Testosterone saved Claire’s sex life, but women still pay more for it than men

There was no issue with the sex life in Claire Atkins’ long marriage until a few years after she went into early menopause, aged 46.

“Sex up until then had been great,” she says. “It was happening all the time, our boys had grown up and left home, and we were having lots of noisy sex again.”

But by the age of 51, her libido had sunk low enough to be distressing. “The bottom dropped out of it,” she says. “I didn’t even think about sex any more.

“I thought, is this what I’ve got to look forward to?”

Atkins had other issues her GP said were likely linked with menopause: joint pain which stopped her long-distance running, insomnia and low motivation to do things that usually gave her joy.

A few months after Atkins started menopause hormone therapy, her GP suggested that because her lost sex drive was also troubling her, she would be a candidate for the only testosterone treatment approved for women, AndroFeme 1.

The Australian product is available on private script, only to treat hypoactive sexual desire disorder – HSDD – in post-menopausal women. It costs $107 to $140 a tube, which lasts three to four months.

Patient advocates are angry that it was rejected late last year for subsidy by the Pharmaceutical Benefits Advisory Committee because many women cannot afford it, and women’s health specialists say the decision is sexist given the government supports men with eight similar products.

The manufacturer, the small Perth pharmaceuticals company Lawley, has announced it will challenge the decision in the Federal Court based, in part, on its argument that women have inequitable access to a medication for sexual dysfunction compared with men.

World-leading Australian research suggests about 60 per cent of menopausal women with HSDD are helped by testosterone, usually moderately, and those who respond well may see a big improvement – as Atkins did.

“It wasn’t just about wanting to have sex all the time, it was making me feel juicy about life and about myself [even though] I was no sexier than I was a couple of weeks before,” Atkins said. She said she feels fortunate to afford it but wonders why women pay so much more.

Michael Buckley, a pharmacist and founder and chief executive of Lawley, said the committee’s decision was an “astounding rejection of the physical, mental and sexual needs of post-menopausal women”.

“It means women will pay between 14 to 16 times more for treatment than their male counterparts pay for the treatment of similar sexual dysfunction conditions,” Buckley said.

AndroFeme 1 was registered by the Therapeutic Goods Administration for HSDD in November 2020, and is approved in the UK, New Zealand and South Africa. If it was funded in Australia, the government would pay $1.07 a day for women on the product – compared with $2.60 a day for men on Testogel.

A Health Department spokesman said the committee “acknowledged the impact of Hypoactive Sexual Desire Dysfunction on postmenopausal women” but had concerns regarding the strength of clinical evidence, potential safety risks if misused and whether the proposed price offered value for money.

A large Australian study published in The Lancet last year by Professor Susan Davis, a Monash University menopause researcher and clinician, found that almost half of Australian women experience poor sexual wellbeing in midlife. But Davis found sexual dysfunction causing distress in many women’s 40s did not correspond with a decline in blood levels of testosterone.

Intense public demand for women’s testosterone, fuelled by non-evidence based claims about it being a “missing link hormone” that can do wonders generally for midlife women, may have slowed the progress of AndroFeme 1, expert observers say.

Doctors who are social media influencers have promoted women’s testosterone as being able to treat or prevent many age-related conditions.

But global expert researchers, including Davis, have stressed that there is no evidence for any therapeutic benefit other than for post-menopausal women with HSDD. She is studying if it has potential to impact leading morbidities in older women including heart failure, loss of muscle mass and function, and cognitive decline.

Dr John Eden, director of the Sydney Menopause Centre at the Royal Hospital for Women and an associate professor of reproductive endocrinology at UNSW, said some claims escalating demand were wrong. “Where some of these YouTube celebrities have gone too far is they’re saying every woman needs estrogen, progesterone and testosterone and that is just not true,” he said.

It was useful for many women with HSDD, he said, and “for a significant minority it’s a game-changer; when it works it’s dramatic”.

“There is plenty of published data to show if you have someone who loves their partner and is not depressed, and their menopause symptoms are controlled well, and they’re not having a lot of hot flushes … and you give them an appropriate dose of testosterone, over four to five months you get an improvement in sexual function,” Eden said.

Testosterone is not a panacea and not something all women need, Eden said, but rejecting a female product from the PBS “looks sexist, it looks terrible”.

Professor Rod Baber, head of the Menopause and Menstrual disorders clinic at Royal North Shore Hospital in Sydney and a clinical professor of obstetrics and gynaecology at the University of Sydney, said he had prescribed AndroFeme 1 for HSDD since it was registered by the TGA in 2020, and it had helped patients who responded well.

Baber was a lead author on a 2019 global consensus position statement by international menopause experts on the use of testosterone for women, which declared treatment to have a “moderate” therapeutic effect, but only for HSDD.

The evidence-based statement had “been accepted by most appropriate colleges or societies interested in this area of women’s health” in the world. “In my experience, and the literature reflects this, two out of three women get a clinical response,” Baber said.

Women’s testosterone was a useful tool for HSDD, he said, though data suggested it still produced only “an average of one satisfying sexual event per month”, and side effects could include acne and increased facial or body hair.

“The outburst of over-enthusiastic [off label] testosterone treatments which lack any evidence and efficacy, all the fuss and bother on the social media scene may have given the committee cause for concern,” Baber said.

Davis has also conducted world-leading research which found that 60 per cent of post-menopausal women with HSDD who are in good relationships and have no other significant health issues benefit from using testosterone.

Twenty per cent experience no change in desire or responsiveness, and symptoms worsened for 20 per cent. Davis has said that “women who it’s really working for” could experience four more satisfying sexual events per month.

Eden said his clinical practice supported the product’s effectiveness. “We know that for a substantial number of women with low sexual desire who are menopausal, an appropriate female dose works and is safe,” he said.

“There’s no doubt about that statement, but that seems to be the statement the PBAC is arguing against.”

The Health Department spokesman said more information about the committee’s consideration would be available in a public summary document for AndroFeme 1 in March.

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