22-23 WOMEN’S HEALTH

International Women’s Day and Women’s History Month provide an opportunity not only to celebrate progress in women’s health, but to also confront structural barriers that have shaped it. For decades, women’s health was narrowly defined through a reproductive lens. Symptoms were frequently attributed to the uterus, even when unrelated, and as such research priorities reflected longstanding gender bias.

Systemic exclusion from research compounded the problem. In 1977, the US Food and Drug Administration (FDA) banned women of childbearing age from participating in phase 1 and phase 2 clinical trials.1 Although the decision was motivated by concerns following the thalidomide tragedy, it resulted in decades of limited understanding about how drugs affect women. While this policy was reversed in 1993, the legacy of underrepresentation continues to influence data gaps today.

Despite recent advances in menopause awareness, the legacy of under-investment remains visible. Women’s health continues to receive a disproportionately small share of private healthcare innovation funding. The consequences are evident with limited product development tailored specifically to female physiology, variability in clinical pathways and inconsistent access to specialist care.

For much of the twentieth century, menopause received limited research attention. Substantial scientific focus did not begin to emerge until the 1990s,2 and even today, understanding remains incomplete. Yet the demographic need is clear. By 2030, nearly 500 million women worldwide will be aged between 45 and 55, meaning around 6% of the global population will be experiencing menopause.3

Menopause is associated with declining levels of oestrogen, progesterone and testosterone. Oestrogen has traditionally dominated both public and clinical conversations, and for many women experiencing vasomotor symptoms, it remains the cornerstone of hormone replacement therapy (HRT), typically prescribed alongside progesterone to protect the womb lining.

However, the menopausal transition is biologically complex. Hormonal fluctuations influence not only temperature regulation and reproductive function but also mood, cognition, sleep and sexual health. For some women, conventional oestrogen-based HRT does not fully address symptoms, particularly those relating to sexual desire and well-being.

Despite increasing awareness, gaps in menopause care remain evident. Access to specialist menopause services varies regionally, prescribing confidence differs among healthcare professionals, and women often report inconsistent or delayed support. Variability in treatment pathways, limited product availability tailored to women’s physiological needs, and ongoing stigma surrounding sexual health can all contribute to fragmented care experiences. Against this backdrop, the role of testosterone deserves closer attention.

Although commonly perceived as a ‘male’ hormone, testosterone plays an important role in women’s physiology throughout life. As part of the androgen hormone group, testosterone contributes to the development and maintenance of sexual anatomy, influences sexual psychology and modulates aspects of behaviour. It also contributes to energy levels, mood stability, cognitive function and overall physical well-being.

Women produce testosterone in lower quantities than men, but it remains biologically significant. In fact, testosterone has been used in the management of menopausal symptoms for more than 80 years.4 However, its historical association with male health has contributed to limited appreciation of its relevance in women.

Testosterone levels in women typically fall by about half between the ages of 20 and 60.
This decline can be more pronounced following surgical menopause, when ovaries are removed, or iatrogenic menopause, where hormonal changes are triggered by medical treatment rather than the natural ageing process. The drop in testosterone, along with other hormonal changes during menopause, can contribute to symptoms that many women experience, including low libido, sexual dissatisfaction, fatigue and brain fog.

The most clearly established role of testosterone for women is sexual function. While persistent reductions in sexual desire during menopause are influenced by multiple hormonal factors, testosterone therapy can help address this in some women.
Hypoactive Sexual Desire Disorder (HSDD) is characterised by a sustained loss of sexual desire that causes personal distress. HSDD is estimated to affect more than one in three menopausal women and can significantly affect relationships, emotional well-being and quality of life.5

In the UK, the National Institute for Health and Care Excellence (NICE) recommends testosterone therapy for HSDD in postmenopausal women if oestrogen-based HRT alone is not effective. This guidance reflects increasing recognition that declining testosterone can be a treatable factor contributing to symptoms in some women. While this represents progress, treatment limitations remain.

HRT has evolved significantly since its early formulations. Modern regimens are more tailored and risk-benefit profiles are better understood than in previous decades. Nevertheless, conventional HRT is not suitable or sufficient for all women.

Some women continue to experience persistent symptoms despite optimised oestrogen therapy. Others may be unable to tolerate certain formulations due to side effects. Dosing flexibility, delivery method preference, and adherence challenges can all influence real-world outcomes. Additionally, not all symptoms of menopause respond equally to oestrogen replacement.

In the context of testosterone therapy, formulation challenges are particularly evident.
In many regions, testosterone products available for women are adapted from male formulations. Creams and gels designed for higher male dosing must often be adjusted manually, creating potential challenges in achieving consistent and precise dosing within the physiological female range.

Frequent daily application can also affect convenience and adherence. Concerns around dosing variability and accidental dermal transfer to partners or children may further complicate use. These practical limitations highlight the need for delivery systems specifically designed with women’s physiological requirements in mind.

Encouragingly, research into testosterone therapy for women has expanded over recent decades. Clinical trials have clarified appropriate dosing ranges, safety considerations and therapeutic indications. There is now stronger consensus around its use for carefully selected women with HSDD.

Alongside improved clinical understanding, advances in drug delivery technology are also emerging. Transdermal systems, including patch-based approaches, are being developed to provide delivery of low-dose testosterone within the physiological female range. Such systems aim to reduce variability associated with manual dose measurement and improve convenience compared with daily topical applications.

Drug-in-adhesive technologies provide steady hormone release and support skin tolerability. For example, early clinical evaluations of Medherant’s testosterone patch show predictable pharmacokinetics within premenopausal ranges, indicating progress towards more tailored treatment options. Innovation in this space reflects a broader shift towards therapies designed around women’s biology, rather than adapted from male treatments.

Chronic underinvestment in women’s health has created enduring gaps but it also presents a clear opportunity. Large patient populations, persistent unmet need and growing public awareness together signal an urgent call for targeted research and product development.

Menopause is no longer a marginal topic. As women remain active in the workforce for longer and as societies confront ageing populations, the health and well-being of midlife women have economic as well as clinical significance. Addressing persistent care gaps is therefore not only a matter of equity, but of public health and economic sustainability.

Testosterone highlights a key, often overlooked, piece of the hormonal picture in menopause treatment. While not appropriate for all women, evidence supports its use in selected cases where symptoms persist despite traditional HRT.

Closing the hormone gap requires continued investment in women-focused research, more inclusive clinical trials and development of therapies designed for women. As understanding evolves, the goal should be clear: ensuring that women’s health is no longer an afterthought but a research and innovation priority.

Closing the hormone gap

The hormone gap

Testosterone and its impact on women’s well-being

Limitations of hormone replacement therapy

Innovation and progress in testosterone therapy

The future of menopause treatment