to a sudden drop in testosterone, when the real cause may be the cumulative effects of ageing, stress, workload and emotional demands.<\/p>\n

But if testosterone drops over time and these emotional and embodied changes are experienced, a question naturally arises: does putting more testosterone into the body help?<\/p>\n

For premenopausal women, the answer right now is simply: we do not know. Two trials have hinted at some possible benefits for women in their late 30s and early 40s, \u201cbut the studies are too small to have any degree of confidence\u201d, Davis says. Another trial is planned, but for now, \u201cthere is no good evidence that giving premenopausal women testosterone will be beneficial\u201d.<\/p>\n

For postmenopausal women, the picture is clearer, though still limited.<\/p>\n

\u201cAll the published studies show that the only evidence of benefit is for postmenopausal women who are bothered by low libido,\u201d Davis says. <\/b>Her own meta-analysis of 36 trials involving 8,480 women found consistent improvements in desire, arousal, orgasm and overall sexual satisfaction. Though more modest than the accounts of teenage boy-levels of sexual desire experienced in women on high doses, these research-backed improvements were meaningful. \u201cThe beneficial effects for postmenopausal women shown in our study extend beyond simply increasing the number of times a month they had sex,\u201d she says. \u201cMany women who are sexually active report dissatisfaction, so increasing the frequency of a positive sexual experience from never or occasionally to once or twice a month can improve self-image and reduce concerns and distress.\u201d<\/p>\n

Hartley sees the same patterns clinically. In Ireland, doctors can prescribe testosterone for women, but only off-label and only in carefully selected cases, such as postmenopausal women distressed by low libido. Because no female-specific product is licensed here, clinicians like Hartley rely on precisely titrated-down doses of male testosterone gels, monitored with blood tests to keep levels within a normal female range. She prescribes testosterone when low libido is causing distress, usually after menopause or after surgical removal of the ovaries. \u201cIt makes a bit of physiological sense,\u201d she says of its use following surgical menopause, \u201cbut it is still for low libido and nothing else\u201d.<\/p>\n

Beyond this specific use for improving libido for older or postmenopausal women, the evidence around the benefits of testosterone therapy for women fades. \u201cNo benefits have been shown for cognition, bone mineral density, body composition, muscle strength or psychological wellbeing at physiological doses,\u201d Davis says of the clinical trials to date. \u201cThere simply isn\u2019t evidence.\u201d<\/p>\n

\"\"Menolicious: Mariella Frostrup & Belles Berry \/ Should all women be on HRT?Placebo effect<\/b><\/p>\n

If testosterone\u2019s proven benefits are relatively modest, why do some women who\u2019ve taken it sound as if they have been converted to a new faith?<\/p>\n

Part of the answer is placebo. \u201cThere is a huge placebo effect, and everybody is in complete denial of this placebo effect,\u201d Davis says. She points to a company that developed a testosterone gel for women and then ran two large trials of libido, each with 500 participants. \u201cTestosterone improved libido, but not better than placebo,\u201d she says. In her own 800-woman trial of a testosterone patch, published in the New England Journal of Medicine, women on testosterone had better sexual function than those on placebo. But when the team buried validated wellbeing questionnaires inside the study, they found no difference in general wellbeing at all.<\/p>\n

Hartley encounters the anecdotal power of testosterone every day. \u201cI have patients who will come back and say, \u2018I went on testosterone and my brain fog improved\u2019 \u2013 and I am not in their brain, I cannot tell them that they are wrong.\u201d The problem is that individual stories, which are very real to the woman telling them, are not the same as evidence. \u201cHow do you remove all the other things that may have helped? How do we know it is not placebo?\u201d Hartley asks. \u201cThat is why we do studies.\u201d<\/p>\n

But when women are looking for answers and hear one or two stories saying, \u2018This transformed my life\u2019, the effect is infectious. \u201cIt is human nature to want to believe it,\u201d Hartley says.<\/p>\n

