Testosterone bought by menopausal women posing as men due to NHS issues

Women are increasingly resorting to deceptive tactics, posing as men to procure testosterone from online pharmacies due to significant hurdles in obtaining NHS prescriptions in Wales. This concerning trend, highlighted by a leading menopause specialist, points to a stark inequity in access to a hormone treatment that can profoundly impact the quality of life for post-menopausal women. The situation is so dire that some women are taking dangerous doses, risking permanent side effects, in their desperation for relief from menopausal symptoms.

Dr. Michelle Olver, a consultant in sexual and reproductive health and a menopause specialist, has witnessed a "very sharp increase" in testosterone referrals for post-menopausal women within the NHS. However, she notes a significant disparity in access across different health boards in Wales. This inconsistency means that a woman’s ability to receive testosterone treatment can depend heavily on her geographical location and the specific policies of her local health board. Dr. Olver has treated women with testosterone levels up to 12 times the safe limit, a direct consequence of self-medicating with unregulated online products. These dangerously high levels put women at risk of permanent and undesirable side effects, including hair loss, voice deepening, and clitoral enlargement.

"It is incredibly sad to see women resorting to deception to obtain this medication online because they are being denied access to something they need," Dr. Olver stated. She advocates for a unified, all-Wales approach to testosterone prescribing, ensuring equitable access for all post-menopausal women who could benefit from its therapeutic effects, particularly in addressing diminished libido. She emphasizes that while the goal is to maintain women within a physiological female range for testosterone, the current situation is pushing them to dangerous extremes. "We want to maintain women in female physiological range for testosterone. We don’t want them to have sky-high levels," she reiterated. "When you persistently have very high testosterone levels you can get undesirable permanent side effects. Nobody wants to have baldness, deepening of the voice or enlargement of the clitoris."

The impact of these access issues is deeply felt by women navigating the menopause. Emma Thomas, co-founder of the menopause support group Menopals Cardiff and Vale, confirms that many members have shared their struggles in obtaining testosterone through the NHS. "We hear a lot of women saying their GP thinks there’s no need for it or their surgery won’t prescribe it," she reported. Thomas, 59, from Sully in the Vale of Glamorgan, experienced a significant personal shift in her own well-being at the age of 47. She described a transformation from a "really sociable, happy person" to someone who felt "quite insecure, paranoid, low in mood." The joy seemed to have evaporated from her life.

For Thomas, Hormone Replacement Therapy (HRT) proved to be a turning point, making a noticeable difference within just ten days of starting treatment. Once her HRT dosage and type were stabilized, her GP prescribed testosterone. She noted that it took approximately six months to observe the full effects, describing it as "the final piece of the puzzle for me." Now, she feels like her former self, possessing a renewed "zest for life."

However, both specialists and women who have undergone testosterone therapy agree that it is not a universal panacea. Emma Jones, 57, shared her experience of increased energy levels within a week of starting the drug, but also reported feeling "jittery and on edge." She humorously recalled feeling as if she had "changed into the body of an 18-year-old, thinking about sex from the moment I woke up." Despite these initial side effects, Jones strongly believes that women should have the autonomy to explore different types of HRT to find what best suits their individual needs.

The inconsistency in NHS provision is starkly illustrated by the case of a woman who was initially prescribed testosterone by her NHS GP. Upon moving to a neighbouring health board area, her new GP surgery refused to continue her prescriptions. Faced with this barrier, she sought a private consultation, prescription, and blood tests. Once her testosterone levels were stabilized through private care, she resorted to filling out a questionnaire for an online pharmacy, falsely claiming to be a man, to acquire the hormone at a significantly lower cost.

Dr. Olver described the current system as a "postcode lottery," heavily dependent on individual practices and clinicians, leading to considerable barriers for patients. "It’s really difficult when you might know somebody else who’s going through exactly the same thing and has sailed through the process and might not have gone into secondary care," she commented. "There is no consistency across the board unfortunately."

Dr. Olver, who runs the menopause clinic at Aneurin Bevan’s health board, confirmed the substantial increase in testosterone referrals from primary care for women seeking access. "It is difficult to meet demand and we have a testosterone clinic set up now for women who want to trial it," she stated. She explained that each of the seven health boards in Wales employs a "traffic light system" for prescribing testosterone. In some areas, the system is red, meaning only specialists can prescribe the drug. Other areas have amber classifications, which can involve a GP seeking specialist support or agreement for testosterone to be prescribed, or a hospital specialist initiating and monitoring the prescription with a shared care agreement, allowing GPs to continue prescribing.

A significant contributing factor to this disparity, according to Dr. Olver, is the lack of a licensed testosterone product specifically for women within the NHS. While such products have been available in other countries for years and are accessible from private clinics across the UK, a female-specific testosterone product has only recently achieved a license in the UK. However, it still requires appraisal by the National Institute for Health and Care Excellence (NICE) to determine its cost-effectiveness for NHS use. Following this, discussions with the pharmaceutical industry regarding its cost to the NHS would be necessary. Currently, the female product, Androfeme, costs the NHS approximately £100, whereas the male product, Testogel, is available for around £30.

Dr. Olver’s research indicates that "Studies show about 60% of women will find benefit in improving their libido." She stresses the importance of managing expectations, cautioning that testosterone is not the "wonder drug" often portrayed on social media. She highlighted that numerous factors can affect women’s desire for intimacy, including external circumstances and anatomical considerations. Therefore, comprehensive counselling on what to expect from testosterone therapy, as well as its limitations, is crucial.

The Welsh government stated, "All health boards are expected to adhere to the National Institute for Health and Care Excellence’s (NICE) guidelines on identification and management of menopause including providing individualised care when prescribing HRT." They acknowledged that this may encompass some practitioners prescribing testosterone for certain women. "We expect all health boards to conform to any recommendation made by NICE in relation to prescribing testosterone when its guidance is published," the government concluded, indicating a potential future shift towards greater consistency once NICE provides its guidance.