Menopause news: testosterone for women update, and my new book!
Menopause news: testosterone for women update, and my new book!
A new testosterone product has been funded.. but will this help women?
Kia ora koutou
First, a huge thanks to my new paid subscribers! Your support lets me keep doing this work and sharing what I learn with you. THANK YOU!
This week is a bit of a milestone for me: I've just finished recording the audio form of my new book: The Everything Guide: hormones, health and happiness in menopause, midlife and beyond. This marks the end of the mammoth creative process that is writing and producing a book.
I'm now in the strange limbo right now between finishing a book (so I can’t change anything – an uncomfortable feeling) and the book being out in the world. To call this a nervous time is an understatement. I’m just hoping what I put out there is going to get picked up.
The book (published by Penguin Random House) will hit the shelves (in print, e-book and audio formats) on April 30th. It's available for pre-order now, so if you want to be the first to read it, do that. (This makes authors super happy).
What's the book about? Well, as you might imagine if you follow my work at all - it's about re-framing and embracing ageing for women. It's about all the things we can do to nurture and future-proof our health - both body and mind - for the rest of our lives. I cover it all: ageism, body image, food, exercise, sex, mental health struggles, menopause stuff, aesthetic stuff, and how to embrace life as a fully grown woman (and become a kick-ass old lady). It’s also a bit of a rallying cry - for GenX women in particular - to examine some of the attitudes, thoughts and beliefs we have about our bodies; things we’ve been conditioned to believe by culture and the patriarchy – and call bullshit on those. You might know what some of those things are…
I hope this one will appeal to anyone who's read my menopause book, This Changes Everything, as well as those who haven't. It’s really, just like TCE, a guide you can refer back to whenever you need it, and you can share among friends and colleagues. I’ll be popping some sneak previews into this Substack soon.
Menopause news…
A couple of interesting things have caught my eye in the meno-verse lately.
A study was published recently that reinforces what’s been emerging for a while: strength training is good for us, no matter what our age. The review and meta analysis found that resistance training does indeed improve strength and fitness in postmenopausal women. The researchers here recommend 60-minute sessions, three times a week. That’s quite a lot – I don’t do that much training; I go for twice a week and 30 minutes, but the sessions are quite high intensity. I think variation is possible and you’ll still see benefits, so just do what you can for where you are – anything is better than nothing. Don’t let the ripped influencers put you off!
And it’s never too late to start. If you’ve never done any strength training before, here’s a bit of inspiration, in a piece I wrote for RNZ. I’ve picked the brain here of Kyra Seiler, who’s my trainer – she’s excellent, and understands that people are human and have limitations and injuries and hormones that we need to work with, but it doesn’t mean we don’t want to work hard.
How to get fitter and stronger without the gym
AND…. Testosterone update!
Some news from Pharmac made me think that Testosterone might be getting a bit closer to being more accessible for Kiwi women, which could be good news for those of us in menopause. Women’s bodies make and need testosterone, and it declines during and beyond menopause. This can mean declines in libido, desire and sexual sensation, and testosterone hormone treatment is recommended for treatment in women who’re struggling with this (which is technically called Hypoactive Sexual Desire Disorder or HSDD. I really hate this being framed as a ‘disorder’ but that’s a different rant). It’s worth noting: testosterone is not a magical solution, here – there are lots of things that play into desire and libido.
There’s also growing talk of testosterone being useful for energy, mood and general mojo… but it’s not officially recommended for that, and the evidence is just not there currently for this, despite anecdotal reports (and much hype on social media).
Anyway: A transdermal testosterone gel, Testogel, has been approved by Pharmac from April 1st. It’s a product formulated for men, or for people undergoing gender affirming therapy. Pharmac haven’t limited its use, though – so that means it could technically be prescribed for women too.
BUT: this is not recommended by experts here. For women to use Testogel, they have to measure carefully a dose from the man-sized pump dispenser – quite hard to do. Care is required, because using too much testosterone can have side effects, some of which can be permanent and serious. Experts caution that not being able to get a reliable dose means side effects are far more likely.
