July 9, 2024 - 10:00am

A new article in the Guardian cautions that testosterone prescriptions for women experiencing the menopause are spiralling “out of control”, with “long-term implications” for female health. Experts even go so far as to warn about the influence of “testosterone evangelists” on social media who exalt the drug’s life-changing benefits.

Dr Paula Briggs, a sexual and reproductive health consultant and chair of the British Menopause Society, told reporters that “people are being led to believe that they must have this. But we have no idea what long-term testosterone supplementation does to women.” Dr Briggs drew parallels to the potentially fatal risks of steroid use among male bodybuilders, pointing to unknown risks to the arteries and hearts of women who may end up with “supra-physiological” levels of the hormone in their bodies.

The article enlists the expertise of medical specialists with a range of opinions on the treatment at hand, and ultimately emphasises the need for caution in the face of known and unknown risks. In other words, it represents typical health reporting. But the subject — testosterone use among females — draws attention to the reckless exceptionalism that defines gender medicine and which has deformed reporting on this issue. The balance of perspectives and caution applied here, regarding the use of small doses of testosterone in middle-aged women over a short period of time, is absent from most reporting on gender medicine, which involves the use of high (one might even say “supra-physiological”) doses of testosterone in adolescent and young adult females over long periods of time.

Testosterone is a controlled substance for a reason: the drug’s risks are substantial. The Mayo Clinic warns middle-aged men considering testosterone replacement therapy to weigh the risks carefully, and discourages unrealistic expectations among those seeking such treatments. “Although some men believe they feel younger and more vigorous if they take testosterone medications,” a report reads, “there’s little evidence to support the use of testosterone in otherwise healthy men.” On the subject of testosterone supplementation during menopause, the clinic notes that “[m]ore studies are needed to understand the risks associated with use of testosterone over the long term in women.” Harvard Medical School encourages patients to “consider alternatives before boosting your hormones indefinitely”.

The risks of “masculinising hormone therapy” (testosterone prescribed to females for identity reasons), on the other hand, are presented only after a declaration that testosterone “can be safe and effective when delivered by a health care provider with expertise in transgender care”. The Mayo Clinic also suggests that, in order to “minimize risk”, medical providers will monitor patients in an attempt to keep “hormone levels in the range that’s typical for cisgender men” — never mind that female bodies aren’t male bodies. Testosterone levels in adult females typically range from 15 to 70 nanograms per deciliter, while typical male levels range from 300 to 1,000 nanograms per deciliter. On what basis, exactly, does dosing a female patient with 20 times her body’s natural testosterone levels represent cautious risk management?

Reporting on the subject has been — for the most part — abysmal, more concerned about relaying support for patient identities than deploying the same scrutiny reporters would apply to any other health issue. A recent Guardian headline, for example, proclaimed “fast access” to gender-affirming hormones to be “lifesaving”. The rest of the article focused narrowly on a study of the self-reported mental-health benefits of 64 adults followed for a period of just three months, and admitted no consideration of risks to physical health whatsoever. Why was there no scrutiny here?

The goal of gender medicine’s critics can perhaps best be summarised as an end to the exceptionalism that has shaped both medical practice and reporting. Doctors should hang on to their medical training and not forget everything they know about male and female bodies when patients’ gender markers change. Health reporters should ask questions, balance perspectives, and report their findings in the clearest language available. We’ll know we’ve turned a corner on gender medicine when the magical thinking — and prescribing, and reporting — stops.


Eliza Mondegreen is a researcher and freelance writer.

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