In what could be the plot of a gender-bending heist movie, women in Wales are reportedly posing as men to purchase testosterone from online pharmacies, all because getting an NHS prescription for the hormone is about as easy as finding a unicorn in a haystack.
Dr Michelle Olver, a consultant in sexual and reproductive health, has witnessed a 'very sharp increase' in testosterone referrals for post-menopausal women, but access is a postcode lottery, with some health boards more generous than others. Dr Olver has seen women with up to 12 times the safe level of the hormone, risking permanent side effects like baldness, voice deepening, and clitoral enlargement - not exactly the fountain of youth.
'We want to maintain women in female physiological range for testosterone. We don't want them to have sky-high levels,' she said, adding that nobody aspires to baldness or a voice like a foghorn.
The Welsh government, in a statement as generic as a birthday card from a distant relative, said all health boards are expected to provide individualised care. Meanwhile, Dr Olver is calling for an all-Wales approach to prescribing, which would be a novel concept: consistency in healthcare.
Testosterone, naturally occurring in women but declining with age, is only prescribed for post-menopausal women to boost libido. Yet anecdotal reports of improved energy and cognition have sparked a study in Wales to see if these claims hold water.
One woman, Emma Thomas, co-founder of Menopals Cardiff and Vale, says many members report GPs dismissing their needs or refusing to prescribe. She herself felt like a different person at 47 - going from 'really sociable, happy' to 'quite insecure, paranoid, low in mood.' After HRT and eventually testosterone, she felt like her old self, with a zest for life.
But not everyone has a smooth ride. Emma Jones, 57, felt 'jittery and on edge' within a week of taking testosterone, though she also felt like an 18-year-old with a sudden interest in sex from dawn to dusk. She supports women having access to different types of HRT to find what works.
BBC Wales spoke to a woman who, after moving to a different health board, had her prescription abruptly stopped. She resorted to a private consultation and then, once her levels were stable, filled out an online questionnaire pretending to be a man to get the hormone cheaper.
Dr Rebeccah Tomlinson, a GP running an NHS menopause clinic, explains that some doctors are reluctant to prescribe 'off licence' medications, leading to a 'total ban' in some practices to keep workloads fair - because equality means denying everyone equally.
This 'postcode lottery' and inconsistency across Wales is frustrating for women who see others sail through the process. Dr Olver's clinic at Aneurin Bevan's health board has seen a sharp increase in referrals, and they've set up a testosterone clinic to meet demand.
Each of Wales's seven health boards uses a traffic light system for prescribing, with some being 'red' (specialist only) and two 'amber' options involving specialists and shared care agreements. The root cause? There's no licensed female testosterone product on the NHS. The female product, Androfeme, costs around £100, while the male version, Testogel, is £30.
Dr Olver notes that studies show about 60% of women benefit from testosterone for libido, but it's not a wonder drug. 'It's really important to manage expectations,' she says, especially given the hype on social media.
The Welsh government says it expects health boards to adhere to NICE guidelines and provide individualised care, and will conform to any future NICE recommendations on testosterone prescribing.
In the meantime, women are left to navigate a system that seems to have them jumping through hoops, or in some cases, pretending to be men to get what they need. The lengths people will go to for a bit of libido, eh?