Dangers of unregulated use<\/b><\/p>\n

This gap between evidence and promise is sharpened by what happens outside regulated medical practice. In the US, an increasingly booming, unregulated industry of influencers and wellness clinics is offering female clients testosterone pellets and gels at doses that take women well beyond a normal female range for the hormone. At those levels, the side effects can be alarming: scalp hair loss, unwanted facial hair, acne, irritability, voice deepening, clitoral enlargement, and surges of arousal that disrupt daily life. Some of these side effects, like clitoral enlargement and voice changes, can be irreversible. Hartley notes that such dramatic changes \u201creally should only occur if your testosterone level is bumped outside of a normal female range\u201d \u2013 yet in unregulated settings, that boundary is routinely crossed.<\/p>\n

In countries like the United Kingdom or Australia, women have access to a licensed female-specific testosterone cream that allows safe, standardised dosing. In countries like the US or Ireland, without such a product, the gap between evidence-based prescribing and unregulated hormonal experimentation is widening, leaving women vulnerable to treatments that promise transformation but bypass the safeguards of medical care.<\/p>\n

\u201cKnowing that this is an option that might help them, women are forced to use either compounded therapies or try microdose male options,\u201d Davis says of countries without an approved product. \u201cThat is really where things go out the window, because it is very difficult to safely dose using very concentrated male formulations.\u201d<\/p>\n

In her view, \u201cthe best thing to protect women is a regulated product\u201d, one tailored to female physiology. Hartley would welcome the UK\u2019s new female-specific cream for similar reasons. It contains the same active ingredient as existing male gels, she notes, just at a concentration and formulation that makes it easier to apply in tiny doses.<\/p>\n

Regulation, though, is not enough on its own \u2013 doctors need to understand the drug and how best to help their patients. For Hartley, the safeguard is information. \u201cThe more we have well-educated healthcare professionals at every level,\u201d she says, \u201cthe more we are passing that on to women.\u201d She wants GPs and specialists who are \u201cwell armed with information on what is evidence-based and what is rubbish\u201d, so that they can help patients sift through hype and anecdote.<\/p>\n

\"Testosterone’sTestosterone\u2019s proven benefits for women are relatively modest The real issues affecting women<\/b><\/p>\n

Both Hartley and Davis think the fervour around testosterone says as much about the state of women\u2019s lives as it does about the hormone itself.<\/p>\n

\u201cI think women are sick of their symptoms being dismissed,\u201d Davis says. \u201cAnd when someone says this will make you feel better, of course, they want to take it. I get that, and I think that is perfectly reasonable.\u201d<\/p>\n

Davis\u2019s team has documented the decline in women\u2019s quality of life at mid-age. Despite a huge amount of cultural discourse focusing on the so-called male loneliness epidemic, the documented mental health struggles of middle-aged women remain unacknowledged. \u201cWomen are suffering,\u201d she says. \u201cWe have shown in our latest work that midlife wellbeing has gone down compared to 10 years ago. There is a real decline.\u201d Davis explains the multitude of factors affecting women, noting: <\/b>\u201cThis is the sandwich generation. Women trying to \u2018have it all\u2019: have children, take care of ageing parents, have work, have work-life balance, have financial stability. These are enormous pressures.\u201d <\/p>\n

Depression rates are high, distress is high, and time is scarce. Hartley is watching the same pressures play out in Irish consulting rooms. \u201cYou see how much women are carrying,\u201d she says. \u201cIt is no wonder their libido is low or that they feel flat or foggy or depleted. That is not a pathology. It is life.\u201d<\/p>\n

Amid all the stresses affecting women, it thus becomes necessary to be careful of how we speak about women and low libido, in order not to pathologise a lack of desire that may be natural or due to a host of interlocking external factors, or to risk reinforcing damaging ideas about women owing their bodies and sexual availability to others.<\/p>\n

Neither doctor wants to minimise the distress of women whose sexual desire has vanished. Both prescribe testosterone in carefully selected cases, understanding the stakes for relationships and for individual self-esteem.<\/p>\n

\u201cOur own research has shown that if women themselves personally have poor sexual wellbeing, that impacts them personally in their general wellbeing and their relationships,\u201d Davis says. \u201cSo I prescribe testosterone for women with low libido. I am not anti-testosterone.\u201d<\/p>\n

But what does concern Davis and Hartley is how the issue of women\u2019s libido is often medicalised or framed. Hartley notes how many women <\/b>come in apologising, or framing their lack of desire as a personal failure or a dereliction of duty to their partners.<\/p>\n

