We have had an increasing number of enquiries from patients asking us to prescribe testosterone replacement in menopause. We aim to provide high quality care to women with menopausal symptoms and we manage many aspects of their care including HRT (hormone replacement therapy). We also recognise that current waiting times to be seen in NHS specialist menopause clinics can be frustratingly long.

However, as testosterone for menopause remains “off-label” and the GPs at BVMC do not hold specialist menopause qualifications, it is our practice policy that confirmation of suitability for testosterone prescribing, plus initiation and stabilisation of treatment should be done by a specialist in all cases.

The British Menopause Society’s statement on testosterone published in July 2024 includes the following:

“Whilst some women do benefit from the addition of testosterone (to standard HRT) this is not the case for all women and in the interest of patient safety, it is important that women are advised within readily available clinical guidance from the National Institute for Health and Care Excellence (NICE), British Menopause Society (BMS) and International Menopause Society (IMS). The only current evidence based factual indication for the addition of testosterone to standard HRT, is for persistent low libido in postmenopausal women, after all other contributory factors have been addressed. There is no evidence to support claims that testosterone will help with other symptoms associated with menopause or prevent bone loss or dementia”.

We also recognise that earlier BMS guidance published in December 2022 included the statement  “It is hoped that with support from this prescribing tool, the off-label prescribing of testosterone can take place in primary care, with support from secondary care / menopause specialists where required through management care pathways”.

As stated above our interpretation of this guidance is, that in order to maintain patient safety, confirmation of suitability for testosterone prescribing plus initiation and stabilisation of treatment should be done by a specialist in all cases.

We welcome patients coming to speak to the BVMC clinicians about menopause symptoms and can prescribe non-testosterone forms of HRT in many cases if safe and appropriate. For patients wishing to consider testosterone we can refer you to an NHS specialist clinic for an assessment. If you are prescribed testosterone for menopause treatment by an NHS specialist and they wish to discharge you back to our care for us to continue prescribing, we will consider this on a case by case basis and may ask that an ESCA (Essential Shared Care Agreement) remain in place. We do not enter into ESCAs with private providers for any medications.