Health experts call on Pharmac to fund female-specific testosterone

Source: Radio New Zealand

An endocrinologist says more than half the women she sees on testosterone for low libido are taking too high a dose, and she and her colleagues are calling on Pharmac to finally fund a female-specific product.

Pharmac is set to consider funding AndroFeme 1 on Thursday, which unfunded costs anywhere between $150 and $250 for a three-month supply, depending on the pharmacy.

To avoid that cost, many women are prescribed a funded alternative, called Testogel, which is formulated for men.

Testosterone is usually thought of as a male hormone, but it is also found in women. It is prescribed to treat low libido, also know as Hypoactive Sexual Desire Disorder (HSDD), in women who are postmenopausal.

Women’s health advocate and director of Cala Clinic, Jenna Scullin, explained: “Similar to males, women’s testosterone levels decline gradually over their lifetime.

“By the time a woman is at a menopausal age, it has often halved.”

Men who needed a boost of the hormone had the choice of four funded products, whereas women had no funded options.

Pharmac has twice declined to fund AndroFeme 1, first in 2024, saying the eligibility criteria (“postmenopausal women with HSDD”) was not appropriate and posed significant barriers to equitable access for women – particularly for women who, for cultural reasons, did not wish to undergo aspects of an HSDD diagnosis.

It also considered there was an “uncertain health benefit” in using AndroFeme 1 over the unapproved, or off-label use of Testogel, saying that if equivalent doses were administered, there should not be a significant difference in their effect.

At that stage, the discussion document showed there were 2300 people dispensed Testogel between February and November, and approximately 46 percent of those identified as female.

In 2025, the decision was reassessed, and the result was “no formal recommendation” which meant the previous decision stood – but this time Pharmac noted there was a need to fund a product with an appropriate dose for women, to minimise potential harm.

Endochrinologist Dr Anna Fenton from Oxford Women’s Health explained there was no research on how testosterone was metabolised by the female body.

“Women are being prescribed this without the appropriate baseline testing without, often, follow-up blood testing to make sure the level is appropriate.”

And it could be difficult for women to work out the correct dose of Testogel when it came out of the pump bottle, she said.

“It’s very hard to titrate the dose of a blob of gel, which is what you get from the pump dispenser, into something that is a quarter or a fifth of that dose, which is possibly what’s appropriate for women.”

Fenton said more than half of the women she treated who had been prescribed Testogel were showing testosterone levels that were too high.

“I had a woman the other day who had 12 times the upper end of the female range, so it was well into the male range.”

Side effects included greasy skin, acne or extra body hair growth, but at the extreme end, it could lead to changes in voice or enlargement of the genitals – and those effects were permanent, Fenton said.

New Zealand had “the bare minimum” available when it came to hormone replacements, which included things like oestrogen patches, trailing behind the likes of Australia, the UK, US, and Canada.

She, along with fellow endocrinologists Dr Megan Ogilvie, Dr Sylvia Rosevear, Dr Susannah O’Sullivan and Dr Sasha Nair, have made a joint submission to Pharmac ahead of its meeting, endorsed by the Australasian Menopause Society, urging it to prioritise “evidence-based, female-specific therapies” and fund AndroFeme 1.

“We urge Pharmac to refrain from normalising the use of male-formulated testosterone products in women.”

The company behind Testogel, Pharmaco, has made no claims of its safety for women.

It supplied RNZ with a statement, saying: “Testogel is a prescription medicine specifically formulated and approved to be used by men with low testosterone levels. The relevant data sheets and Consumer Medicine Information clearly state that the medicine should not be used by women.”

Pharmac director for advice and assessment David Hughes confirmed AndroFeme’s application was on the agenda for the Pharmacology and Therapeutics Advisory Committee (PTAC) meeting on Thursday.

“PTAC gives Pharmac clinical advice to help us make decisions about how to use our funding,” he said in a statement. “The committee reviews the evidence behind funding applications and looks at how strong and reliable that evidence is.”

He said a recently-received a submission would be discussed at the meeting.

Pharmac would aim to publish the provisional recommendation online within 30 days of the meeting, although that could be subject to change.

Female testosterone deficiency ‘more than just a low libido’ – health advocate

Scullin said one in three women between the ages of 40 and 64 experienced the effects of reduced sexual desire.

“It’s more than just a low libido, we see that it affects women’s mental health, it affects their social functioning, their relationships, their confidence and their overall wellbeing.

“There’s this view sometimes that a woman’s sexual function is not essential,” she said. “But when a man comes forward with needing assistance, there’s one of four funded options accessible to him.”

She said while some GPs and specialists were comfortable prescribing Testogel to women despite the lack of safety data, a number were not, “so it’s not just that we’re asking for a female-formulated option, but in many cases we’re actually asking for an option for women”.

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– Published by EveningReport.nz and AsiaPacificReport.nz, see: MIL OSI in partnership with Radio New Zealand