For Frances Goodman the hormone replacement therapy was good in every respect — except one.
The interior designer from London was relieved when combined HRT (oestrogen and progesterone) ended the ‘horrible’ hot flushes and other menopausal symptoms that had made her early 50s a minor nightmare.
"I went back to my normal self in just a few weeks — apart from my libido. I’d hoped my interest in sex might also return to pre-menopausal levels, but that didn’t happen".
For Frances, 62, and her doctor husband, David, it was a disappointment.
"I never went off sex completely — but it was certainly less enjoyable and we both missed that".
Two years ago, Frances made an appointment to see her gynaecologist and asked for another hormone to be added to her HRT mix.
"When I’d originally consulted her, my doctor had mentioned testosterone as a possible hormone that could usefully be replaced - she recalls - but I was horrified at the idea. To me, testosterone means hairy men and rampant adolescent boys — neither of which, needless to say, I felt would add to my quality of life.
But realising that my libido was not going to improve on its own, I decided to give it a try".
Frances had a testosterone implant inserted just under the skin of her stomach — this releases very small doses of the male hormone into her bloodstream.
It did improve her sex life — though unlike celebrities such as Jane Fonda, who described a dramatic improvement in her libido with testosterone, the changes for Frances were subtle. "There was certainly no ramping up of sexual desire — if anything, it subtly changed the quality of sex rather than the quantity".
What did improve dramatically, however, was her health.
In 2008, four years after starting combined HRT, Frances had a bone density test carried out routinely "because of my age" and had been shocked to discover that she had osteopenia, a precursor to osteoporosis.
"I immediately took up Pilates to boost bone strength and gave up coffee as I’d read it could weaken the bones. But it didn’t make any difference".
Yet six months ago her latest bone density test — a year after the testosterone implant — revealed that her bones were back to normal levels.
"My gynaecologist said she had no doubt it was testosterone that had made the difference".
Frances’s gynaecologist is not alone in her enthusiasm for testosterone in combination with HRT.
"Any gynaecologist with a serious interest in menopause today advocates the inclusion of testosterone in HRT" says Charles Kingsland, a consultant gynaecologist at Liverpool Women’s Hospital and a spokesperson for the Royal College of Obstetricians and Gynaecologists.
Women’s production of testosterone falls by 50 per cent as a result of the menopause; it also drops dramatically if women go through the menopause before they are 50 as a result of a hysterectomy or because of illness.
"It’s long been recognised that this drop causes a potentially distressing decrease in sexual desire for many women - says Janice Rymer, professor of gynaecology at King’s College Hospital - But we now know much more about the impact of this loss of testosterone production on physical health, including bone and muscle strength as well as drive and confidence" she says.
"Both oestrogen and testosterone play a significant role (alongside exercise and nutrition) in building and maintaining bone density and muscle mass" explains Professor Rymer.
Indeed an authoritative study, first published in 2006 and since then repeated several times, has shown that testosterone hormone replacement is an important treatment for maintaining bone and muscle and mass in women with testosterone deficiency.
- Tags: Jane Fonda Frances Goodman London HRT Pilates Charles Kingsland_consultant gynaecologist_Liverpool Women’s Hospital Spokesperson_Royal College_Obstetricians_Gynaecologists Janice Rymer_professor of gynaecology_King’s College Hospital Professor Rymer Mr Kingsland