Testosterone Therapy in Women
Women make testosterone in the ovaries and testosterone precursors in the adrenal glands. Testosterone is important in female development. It stimulates the growth of axillary (underarm) and pubic hair. There are testosterone receptors in the nipples, vagina and clitoris. Testosterone is important for sexual responsiveness. Testosterone levels can decline as a result of: childbirth, endometriosis, oral contraceptive use, psychological trauma, depression, surgery that removes or injures the ovaries and adrenal stress (insufficiency). Finally, the normal aging process including the menopause will result in reduced levels of testosterone.
Testosterone supplementation, when indicated, may be beneficial in improving health and vitality for women. It may be helpful in preventing or reducing the severity of a variety of illness conditions including:
- Psychological problems such as depression
- Sexual problems such as poor libido and sexual responsiveness
- Cardiovascular problems such as arteriosclerosis and coronary artery disease
- Musculoskeletal problems such as inflammatory arthritis, non-specific arthritis, muscle pain and weakness
- Endocrine problems such as insulin resistance
- Urological problems such as incontinence
SYMPTOMS AND SIGNS OF TESTOSTERONE DEFICIENCY IN WOMEN:
Signs of Sexual Dysfunction:
- Reduced Libido
- Reduced Sexual Responsiveness
- The feeling of being burned out
- Symptoms of mental fatigue and difficulty in concentrating
- Fatigue most marked in the early afternoon or evening
- A decrease in mental acuity (sharpness, wit)
- A reduction in creativity or spontaneity
- A decrease in initiative or desire to start new projects
- A decrease in interest in hobbies or new work-related activities
- A decrease in assertiveness
- A change in memory manifested by an increase in forgetfulness
- A sense of depression manifested by sadness, tearfulness, an inability to enjoy the simple pleasures of life
- “Sore-Body Syndrome” manifested by non specific muscle and joint discomfort
- Decline in flexibility and mobility; increased stiffness
- A loss of muscle size, tone and strength
- A reduction in stamina
- Reduced athletic performance
- Pain in neck, shoulders and low back
- An increased injury rate with a slower recovery/repair time
- The development of inflammatory arthritis such as rheumatoid arthritis in mid or late life
- The development of osteoporosis; bone thinning
Metabolic and Vascular Problems:
- An increase in total cholesterol and or triglycerides
- A decrease in HDL; the protective transport protein
- Insulin resistance or overt Diabetes
- Blood pressure elevation
- A loss of the elasticity of the arteries (endothelial dysfunction)
- Heart attack, stroke and other problems related to arteriosclerosis (hardening of the arteries)
Other Physical Problems:
- Thinning of Skin
- Venous insufficiency
- Urinary incontinence
TESTING TO IDENTIFY ADROGEN DEFICIENCY STATES
The basic tests involve testosterone blood levels, DHEAS, estradiol, progesterone and sex hormone binding globulin. These are blood tests best done in the morning when testosterone levels are highest. In complex situations I may order a 24-hour urine test that measures the sex hormones and their metabolic by-products in order to understand how best to individualize therapy. Knowing the level can help direct therapy for the individual. One size does not fit all; one treatment does not fit all. Individualization of therapy is the key to an optimal outcome. Monitoring hormone levels, physical findings and patient symptoms should be done at 3-4 month intervals while on hormone replacement therapy.
I have not found salivary levels particularly useful in monitoring therapy. The results do not match the clinical picture once therapy has started. Salivary hormone measurements may be useful in screening or early diagnosis.
Symptoms and Signs of Androgen Excess:
Androgen excess can occur in women who are not using supplementation. In this case there may be an underlying disorder (Polycystic Ovary Disease) that may be resulting in over secretion of androgenic products. Women on supplements of testosterone can also experience side effects of excess. These symptoms and signs may include:
- Oily Skin
- Thinning hair on the scalp (this can also be a sign of insufficiency of estrogen and or progesterone)
- Increased hair on the face or body
- Increased aggressiveness
- Wanting to watch football
- Losing interest in shopping
Only kidding on the last two!!
What is the point of spending money on expensive medication and going to the trouble of monitoring its effect if you are not going to make the life style changes that will optimize a therapeutic outcome?
Diet should be individualized using the principles of our metabolic typing program. At the very least follow our general guidelines on diet and exercise as outlined on this website.
Supplementation with vitamins, minerals, therapeutic nutrients and herbal products is also an important part of a comprehensive program. Supplementation recommendations are individualized.
Testosterone is used as a transdermal cream. The potency of the cream is adjusted to achieve an optimal blood level of testosterone. Blood levels are checked at 6-8 week intervals until an optimal level is achieved. After that I recommend checking blood levels at 3-4 month intervals. Hormonal therapy is most effective when the complex interactions of all the hormones are taken into consideration and supplementation is balanced with this in mind. Diet and exercise issues are always important.