Testosterone: is the hormone the key to vitality in later life for men and women?
Can testosterone replacement therapy (TRT) really boost your energy and mood? Medical experts and hormone specialists reveal the pros and cons.
Can testosterone replacement therapy (TRT) really boost your energy and mood? Medical experts and hormone specialists reveal the pros and cons.
Actress Kate Winslet, 50, has praised testosterone’s libido-boosting properties for making her “feel sexy again”, while singer Robbie Williams, 52, credits TRT for giving him “a new lease of life”.
And broadcasters Piers Morgan, 61, and Prue Leith, 86, have both spoken about how a decline in testosterone can impact overall wellbeing in later life.
But it’s not just celebrities who are exploring the potential benefits of TRT. A 135% rise in prescriptions between 2021 and 2024 was reported in the latest data from the NHS Business Authority, compiled by the Care Quality Commission.
However, some experts believe that concerns around side effects and a lack of knowledge might be holding some people back from seeking advice on the subject.
Women’s hormone specialist, best-selling author, podcaster and physician Dr Louise Newson explains: “Many women are wary of testosterone because it’s long been labelled a ‘male hormone’, with fears about side effects like excess hair, voice changes or increased anger.
“In reality, these concerns aren’t supported by evidence when it’s prescribed at the low doses used for women. The aim is simply to restore levels to the normal female range.”
Dr Newson continues: “In my clinic, we have thousands of women taking testosterone, and the incidence of side effects is very low. Much of the concern comes from lack of awareness and clinical experience. With the right dosing and monitoring, testosterone is a safe and effective option for many women who both want and need it.”
Dr Newson explains the science behind the hormone: “Although it’s often referred to as a male hormone, it is actually the most abundant biologically active hormone in women.
“Testosterone plays essential roles throughout the body, having effects on every cell and organ in the body, and impacts brain health, mood, energy levels, muscle mass, bone strength and cardiovascular health.
“It also influences key neurotransmitters such as serotonin and dopamine, which affect mood and overall wellbeing, and can improve libido.”
Specialising in TRT, NHS GP and men’s health expert Dr David Weinstein further explains: “Testosterone acts as a chemical messenger, regulating everything from bone density and muscle mass to mood and cognitive function.
“It isn’t just about libido; it’s an essential part of our internal engine that helps maintain heart health, energy levels and mental clarity as we age.”
The medical term for low testosterone production in the reproductive glands (testes in men, ovaries in women) is 'hypogonadism'.
“Most people begin to see a natural decline from their late 30s or early 40s,” says Dr Weinstein. “For women, this drop is often linked to the menopause transition, while men typically experience a more steady decrease of about 1% per year. The very gradual nature of this decline is partly why many men often don’t notice the onset of symptoms.”
Newson adds that this reduction is usually more sudden in women who have had their ovaries removed and experience a surgical menopause.
For both men and women, Dr Newson says: “Symptoms often include reduced libido and sexual pleasure, low mood, anxiety, fatigue, poor concentration or brain fog, reduced muscle strength and poor sleep. Some people also experience joint pains, and worsening headaches and migraines.”
Dr Weinstein adds that men specifically may notice a decrease in morning erections, and suffer from more frequent irritability.
For many of us, it might be easy to put symptoms down to the general ageing process. So, addressing notable symptoms with your GP or hormone specialist is the first port of call, but it’s essential to acknowledge the bigger picture around your current health and lifestyle when talking to your GP or hormone specialist about initial testosterone concerns.
“A thorough discussion about symptoms, medical history and expectations is important,” says Dr Newson. “Blood tests are then usually recommended before starting treatment, to establish baseline levels, and again after a few months to ensure that levels remain within the normal range. Ongoing monitoring, often annually, is also advised.
“Frustratingly, many women are still refused testosterone by their GPs, so if you're declined testosterone without a good clinical reason then I would consider seeing another doctor.”
Lifestyle factors including poor sleep, an unhealthy diet, high stress and limited exercise can affect our all-round hormonal health and lower testosterone production.
“Anyone looking at their hormones during mid-to-later life needs to consider the impact of their general lifestyle on their hormonal health,” advises Dr Weinstein. “I always advise my patients that any hormone replacement therapy should accompany a big lifestyle push. This combination can offer an incredible improvement to health and wellbeing.
“Alongside a comprehensive blood test for a diagnosis of low testosterone (hypergonadism), I think it’s important to look beyond the numbers. I use clinical symptom checkers and a full physical MOT to ensure that the blood results align with how the patient actually feels.”
A boost in sexual desire is the most evidence-based outcome of TRT for women, according to studies, particularly during and post-menopause. Key benefits include increased arousal and pleasure, with an average of one additional satisfying sexual event per month, according to research.
