Women are being warned using high levels of testosterone can cause acne, body and facial hair.
A group of doctors is calling on Pharmac to fund a testosterone cream designed especially for women rather than giving them alternatives made for men.
Pharmac met yesterday to consider funding Androfeme, a testosterone cream formulated to treat low libido, also known as Hypoactive Sexual Desire Disorder, in women.
Men who need additional testosterone have the choice of four funded products, whereas women have none. Because Androfeme is unfunded, it currently costs $150 for a three-month supply.
Many women seeking treatment are instead prescribed Testogel, which is publicly funded – but formulated for men and trans men.
The submission from four endocrinologists, Dr Megan Ogilvie, Dr Anna Fenton, Dr Susannah O’Sullivan, Dr Sasha Nair and gynaecologist Dr Sylvia Rosevear, challenges the assumption that it’s appropriate for women to use testosterone products designed for men.
“We urge Pharmac to refrain from normalising the use of male-formulated testosterone products in women,” they wrote.
Ogilvie, an Auckland endocrinologist, said Testogel was designed to boost testosterone levels in men and trans men.
She claimed social media influencers were also promoting testosterone supplementation for muscle strength.
“We have no research for the use of Testogel in women to demonstrate safety or efficacy – it’s a step backwards,” she told the Herald.
“When I was a junior doctor 30 years ago, we adapted male testosterone products for women because there were no alternatives.”
She said by contrast, Androfeme is designed for daily use by women, has been well researched, is safe and contains a lower dose of testosterone.
Ogilvie said women need to know about the risks of using testosterone at high levels: “You will develop acne, body and facial hair, your voice will deepen, and you can experience enlargement of the clitoris. Is that really what you want?” she said.
Pharmac’s Pharmacology and Therapeutics Advisory Committee has previously declined to support funding for Androfeme, and has said that if an equivalent dose of Testogel were administered, there should not be a significant difference to Androfeme in its effect.
Fenton, an endocrinologist from Christchurch, said she has seen irreversible damage from Testogel in one of her patients – a singer whose vocal cords were affected after taking the testosterone for three months. Testogel turned the soprano singer into an alto, Fenton said.
She said there needed to be regular monitoring for women who take Testogel – or any form of testosterone therapy, because there is no research showing how it is absorbed or metabolised in women.
Testogel is often dispensed via a pump-pot, whereas Androfeme comes in a tube.
“It’s very hard to divide the dosage of the dispensed gel and women will often become relaxed about how much they pump out without rigorous checking of the dose.
“When we measured my client’s testosterone levels, they were well into the male range. Because she was aware of her vocal range, she noticed it had become more limited. She was singing at a much lower pitch than normal and could no longer reach the high notes,” Fenton said.
She said her patient sought help for menopausal symptoms and low libido and was advised by a gynaecologist to use one pump of Testogel a day, later increasing to two pumps.
“That would be about 10 times the female dose. Your skin can become greasy, you can get acne, you may develop facial and body hair, and you can lose hair at the front and temples. In this case, my patient’s voice deepened, and the worst part was that it didn’t improve her libido,” Fenton said.
She is calling on Pharmac to “step into the 21st century” and provide an equal level of support for women’s health.
“Telling women they cannot access an equitable pathway to a product designed specifically for them, and instead must use a product designed for men that has never been studied from a safety – or any other – perspective in women, is a deeply retrograde step," she said.
In a statement, Pharmac’s director of advice and assessment Dr David Hughes told the Herald Pharmac will publish a provisional recommendation on its website in about 30 days.
“A routine part of Pharmac making assessments of medicines involves us gathering and receiving submissions from clinicians and members of the public. These are considered alongside clinical evidence and guidance. This information is used by our Pharmacology and Therapeutic Advisory Committee when making recommendations about which medicines to fund,” Hughes said.
Carolyne Meng-Yee is an Auckland-based investigative journalist who won Best Documentary at the Voyager Media Awards in 2022. She worked for the Herald on Sunday from 2007-2011 and rejoined the Herald in 2016 after working as an award-winning current affairs producer at TVNZ’s 60 Minutes, 20/20 and Sunday.