The struggle of HRT supplies for women vs testosterone for men

The last few months since Christmas have seen a gradual reduction in the availability of hormone replacement therapy (HRT), for women, which eventually coincided with the Channel 4 documentary starring Davina McCall titled “Sex, Myths, and Menopause”.

The timing of this program was particularly ironic as it beautifully highlighted the symptoms and troubles faced by thousands of menopausal women at a time where shortages of available treatments is becoming critical.

Daily, we are having discussions with women who are struggling to access a treatment that not only makes them feel better, improves multiple aspects of their overall health, and often just allows them to feel normal.

So, have men on testosterone replacement therapy (TRT), encountered similar difficulties?

The numbers of men on TRT compared with women on HRT is very small.  In addition, there are a variety of different testosterone treatments available, which further helps dilute any problems with availability of one particular brand.  The bigger struggle men have been finding with hormone therapy is not so much the availability of the medicine, but getting treatment in the first place.

In comparison with menopause where diagnosis is based solely on symptoms, low testosterone in men is only diagnosed by confirmation of either a low total or free testosterone.  The problem, however, comes in determining what testosterone level is low enough to provide a formal diagnosis?

The British Society of Sexual Medicine (BSSM), which provides official guidance on target reference ranges for testosterone levels in men, states that men with a total testosterone of < 12nmol/l or a free testosterone < 0.225nmol/l are classed as having “low testosterone”.

However, most NHS clinics use much lower cut off points; often 6-8nmol/l and sometimes even lower than that.  Most of the time, men have their blood tests done and are simply told their results are “normal”.

So why are levels in the NHS so much lower than the national BSSM guidance? This may be down to financial reasons, failure to update local reference ranges, or a lack of provision to provide for male hormonal deficiencies.

Overall, it is probably multifactorial, but in practice this means that hundreds, perhaps thousands of men are being told everything is fine, when actually their testosterone levels are low.

I have always maintained that when it comes to hormones, men and women are not that different.

Symptoms of oestrogen deficiency in women (menopause), and low testosterone in men, present in similar ways and evidence shows that for both men and women, optimizing their testosterone and oestrogen respectively, can improve health outcomes as well as radically improve quality of life.

As a nation we need to spend more time thinking about improving and optimizing our health as we age.  This means offering better availability to medicines, planning for shortages and increased demand, as well as removing antiquated barriers to getting a diagnosis.

We have a team of doctors who specialise in men’s and women’s health. If you’d like to speak to a doctor about low testosterone, menopause, or any of the topics we’ve touched on you can make a booking here – to make it easy we offer consultations online or face to face, whichever you prefer.