Issued 20 December 2012

Testosterone replacement can have a huge impact on general quality of life as well as the libido of many women in the menopause.

The expected announcement by MSD of the withdrawal of testosterone implants has recently been circulated to health professionals. This is a global profitability decision by the company which follows closely on from the withdrawal of estradiol implants.

Even more disappointingly, this decision followed on closely from the withdrawal of the Intrinsa testosterone patches, leaving no licensed female testosterone replacement preparations available in the UK or abroad.

The BMS and all other menopause societies globally, have already protested the withdrawal of estrogen and testosterone implants, which will disadvantage a significant proportion of menopausal women who have struggled with alternative preparations. Whilst the decision by MSD to withdraw hormone implants was immoral, it was not illegal and cannot be reversed.

It has been possible for most clinics to source estrogen implants from an alternative supplier, Pharmarama in the UK. The BMS are now striving to source alternative testosterone implants and will inform the membership as soon as we have any news.

In the meantime, off license use of testosterone gel can be used as an alternative – Testim and Tesostogel can be used at a dose of 0.5 to 1.0 ml per day such that each tube/sachet lasts for approximately 1 week (a large pea sized blob applied to the lower abdomen) or Tostran gel, 1 pump every 2-3 days. As with any off label prescribing, responsibility lies with the health professional rather than the manufacturer/supplier.

Androgenic side effects are uncommon with these female physiological doses and reversible if they do occur, with dose reduction or cessation.

Livial (tibolone) has an androgenic effect and can also be used as an alternative to implants (though the progestogenic effect is not required or desirable in hysterectomised women).

Further updates will be provided as information becomes available.

Nick Panay BSc MB BS MRCOG MRSRH
Chairman, British Menopause Society