There is, in fact, ONE testosterone product formulated especially for women. It’s called Androfeme, and it’s a gel as well. It’s not officially approved for use here, or funded, but can be obtained via a sort of back-door loophole known as Section 29 of the Medicines Act. It’s expensive. There is one pharmacy on Auckland’s north shore that’s importing it.
I asked Pharmac if they have plans to fund Androfeme. Pharmac’s Director, Pharmaceuticals, Geraldine MacGibbon, responded, and here’s what she said (in part):
“Testosterone gel (Testogel) will be funded for anyone for any prescribed use from 1 April 2024 – this would include people experiencing menopause symptoms, such as hypoactive sexual desire dysfunction (HSDD), if their prescriber considers it appropriate.
The datasheet for Testogel does not include menopause hormonal treatment as an approved use. So, prescribing it would be off label for menopause treatment.”
She also said Pharmac had not received a formal application to fund Androfeme, and it is not currently registered with Medsafe for use in New Zealand.
Since Testogel now has ‘Principal Supply Status’ “their brand becomes the main funded brand in the community and/or DHB hospitals. The principal supplier is guaranteed up to 95% of the total funded market for about 3 years.”
To find out what this means in practice, I also talked to Megan Ogilvie, an endocrinologist and menopause specialist at ERH Associates, about this. She’s one of the brilliant experts I interviewed extensively for This Changes Everything. She and colleagues have published a statement about Testogel for women which is enlightening (and disheartening). There’s a section on gender inequity which is particularly depressing:
We note that in New Zealand there were already 4 fully funded options for testosterone treatment available for use in men: Sustenon, Reandron, Androderm patches and Testosterone Cipionate. This provides a gratifying number of options for male hormone treatment. It is frustrating that women continue to experience limited choice for oestrogen treatment, exacerbated by a world-wide shortage of oestrogen patches, and no funding for a second option for transdermal oestrogen treatment in women in the form of oestrogen gel, and no funded options for a testosterone formulation designed for women.
We urgently need more MHT options for women…The lack of funding for Androfeme is an example of an equity of access issue that we need to address locally and internationally.
Megan also told me this:
“I am pretty sure that Pharmac have funded the pump form of Testogel. I don’t believe that it is in any way accurate to get consistent dosing over 1/10 of a pump. If women use this product I think we will see complications from high testosterone levels.
In short, we have good access to a product designed for women that has pretty reliable consistency of dosing. We would support funding of Androfeme, but we actually need oestrogen gels first. These would benefit many more people than Androfeme. I do think funding of oestrogen gels is coming though, eventually.
It is exceedingly frustrating that Pharmac have chosen to fund yet another testosterone product for men and no gels (or Androfeme) for women. Nor are they making obtaining patches through this ongoing shortage any easier to negotiate for women or pharmacies. Half the population go through menopause and yet a very small percentage of men (relatively speaking) have a true requirement for testosterone replacement.”
She also told me that Lawley Pharmaceuticals (who make Androfeme) are currently putting together an application to Pharmac for funding, supported by Sue Davis (who has done the majority of the research on testosterone) and the Australasian menopause society.
So there you go. I guess it’s a ‘watch this space’ situation. Testosterone for women remains, at this stage, an unaffordable dream for many. You can read the full ERH Associates statement here:
And the Pharmac decision announcement here:
And on the subject of sex and libido, there’s a whole chapter on this in This Changes Everything and another different one in the new book. It’s a topic I think is really important to keep talking about!
Recent writing:
I’ve had a couple of cover stories on women’s health topics published in the NZ Listener lately. They’re available online with a subscription (well worth it if you can manage it – it’s important now more than ever to support local journalism I think).
Women and alcohol: why we’re drinking more than ever and ignoring health dangers
Bones, balance ageing: the surprising links between bone health and brain function
I’ve also continued with my ‘health explainers’ for the RNZ website. Here’s some recent ones:
Do you need a continuous glucose monitor?
Is histamine causing you health problems?
Do you need a vitamin IV drip?
Have you got ‘hot girl gut issues’?
As always, thanks for your support of my work and this newsletter. I’m always here for questions and suggestions of topics you’d like me to cover. And I’m always available for speaking engagements on menopause and midlife health. Hit me up here: