Hormonal health
‘Concerning’ lack of female-only medical trials in UK, say health experts
British medical experts are raising concerns about the underrepresentation of women in clinical studies, The Guardian reports, with male-only trials outnumbering female-focused research by 67 per cent.
Healthcare professionals say they often have to make treatment decisions without enough sex-specific evidence, according to The Guardian’s analysis of comprehensive research data.
A joint investigation by the Medicines and Healthcare products Regulatory Agency (MHRA) and the University of Liverpool gathered extensive clinical trial data. The Guardian found that although 90 per cent of studies included both men and women, male-only trials (6.1 per cent) were far more common than those focused exclusively on women (3.7 per cent).
Pregnant and breastfeeding women were even more frequently excluded, taking part in just 1.1 per cent and 0.6 per cent of trials, respectively.
Dr Amy Brenner, an assistant professor in the clinical trials unit at the London School of Hygiene & Tropical Medicine (LSHTM), said: “It is particularly concerning that there are more male-only trials than female-only trials as, while they may be disease-specific, it is certainly not true that there are more male-only than female-only diseases.
Brenner said the imbalance could have serious consequences for women’s healthcare. This under-representation means there is a lack of evidence on the safety and effectiveness of many interventions in women.” She stressed the urgent need to address the gap to improve outcomes for women.
According to The Guardian’s findings, there were 282 male-only trials compared with 169 female-only ones. Participation by expectant and nursing mothers was particularly low—roughly one in every hundred trials.
Cancer research dominated the trial landscape, accounting for nearly a third of all studies. In contrast, cardiovascular disease—still the world’s leading cause of death—made up just 5.2 per cent. Studies on reproductive and maternal health were even rarer, representing only 2.2 per cent.
Professor Anna David, director of the EGA Institute for Women’s Health at UCL, said the “important” findings shed light on why new treatments for women’s health issues are slow to emerge, and why some women “are not getting the care they need.
There is this perception that women, pregnant women and breastfeeding women do not want to participate in clinical trials and therefore they are usually not considered as potential participants, even in phase 3 clinical trials. This is not the case,” she said.
David highlighted the lack of research into reproductive health issues as especially troubling. “Pregnancy conditions such as pre-eclampsia, preterm labour, and placental insufficiency leading to foetal growth restriction are major diseases with no current treatments,” she said.
Professor Andrea Manfrin, the MHRA’s deputy director of clinical investigations and trials, said there was a “notable imbalance” between male-only and female-only trials. “When specific groups are not adequately represented in trials, it creates evidence gaps about how medicines work for them.”
Manfrin said the regulator was working with research partners to encourage more representative studies.
Health minister Karin Smyth said the government was committed to making the UK a global leader in life sciences, developing innovative treatments “focused on the conditions that matter most to patients”.
By Sarah Bolt, Forth
Following recent approval from the Medicines and Healthcare products Regulatory Agency, testosterone is set to become much more widely available to women in the UK.
Offering greater access to testosterone treatment through their GP, the move marks a significant shift in how menopause symptoms are recognised and treated.
However, despite the increased access, many women are still in the dark about the role testosterone plays.
As conversations around women’s health continue to evolve, testosterone is becoming an increasingly important part of the menopause discussion.
Already licensed in Australia, New Zealand and South Africa, the UK becomes among only a handful of countries making testosterone more accessible for women.
The development marks a significant step forward in recognising the full impact hormonal changes can have during midlife and menopause and the benefits that taking testosterone can have.
Testosterone is often misunderstood, and more closely associated with men, but it also plays a vital role in women’s health.
From energy levels and cognitive function to mood and libido, its influence on the body is far-reaching.
Here are the eight things women need to know about testosterone:
1. Testosterone is a vital female hormone
Testosterone is essential for women.
Produced naturally in the ovaries and adrenal glands it supports a wide range of functions in women including maintaining libido, energy levels, mood, concentration and overall wellbeing.
It also contributes to muscle strength and bone health, both of which become increasingly important during later life.
For many women, low testosterone can leave them feeling a bit out of sorts, impacting confidence, memory, motivation and other areas of life.
Because symptoms are often gradual these are often dismissed as part of ageing or the pressures of life and juggling everything that comes with it.
2. Testosterone levels decline with age
Like oestrogen and progesterone, testosterone levels naturally decline as women get older, particularly during perimenopause and menopause.
Our research found that testosterone levels in women decline by more than 51 per cent with age.
These changes can have a significant impact on daily life, affecting everything from relationships and self-esteem to work performance and sleep quality.
Despite this, many women are unaware that low testosterone may be contributing to how they feel.