\u201cWomen come in saying, \u2018Oh my God, my poor husband, my poor partner\u2019,\u201d says Hartley, who is always clear in redirecting them. \u201cI say, \u2018Your partner is not my patient\u2019.\u201d The real question is whether the woman herself is distressed. \u201cIt\u2019s really important to not stick it on the list as something that has to be fixed. Low libido is not a disease,\u201d says Hartley, who notes that it is a normal evolution for spontaneous sexual desire to reduce as you get older. \u201dThat is universal. There is nothing wrong with you if that happens.\u201d<\/p>\n

Davis notes that often, low libido is a \u201cmultifactorial condition\u201d, and she points out that the guidelines from the International Society for the Study of Women\u2019s Sexual Health <\/a>set out a process of care that requires clinicians to look first at depression, relationship dynamics, medications, trauma, pain and vaginal health before they \u201cjump in saying testosterone is going to be the fix\u201d.<\/p>\n

The research gap<\/b><\/p>\n

Underpinning all of this, both the hope and the caution, is a simple fact: there is not enough research into women\u2019s health<\/a>, which leaves us without the data that women deserve.<\/p>\n

\u201cThe future, hopefully, is research,\u201d Hartley says. Without larger, longer, better trials, she and her colleagues cannot give women the clear answers they want about benefits and risks<\/a>.<\/p>\n

Davis has spent four decades trying to generate that data and sounds, at times, weary. Getting funding is brutally hard, she says; she can spend \u201cup to 30 per cent\u201d of her working time writing grant applications. When money does come through, another hurdle appears. \u201cTrying to get women to go into clinical trials is an absolute no,\u201d she says. \u201cThey are all too busy, busy.\u201d Her team is about to start two large new studies, one looking at testosterone\u2019s effects on muscle and bone, the other at bone and sexual function, both including wellbeing questionnaires. She welcomes the increased interest but insists that until the trials report, the honest answer to many questions will remain \u201cwe do not know\u201d.<\/p>\n

That is not a comfortable message in a culture that wants a quick fix for midlife female exhaustion and desire. It is, however, the only message that treats women as adults and demands better for them in the long term.<\/p>\n

So what should an Irish woman do, sifting through a wave of hyped-up Instagram adverts about testosterone pellets and listicles of anecdotes about life-changing results?<\/p>\n

\u201cKeep expectations realistic,\u201d Davis says. If you are going to try testosterone, she urges, treat it as a time-limited trial, not a new identity. Do not try to treat bone loss, muscle fatigue or life itself with testosterone. \u201cTestosterone is not the answer for life.\u201d<\/p>\n

Hartley, for her part, hopes women will come in to talk, not arrive convinced that there is only one solution. \u201cIf they are symptomatic, if they have low libido and it is bothering them, and they want to have a discussion with their GP about it, do that,\u201d she says. But she also wants them to hear something that often gets lost in the hype: \u201cYou are not broken.\u201d<\/p>\n

She\u2019s right. There is nothing inherently wrong about wanting sex less as you age<\/a>. There is also nothing shameful about wanting more<\/a>. But there is something deeply shameful about a society that devalues women; refuses to invest in research about their physical or emotional wellbeing<\/a>; pathologises them for ageing and constantly tells them that they are not enough, only to try then make money selling them an unsafe, unregulated \u201ccure\u201d. <\/p>\n

Women deserve acceptance, accurate information and autonomy, not another marketplace built on their insecurity.<\/p>\n","protected":false},"excerpt":{"rendered":"Humanity has always chased the promise of renewed youth. From ancient myths about the fountain of life to…\n","protected":false},"author":2,"featured_media":230458,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[78],"tags":[18,2215,135,77972,19,17,361,19618,12000],"class_list":{"0":"post-230457","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-eire","9":"tag-for-you","10":"tag-health","11":"tag-hrt","12":"tag-ie","13":"tag-ireland","14":"tag-magazine","15":"tag-menopause","16":"tag-womens-health"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@ie\/115710855044613206","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/230457","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/comments?post=230457"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/230457\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media\/230458"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media?parent=230457"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/categories?post=230457"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/tags?post=230457"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}