Claire noticed the difference within weeks. The Adelaide woman, now in her early fifties, had spent years watching what she described as her libido simply disappear after menopause. Her GP eventually suggested testosterone therapy, a treatment long used by men and increasingly recognised as beneficial for women experiencing low sexual desire after menopause. It worked. But the cost, she says, has never felt fair.
"I'm taking the same hormone my husband takes," she told her specialist. "Why am I paying more for it?"
It's a question that women's health advocates across Australia have been asking for years, and one that has gained fresh urgency after the Therapeutic Goods Administration declined to list a testosterone product specifically formulated for women on the Pharmaceutical Benefits Scheme. That decision has left women like Claire paying out-of-pocket for a PBS-listed product designed for men, used off-label in lower doses, or purchasing a compounded product at significantly higher cost.
Women's health specialists are unambiguous in their frustration. The core of the argument is straightforward: testosterone is listed on the PBS for men experiencing hypogonadism, yet women with clinically recognised low libido after menopause do not have access to an equivalent subsidised option. For a country that prides itself on universal healthcare, the gap is difficult to defend on anything other than historical inattention to women's health research.
A question of evidence, or a question of priority?
The TGA and some clinical researchers urge caution. Their concern is not that testosterone is harmful to women at low doses; the available evidence suggests it is generally safe when used appropriately. The concern is that the volume of public enthusiasm for testosterone as a menopause treatment has run ahead of the volume of robust, long-term clinical trial data specifically in women. Regulators must weigh benefit against risk on the basis of evidence, not popular demand, and that standard applies regardless of the condition or the patient's sex.
That is a legitimate position. The Australian Department of Health and the TGA operate within frameworks designed to protect patients from under-tested treatments, and those frameworks have served Australians well. The risks of regulatory capture by public sentiment, however genuine the suffering of those seeking treatment, are real.
But critics of the decision argue the evidentiary bar is being applied unevenly. They point to the fact that testosterone was listed for men on the basis of evidence gathered primarily in male populations, and that the relative scarcity of women-specific trial data is itself a product of decades of underinvestment in women's health research. In that reading, the TGA's caution is not neutral; it compounds an existing inequity.
The Royal Australian College of General Practitioners has noted that many GPs are already prescribing male-formulated testosterone off-label for women, a practice that is legal but unsubsidised. The result is a two-tiered system in which women with means can access effective treatment, while those on lower incomes go without.
What the cost gap actually means
For communities outside major cities, the practical consequences are sharper. Women in regional South Australia, for instance, are more likely to rely on a single GP rather than a specialist, less likely to have that GP familiar with the nuances of off-label testosterone prescribing, and less able to absorb the cost of compounded preparations that can run to several hundred dollars a month.
What the data shows, and what women and their doctors have known for years, is that gaps in subsidised access do not affect all Australians equally. They fall hardest on women who are older, on lower incomes, and living away from specialist services. The nearest menopause clinic, for many South Australian women, is not around the corner.
The Pharmaceutical Benefits Scheme is one of Australia's great policy achievements, a mechanism for ensuring that effective treatments reach people regardless of their wealth. When that system produces outcomes where men and women pay different prices for the same molecule, used for analogous purposes, the question of whether the system is working as intended is not merely academic.
A pragmatic path forward
The honest answer to the testosterone question is that both sides of this debate have a point. Regulators are right to insist on rigorous evidence before extending subsidised access, and clinicians are right to press for that evidence to be gathered as a matter of urgency. The two positions are not incompatible; they point toward a shared solution, which is sustained public investment in women's health research to close the evidentiary gap that the current impasse exposes.
In the meantime, the cost burden falls on women. That is not an acceptable resting place for a health system committed to equity. A pragmatic middle path would involve the government funding targeted clinical trials in Australian women, reviewing the PBS listing criteria for testosterone in light of existing international evidence, and ensuring that GPs prescribing off-label have access to clear clinical guidance. None of that requires abandoning evidential standards. It simply requires treating women's health as worthy of the same sustained attention that men's health has historically received.
For Claire, the therapy continues. She pays what she pays, and considers herself fortunate to be able to. Not every woman in her position can say the same.