3. Signs of low testosterone can vary
Low testosterone symptoms show up differently for everyone. This is why diagnosis and treatment can sometimes be overlooked.
Common symptoms include fatigue, low energy, hot flushes, night sweats, thinning hair, dry skin, muscle weakness, weight gain, mood swings and difficulty concentrating.
Some women may also experience reduced confidence, lower motivation or a loss of interest in sex.
Because many of these symptoms overlap with menopause itself, it is important that women have access to informed conversations and personalised medical advice to determine whether testosterone could help.
4. Testosterone supports more than libido
One of the biggest misconceptions surrounding testosterone is that it is only linked to sex drive.
While testosterone can help improve libido, its benefits extend much further, helping to regulate energy, motivation, emotional wellbeing, muscle strength, bone density and much more.
For some women, restoring testosterone levels can contribute to feeling more energised, confident and mentally sharp again.
5. Testosterone can support cognitive function
One of the main struggles with menopause is brain fog and difficulties with memory and concentration.
Taking testosterone can help protect brain health by supporting communication between brain cells and increasing blood flow.
As awareness around the cognitive impact of menopause continues to grow, testosterone is increasingly being recognised as a tool that helps women better manage these symptoms.
6. Testosterone does not make women masculine
Many concerns around testosterone come from the misconception that it will cause women to develop masculine features.
However, when prescribed appropriately at the right dosage by a qualified healthcare professional, this is unlikely.
The aim of testosterone for women is to help restore hormones to a healthy female range, supporting wellbeing and symptom management.
7. Testosterone is not linked to an increased risk of breast cancer
Another common myth is that testosterone increases a woman’s risk of breast cancer. Current evidence does not support this.
Testosterone does not stimulate breast tissue growth and studies have not shown an increased risk of breast cancer linked to testosterone therapy in women.
In fact, some research has suggested a lower occurrence of breast cancer among women taking testosterone, although more long-term research is still needed in this area.
8. The benefits of testosterone can take time
Testosterone therapy tends to work gradually.
Many women will start to notice improvements in mood, motivation and energy levels within the first few months with the full benefits building over time.
Because testosterone has a cumulative effect, consistent use and regular medical monitoring is important.
Patience is key and ongoing support from healthcare professionals can help ensure treatment remains safe and effective.
Despite growing awareness around hormone replacement therapy, testosterone remains one of the lesser understood hormones.
Our own research shows that testosterone levels in women decline by more than 51 per cent with age with a debilitating impact for many.
Knowledge is power and it’s really important that women are aware of the role testosterone plays in their health, particularly in midlife, so they can see their GP armed with the information they need.
Hormones will fluctuate but hormone mapping is a great place to start and will give women a greater insight into what is happening in their bodies.
It’s imperative that women are able to advocate for themselves and having this information is crucial for this.
Making testosterone more accessible in midlife gives women another treatment option to consider beyond HRT, helping them to manage menopausal symptoms and improve their overall quality of life.
The NHS has been urged to update its website after PCOS was renamed PMOS, or polyendocrine metabolic ovarian syndrome.
Last week, the condition, thought to affect about one in eight women, was given a new name after a 14-year effort involving medical experts, charities and women with lived experience of the disorder.
However, the NHS website contains no mention of the new name or any change to the information provided about the condition.
Neelam Heera-Shergill, chief executive and founder of the charity Cysters, urged action.
She said: “As an organisation rooted in reproductive and health justice, we welcome conversations around language that better reflect the realities and experiences of those living with PMOS/PCOS. But any name change must go beyond symbolism.
“Communities deserve clear, accessible and timely information so people are not left confused, excluded or struggling to access support and diagnosis.
“We hope to see the NHS move quickly to update information and public-facing resources in a way that is inclusive, culturally competent and centred on the needs of the communities most impacted.
“For many people, especially those from marginalised backgrounds who already face barriers within healthcare, clarity and visibility can make a real difference in accessing the rightful care and support they need.”
However, Caroline Andrews, a trustee of the charity Verity, said the announcement of the new name came with a three-year transition period.
She added that the NHS is going through many changes, with a new health secretary recently announced after the resignation of Wes Streeting.
In addition, 2026 has seen the launch of the renewed Women’s Health Strategy for England, while the UK National Institute for Health and Care Excellence is expected to publish the first standalone guidelines for PMOS/PCOS later this year.
Andrews said: “We fully appreciate that they [the NHS] need transition time just like we do, just like many other organisations do.
“And we’d much rather the NHS do this carefully and thoughtfully, considering this in placement with all the lines of care, such as the fact the Nice guidelines are coming through, and how this is fitting with the delivery of care.”
