Women need Testosterone for good health despite the Myth that Testosterone is only a “male,” hormone.
What is the Testosterone Myth?
It’s time to stop the Myth that testosterone is only a “male,” hormone. In fact, testosterone is the number #1 sex hormone found in both men and women. There is a renewed interest in sex hormones beyond estrogen with prescriptions of testosterone nearly doubling over the past 10 years in women between the ages of 40 to 50. It’s true that women have 1/10 th of the testosterone levels as men but still packs a powerful punch, yet its therapeutic role in Women’s Health remains controversial.
In women testosterone is a hormone made by both the ovary and adrenal gland that sits on top of the kidney. Testosterone breaks down into a female hormone called estradiol. The adrenal gland also makes DHEA (another sex hormone) that is also converted into testosterone in the body. As we age and approach menopause (time when our ovaries stop working), the amount of circulating testosterone goes down by 75 % of our prior levels. This may lead to mood swings, lack of energy, low sex drive, anxiety and even difficulty sleeping at night or insomnia. Many women suffering with these symptoms go unrecognized by their doctors when in fact they should be having their “T,” or testosterone levels checked.
Current guidelines restrict the use of testosterone in women to hypoactive sexual desire disorder (HSDD) or low sex drive despite studies saying low “T,” levels can also negatively impact mood, energy, sleep, and bone density. Low levels may even cause “brain” fog. However, it is important that if testosterone is prescribed, it’s prescribed safely when other hormonal treatments have failed. There really in no role for its use in healthy young women and is currently classified as a controlled substance that is regulated by the DEA (Drug Enforcement Agency) due to its abuse potential.
That said, the effects of testosterone in women are real and the demand is there. Time magazine shares a woman’s journey of transformation after starting TRT or testosterone replacement therapy-“the cognitive effects were very dramatic,” resolving brain fog, anxiety and memory problems. She went on to say, ” it’s the biggest quality-of-life improvement I’ve ever made for myself,” welcoming back the energy she needed to exercise regularly and better sex drive or libido.
Celebrities like Halle Berry have credited testosterone for giving her libido back reporting more energy during menopause and after starting treatment says, “I notice a difference.” Kate Winslet has also sung the hormone’s praises. In fact, it could be the missing puzzle of hormone replacement therapy taking its place alongside estrogen and progesterone as a critical part of Women’s Health.
How can I treat low Testosterone?
There are more than 30 different FDA approved testosterone products available for men in the U.S. and none for women. Testosterone comes in oral, topical transdermal, gel, creams and “pellets,” that are implanted directly under the skin. The “gap,” in FDA approval of testosterone as part of Women’s Health and well-being is a failure of the U.S. medical community to acknowledge its benefits in healthy women.
Unlike the U.S. the British Medical Society (BMS) acknowledges that low testosterone is a true deficiency worth treating in women. BMS also acknowledges that testosterone therapy needs to be considered more broadly for women (not just for low libido) when conventional hormone replacement with estrogen/progesterone is insufficient.
The lack of FDA approval for female testosterone preparations have forced health care providers and specialty centers to prescribe testosterone, “off label,” either made individually at specialty compounding pharmacies in the form of testosterone cream, combination of estrogen/testosterone or dose adjusting male preparations to fit women. Compounding pharmacies may be risky due to unreliable delivery doses that studies say can be 20 % higher or lower than dosages prescribed.
Unfortunately, since ALL testosterone preparations are not FDA approved for women, they are not covered by insurance plans unlike their male counterparts, are difficult to dose adjust “off FDA label,” or require compounding-all of which may pose a potential safety risk.
How do I know as a woman if my testosterone levels are low?
The best way to know if your “T,” levels are low is get a blood test for total testosterone. This is especially important if you are a woman over the age of 50 who is experiencing low sex drive, or lack of arousal that has not improved with traditional female hormonal replacement therapy (HRT). Symptoms of low testosterone for women may range from mood changes. low energy, difficulty concentrating, lack of sex drive, and anxiety.
Scientific data supports low sex drive as the primary indication for doctors to start testosterone treatment in women in Europe and the U.S. Unfortunately, there is lack of evidence that it helps with other symptoms despite widespread antidotal reports to the contrary as many women report more energy and vitality, sleeping better, weight loss and a improved quality of life with its use. There are reports that testosterone may be helpful in migraine headaches, loss of unwanted body fat, bone dynamics and building muscle strength.
