Waning energy? Low mood? Lacklustre libido? You could benefit from hormone therapy

‘I was feeling low and irritable. I stopped getting a kick out of my achievements at work; I even stopped wanting sex — a definite first. I felt broken.’ Remarkably, what changed everything for Sarah was a pot of testosterone cream. Thanks to campaigners such as Meg Matthews, attention has recently focused on the power of hormone treatment and in particular testosterone for women around the time of menopause. But it can also yield remarkable results for women in their 20s and 30s. ‘I was astonished at the turnaround,’ says Sarah ‘My lust came back. My enjoyment of life and living came back. My energy levels soared. It was like the sun coming out from behind a cloud.’

Sarah had no idea that her hormones were out of whack. Wondering if her problems related to mineral deficiency, she consulted clinical nutritionist Peter Cox at Omniya clinic in Knightsbridge. ‘I was out of ideas and thought a change in my diet could help,’ she tells me. In fact, a series of blood tests revealed that her testosterone levels had plummeted. She was referred to the clinic’s hormone specialist Dr Sohere Roked.

‘Hormone imbalances can happen at any stage of life,’ Roked tells me. ‘While hormone levels naturally start to decline as you age, any number of other factors can contribute to irregularities. Hormonal forms of contraception, like the pill, can commonly be an issue, as can stress.’

Most commonly thought of as a male hormone, testosterone is key for women. On average we have three times as much of it as we do oestrogen. As well as being essential to our sex drive, insufficient testosterone can also relate to low mood, inexplicable fatigue and blunted motivation, as well as premenstrual syndrome, loss in muscle tone and osteoporosis. Too much can cause acne, anger and aggression. And yet not enough women are aware of the potential benefits of testosterone and other hormone balancing treatments.

‘I feel very passionately about testosterone treatment, and am concerned that it has been neglected by the medical profession,’ says Nick Panay, consultant gynaecologist at Chelsea and Westminster Hospital. ‘It simply isn’t a priority for the NHS, and it isn’t seen as cost effective enough for pharmaceutical companies to investigate.’

For the moment, the NHS has only regulated testosterone for use in men. This makes it difficult for GPs to prescribe it for women, and means private practitioners often end up having to extract lower doses from male creams for women.

To remedy the situation, Panay is working with doctors around the world to create global awareness of the importance of testosterone treatments. He has also set up Hormone Health clinics on Harley Street and in Maidenhead with a view to reaching out to those with hormonally-based issues.

But how safe is it for women to take lower doses of something specified for male use?

‘In 40 to 50 years of testing we have seen no significant problems,’ says Panay. ‘There were originally concerns it may damage the cardiovascular system; we are now working on research with the Royal Brompton Hospital to show that there are, in fact, benefits to the cardiovascular system.’

Panay does, however, point out that testosterone should not be seen as an instant, stand-alone fix: ‘It is not a panacea.’ In terms of libido, he continues, ‘it isn’t female Viagra — women are more complex creatures than men, and testosterone won’t offer the on/off button Viagra does.’ More generally, he

says it must be prescribed only after full consultation and blood profiling, and given in appropriate amounts with other lifestyle advice: ‘It can then be like switching on a light, transforming your vitality, mental acuity and joie de vivre.’

The good news is that if your get-up-and-go has got up and gone, and you feel an intractable tiredness especially in the second half of your cycle, low testosterone may be the culprit. The even better news is that while testosterone cream can provoke a transformation (and can be issued by private specialists at a cost of around £2 a day), a number of lifestyle adjustments can also work wonders.

First, contraception. Dr Amalia Anna-radnam of the London Hormone Clinic tells me: ‘The combined pill suppresses the body’s natural cycle. This means there may be less testosterone produced; it can also increase levels of sex hormone binding globulin (a protein which binds on to testosterone and makes it inactive).’ The mini pill can also be disruptive but, while there is a reported vogue among millennials to forgo forms of hormonal contraception altogether, Annaradnam advises caution in rejecting them out of hand.

‘Many of the best and most reliable forms of contraception are hormonal, so it is a question of exploring the solution that works best person by person,’ she says. ‘It is incredibly individual ­— there are no set rules or one size that will fit all.’

In talking to her patients, Annaradnam emphasises good sleep hygiene as sleep is well known to regulate hormone levels, and may advise weight training to enhance natural testosterone production.

Taking supplements can also be invaluable. Describing the supplement schedule he designed for Sarah, Peter Cox explains:

‘A busy life and work stress can trigger a response in the body’s stress hormone cortisol. Toxic substances from pollution as well as alcohol or recreational drugs can accentuate this response.’ If cortisol levels continue to be elevated over time, the adrenal glands may exhaust themselves keeping up with demand for cortisol, and not leave enough resources for the synthesis of testosterone. To this end, Cox prescribed supplements to support adrenal function, including glutathione and vitamins C and B. He also advised Sarah to take nettle root. ‘It can be helpful as it binds to SHBG [sex hormone binding globulin] and frees the testosterone.’

Perhaps the most positive note to sound when discussing hormonal health is how, at last, more and more people are taking it seriously. As with periods and other ‘female issues’ (such as pelvic floor health and the award-winning Elvie pelvic floor trainer), it is no longer seen as a sort of female weakness. A wider conversation has been started by the likes of YouTuber Hannah Witton with her firstperson vlogs ‘The Hormone Diaries’, Christa D’Souza (who wrote The Hot Topic) and Mariella Frostrup (who has spoken about being helped by Hormone Replacement Therapy). The Library chain of gyms across London focuses its workouts on optimal hormonal function.

One focal point of the new app Moody Month (of which ES Magazine editor, Laura Weir, is a co-founder) is offering a wealth of information enabling women to track their cycle and recognise hormonal and mood patterns.

‘Our bodies are full of chemical signals, and when these are disrupted it has a knock- on effect,’ says Moody Month CEO, Amy Thomson. ‘I found this out the hard way from having a huge hormonal crash — and wanted to do something to help educate other women.’ The app contains free advice from endocrinologists, gynaecologists and nutritionists on best living for hormonal health.

‘For years women have been putting up with hormonal issues,’ Roked says. ‘We berate ourselves for a low sex drive, for PMS, for lacking energy. It is no longer something we have to put up with; we no longer have to suffer in silence.’

Sarah glows as she tells me about how her relationship has improved, how she is sharper at work, how she feels like herself again. ‘To put no finer point on it, re-balancing my hormones has changed my life.’

Illustrations by Shonagh Rae