Prof Channa Jayasena, an expert in reproductive endocrinology at Imperial College London, welcomed the name change.
He said: “I think it’s a tremendous initiative, and I think it’s a great step forward in trying to help women and clinicians understand the full breadth of the seriousness [of the] condition.”
But he added that the shift has only just occurred, with professional societies around the world meeting to inform their members about the change.
He said: “There’s a long history of many conditions sometimes still being called outdated things by clinicians because it takes a while for the workforce to be updated and upskilled.
“And I can guarantee you, not all doctors know about this at the moment, and therefore not all patients will.
“So I think it’s a great move in the right direction, which shows where we should be going.
“But professional societies which have webpages, obviously patient support groups, and the NHS will, I fully expect, over the next year or two, be updating all their websites.”
However, Dr Sophie Williams of the University of Derby and an expert on PCOS/PMOS and mental health said the three-year transition for the name change could cause confusion.
She said: “When you go on the NHS website and it’s still [saying] polycystic ovaries, PCOS… as a member of the public, that might make you question the legitimacy of the information you’re getting.
“[The NHS website] is one of the first places any person might think to go to for health care advice that is rigorous, that is reliable. So from my perspective, I do think that the sooner the better.”
Williams said one option would be to run two shadow webpages that link together, one for PCOS and one for PMOS, or to include text on the current page referring to the name change and noting that information is being reviewed.
An NHS spokesperson said: “We routinely review and update content on the NHS website to ensure it reflects the latest clinical advice and will carefully consider these recommendations.
“The NHS will also continue our work to improve women’s healthcare, including for this important group, which involves giving women more choice over their care, bringing down waiting times, and delivering more care in communities.”
Wegovy is linked to lower risks of migraine and depression in menopausal women than hormone therapy alone, a study has found.
Women across all menopause stages taking semaglutide had a 42 to 45 per cent lower risk of migraine six months after starting the medication and a 25 per cent lower risk of depression than those who took menopausal hormone therapy alone.
The findings are based on a one-year real-world study of more than 34,000 menopausal women in the US who took hormone therapy, Wegovy or a combination of both.
They were announced by Wegovy manufacturer Novo Nordisk, alongside data from the randomised, double-blinded STEP UP and SELECT trials, at the European Congress on Obesity in Istanbul last week.
Semaglutide is the active ingredient in Wegovy, a weight-loss drug.
Dr Emilia Huvinen, a gynaecologist researcher and associate professor at the University of Helsinki, who was involved in two of the three studies, said: “Menopause, associated weight gain and unwanted changes in cardiometabolic markers can significantly impact long-term health and wellbeing of women.
“Still, they remain one of the most neglected areas in obesity research.
“Whether we look at cardiovascular outcomes or weight loss across menopausal stages, semaglutide appears to offer meaningful benefits for women with obesity that extend well beyond weight loss alone.”
Cardiometabolic markers are measures linked to heart and metabolic health, such as blood pressure, blood sugar, cholesterol and waist size.
Analysis of the STEP UP trial found that premenopausal women with obesity lost an average of 22.6 per cent of their body weight when taking a once-weekly dose of Wegovy compared with placebo.
A placebo is a dummy treatment used to compare results against an active medicine.
Researchers said the average waist circumference reduction in premenopausal, perimenopausal and postmenopausal women was 17.5 per cent, 15.6 per cent and 15.3 per cent respectively, indicating a major loss of dangerous visceral fat.
Visceral fat is fat stored around internal organs and is linked to a higher risk of heart and metabolic disease.
The STEP UP trial involved 1,407 adults with a body mass index, or BMI, of 30 or above and investigated the efficacy and safety of Wegovy 7.2mg jabs.
BMI is a measure that uses height and weight to estimate whether a person is in a healthy weight range.
The SELECT trial involved 17,604 participants aged 45 or older with a BMI of 27 or above and assessed the impact of Wegovy on cardiovascular health compared with placebo.
A post-hoc analysis of the SELECT trial found that perimenopausal and postmenopausal women with obesity and heart disease had a reduced risk of heart attacks, strokes and cardiovascular death.
A post-hoc analysis is carried out after a study has finished and can help identify patterns, although it is generally seen as less definitive than the original planned analysis.
Novo Nordisk said obesity affects nearly one in five women globally, and the burden intensifies during menopause because hormonal changes accelerate weight gain, redistribute fat to the abdomen and increase cardiometabolic risk.
It added that the three studies show that when women with obesity lose weight with Wegovy, they improve their body composition with reduced waist circumference, indicating less visceral fat, and also reduce their risk of heart attacks and strokes while improving quality of life, from migraine burden to depression and menopause symptoms.
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