Testosterone can be measure by a blood test and can be combined with other blood tests for greater accuracy including a free androgen index (shows bioavailable testosterone), or with SHBG or sex hormone binding proteins. In general, total testosterone under 20 ng/dl in post-menopausal women is considered low “T,” in the setting of low sex drive and symptoms.
What kind of Testosterone can women safely take?
In the U.S., there are no prescription testosterone medications that have been approved for women but may be prescribed “off label,” at very low doses or more commonly mixed or compounded by specialty pharmacies in the form of 1 % testosterone cream that can be applied to the buttock, or thigh. In Australia, there is currently a prescription testosterone formulated made especially for women called AndroFeme (1% testosterone) used to treat “low sex drive.”
In terms of safety of testosterone, a recent article from NEJM although studied only in men says its safe overall and helps with sexual desire, correction of anemia, mood and walking ability but did improve cognition or thinking. Another article reviewed over 38 studies in women and found that testosterone supplementation improved female sexual health including desire, arousal, orgasms and frequency of sexual events after 12-24 weeks of use. This was true with transdermal testosterone preparation or creams but also with pellets that are injected under the skin.
The most common side effects of testosterone in women are growth of facial hair, and acne both considered the “male,” or androgen like side effects. It is usually minimal and most women do not discontinue use because of it. One of the health concerns is that it may lead to heart attacks and cancer including breast and uterine, but some studies show it may even decrease the risk of breast cancer but is still recommended to use with caution. It does not seem to increase the risk of heart attacks or cardiovascular disease when used appropriately or increase the risk of prostate cancer in men when used in men at low risk.
According to the European Society of Medicine , “Testosterone: Strong enough for a Man but made for a Woman.” there is mounting evidence that testosterone pellets or combination of estrogen/testosterone may be protective against certain types of breast cancer and a critical part of women’s health and wellness and stresses the need to de-mystify the Myths of women and testosterone.
The global consensus is for women with symptoms of low libido that is life altering is to first try traditional hormone replacement therapy (HRT) with estrogen or estrogen/progesterone and if fails consider testosterone creams usually 1 % testosterone applied three times a week to the thigh or buttock, or testosterone pellet one application (dose will vary but start with low dose) implanted every 3-4 months. It’s important for safety to follow testosterone levels, liver tests, and hemoglobin to guide management with the lowest dose needed to provide symptom relief.
Is there anyway to raise my testosterone levels naturally?
Regular exercise especially weight training can raise testosterone levels naturally. A balanced diet can also help including a healthy number of proteins and fats. High chronic stress can also affect testosterone levels so important to destress with meditation, yoga, exercise and try to get lots of sleep as sleeping less than 5 hours a night may lower testosterone levels.
Vitamins can also help including Magnesium, Zinc and Vitamin D. There are reports that certain herbal supplements like fenugreek can also raise levels but remember to consult your doctor to see if these are right for you.
Any last advice on Women and Testosterone?
It is time to debunk the Myths of testosterone and make it a real part of Women’s Health. Testosterone is not just a male hormone; it is the most abundant necessary active biological hormone in women although present in much smaller amounts than men that decreases as we age. At very low levels it may negatively impact our sexual health, and wellness but also numerous case reports and studies also say it may impact our emotional and mental well-being, muscle mass, and bone dynamics.
Its safety profile in women has not been studied as closely as in men but remains safe with primary side effects including acne and facial hair although there have been case reports especially with the pellet formulation (due to supratherapeutic rises in initial testosterone levels) with neuropsychiatric instability. It is important to discuss the risk and benefits carefully with your doctor and to review if there are contraindications to its use including pregnancy, breast, or uterine cancer, liver disease or active cardiovascular disease.
Until we have the clinical trials performed in women, as we do in men, it will likely be a long time before testosterone finds its place in Women’s Health. The current medical society guidelines for prescribing testosterone for women in the U.S. is to treat hypoactive sexual desire disorder (HSDD) after exhausting alternative therapies including hormone replacement therapy (HRT) with estrogen/progesterone. This is based on lack of scientific evidence to support other symptoms including mood, muscle weakness, and brain fog to be caused by a low testosterone state. In addition, there remain concerns over side effects including liver disease, breast cancer, and high cholesterol that may limit its use in certain populations.
If you are experiencing side effects of low testosterone and have failed traditional HRT contact your doctor about testing for low testosterone especially if you are perimenopausal or menopausal. It may be a game changer.
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