The NHS says it is guided by the National Institute of Care Excellence (NICE), which states that testosterone should only be considered for women following a trial of HRT (oestrogen and progesterone), and after all other potential contributors to a lowered sex drive have been excluded.
“For post-menopausal women, testosterone can be the missing piece of HRT, specifically helping to restore a flagging libido,” says Dr Weinstein.
For men, studies have shown a rise in motivation in the bedroom, and a higher frequency of sexual thoughts and intercourse. The proven effects of TRT on improving erectile dysfunction, however, are limited in medical research.
By activating muscle-binding pathways, testosterone boosts the process of protein synthesis, which can effectively lead to stronger muscles and more efficient repair.
It may also act as an osteogenic (something which stimulates bone growth), with one study showing small improvements in the strength and density of hip bones in men aged over 70, while further research found that the hormone offered a therapeutic effect to men suffering from osteoporosis in later life.
For women during and post menopause, Dr Newson says there is evidence that testosterone improves muscle strength and is associated with improved bone density, both of which can decline with a drop in oestrogen.
Dr Newson points out, however, that all hypogonadal women can benefit from this boost in muscle and bone health due to testosterone levels generally declining with age, rather than an acceleration during natural menopause.
Testosterone can influence our brain chemistry by increasing dopamine activity (for motivation and positivity) and improving serotonin signalling (for mood stability).
“Many women find that their motivation, mood, concentration and stamina improve with testosterone,” says Dr Newson.
And Dr Weinstein states that men can experience a similar boost in mental and physical energy: “While the conversation in the UK has recently focused on women, and specifically the menopause, men suffering from the grey cloud of low testosterone can see transformative improvements in their metabolic health and overall zest for life when levels are safely restored.
“We often see the most significant benefits in men over 45 who have struggled with persistent fatigue or a lack of mental focus that they’ve previously dismissed as just part of getting older.
Some evidence has shown that testosterone may improve underlying risk factors associated with heart disease, including a reduction of visceral fat, greater muscle mass and an increase in exercise capacity. But many medical researchers say that further studies are needed.
However, Dr Weinstein believes that the cardiovascular benefits of TRT are clear: “It can be a game-changer in that it provides a foundation for long-term wellbeing, as optimum testosterone levels are linked to better heart health in later life.”
Dr Newson adds that her experience in hormonal health has shown that TRT can indeed lead to a reduction in diabetes and heart disease.
TV doctor and Royal College of GPs lifestyle and physical activity lead Dr Hussain Al-Zubaidi warns of the risk factors when suffering from existing or recent health problems: “TRT should either be avoided or discussed thoroughly with your GP, and closely monitored by anyone with prostate or breast cancer, as it can potentially stimulate existing cancer cells.”
Testosterone can also trigger an increase in red blood cell production (polycythaemia), which can raise the risk of blood clots, warns Dr Al-Zubaidi.
“Men with untreated, severe sleep apnoea should also be cautious when considering taking testosterone, as it can affect the brain’s regulation of breathing,” he explains.
Although some studies have shown potential benefits to heart health with TRT, other research has found an increased cardiovascular risk. Although this evidence is mixed, Dr Al-Zubaidi says: “For anyone who has experienced a recent cardiovascular event, including a heart attack or stroke, or has an underlying heart condition, some evidence has pointed to a higher risk with testosterone.”
Dr Al-Zubaidi warns: “Particularly in men over 65, who are more likely to have underlying cardiovascular disease and higher baseline clot risk, the risks associated with TRT can be higher. It can raise haematocrit (our red blood cell count) and increase the risk of blood clots.
“One trial suggested no clear rise in major cardiac events in this age group overall, but higher rates of pulmonary embolism and atrial fibrillation were observed.
“Indeed, regulators such as the MHRA [the Medicines and Healthcare Products Regulatory Agency] advise caution in older or higher-risk patients.”
Dr Al-Zubaidi adds: “Age alone isn’t a contraindication, but the threshold for prescribing should be higher.”
Mild to adverse reactions can be both frequent and common in some patients, advises Dr Al-Zubaidi: “The most significant is a potentially raised haematocrit. Some people can also experience acne and oily skin, fluid retention, breast tenderness and mood changes.”
He adds that it’s important to discuss any concerns with side effects before starting TRT.
“TRT should only be used when there are clear symptoms and confirmed low testosterone, not for general ‘ageing’ or wellbeing,” concludes Dr Al-Zubaidi. “In older adults, particularly those with cardiovascular risk, it requires cautious prescribing, informed consent and regular monitoring.”
(Hero image credit: Getty)
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