The discussion of low T in men is everywhere. You can’t escape the constant advertising of testosterone boosters and “low T centers” in today’s world.
There’s no doubt that treating low T in men improves everything from sexual performance to energy levels. However, few people know the importance of optimizing testosterone levels in women as well.
You heard me right, testosterone therapy for women. In fact, I will make a bold statement that testosterone is THE MOST IMPORTANT hormone in women.
I’m sure you’re really shaking your head now. Allow me to guide you through the facts about testosterone and testosterone therapy for women.
Understanding the Role of Testosterone in Women
Testosterone is THE PRIMARY HORMONE produced by the ovaries with levels 3-4x greater than estrogen. Although a woman’s T levels are 1/10 of the levels in men, testosterone still plays an important role in a woman’s body.
Testosterone or androgen receptors in women are found almost everywhere:
- Hair follicles and skin
- Brain, nerves, spinal cord
- Thyroid and endocrine glands
- Cardiovascular system (heart and arteries)
- Lungs
- GI tract
- Vagina, bladder, uterus
- Genitalia
- Bones, muscle and fat
- X chromosome (women have two and men only have one)
Testosterone levels in women will decrease with age. By the time a woman is 40 years old, her T levels are on average 50% lower than when she was 20 years old.
It should come as no surprise, then, why so many women in their 40s notice the onset of:
- Weight gain
- Decreased energy levels
- Mood swings
- Onset of many autoimmune disorders and chronic illnesses
- Loss of libido or interest in sex
- Joint pain
- Difficulty sleeping
- Brain fog
Diagnosing low testosterone in women can be challenging.
First, the medical community knows very little about the role of testosterone therapy in women. I myself received zero education about the importance of testosterone therapy in women despite 4 years of medical school and 6 years of urology residency at a top institution.
Second, lab assays were designed to test testosterone levels in men. The “normal” range in women of various ages is not well defined. To further confuse things, women have higher levels of SHBG (sex hormone binding globulin), a protein that binds testosterone, so less testosterone is available for use in a woman’s body.
Lastly, testosterone levels do not always correlate with symptoms. The diagnosis of low testosterone in women should be made based on symptoms and NOT lab values.
Benefits of Testosterone Therapy for Women
First and foremost, testosterone therapy makes women feel better. A study by Cardozo dating back to 1984 demonstrated that testosterone pellets improved:
- Hot flashes
- Insomnia
- Sexual dysfunction
- Depression symptoms
Further evidence was supplied by Sherwin, who showed that quality-of-life improvement was better in women receiving testosterone therapy compared to those that only received estrogen.
With continued testosterone therapy, women can expect improvements in their body composition as well. Muscle development and fat “burning” require adequate testosterone levels. There’s a reason that post-baby muffin top won’t disappear . . . you don’t have enough testosterone!
Consequences of Low Testosterone in Women
Women are often the primary caregiver of the household, and therefore may ignore their own health concerns. I’ve had some women tell me, “I feel happy with my body and sex just isn’t important so . . . I don’t need testosterone therapy.”
Unfortunately, this mindset can potentially be harmful to a woman’s health. Testosterone plays an important role in the normal function of many key body systems.
Testosterone Therapy and Bone Health
Testosterone plays a vital role in bone metabolism. Numerous studies have documented the increased rates of osteoporosis and osteopenia in men with low testosterone. Due to the reasons listed above regarding diagnosing low T in women, there is a lack of similar data in women supporting the link between low testosterone and decreased bone density.
Nonetheless, studies suggest that women with higher free T levels have higher bone density. Furthermore, adding testosterone to estrogen replacement in post-menopausal women seems to have an additive positive benefit on bone health.
Testosterone Therapy and Brain Health
Alzheimer’s disease is devastating. With no known cure and cases set to triple by 2050, prevention at all costs should be our priority.
Women have 8x the incidence of Alzheimer’s. What’s the likely cause? Hormone imbalance. Women’s estrogen and testosterone levels start heading to zero by age 40.
A study in JAMA from 2002 demonstrated that women who used hormone replacement therapy for over 10 years had decreased rates of Alzheimer’s disease with rates similar to men. Women who did not take hormone replacement therapy . . . not good.
Testosterone Therapy and Cardiovascular Health
The effects of testosterone replacement therapy on cardiovascular health in men has been a controversial topic in recent years. To make a long story short, evidence in men suggests that testosterone PROTECTS AGAINST HEART ATTACKS.
A recent study in women suggests that if women have a high testosterone to estrogen ratio, then there is an increased risk of cardiovascular events. The average age of women in this study was 65 years old. Therefore they had been suffering with hormone imbalance for over 20 years prior to being followed.
How this data relates to younger women on testosterone and subsequently estrogen replacement therapy is not well understood.
Testosterone Therapy and Breast Cancer
This is a sensitive subject for obvious reasons. Women have been incorrectly been told for years that “hormone replacement therapy causes breast cancer”. The controversial Women’s Health Initiative in 2002 did not see an increase in breast cancer in the estrogen-only treatment arm.
In fact, a follow-up study 15 years later in JAMA showed that cancer deaths were NOT associated with hormone replacement therapy.
But what about testosterone therapy and breast cancer?
Starting with work in the lab, testosterone has demonstrated anti-cancer properties in animal models of breast cancer. More importantly, a study by Glaser in 2013 showed that testosterone therapy in women reduced the incidence of breast cancer.
That’s right . . . testosterone actually PROTECTS women against breast cancer.
Several observational studies of women on testosterone therapy confirm this finding with breast cancer rates lower than predicted.
Testosterone therapy will help you and your two best friends stay together.
Side Effects of Testosterone Therapy in Women
There are a lot of myths about testosterone therapy in women. I’m sure most women would be scared to take testosterone therapy because of concern over losing their femininity. Let us assure you that this is not going to happen.
In order to “masculinize” a woman (e.g. cause her to pee with the toilet seat up and not load the dishwasher properly), the dose of testosterone therapy would have to be 20x the dose that is typically used in women. There is no risk of voice changes or aggression.
Again it’s important to remind you that there is NO EVIDENCE supporting the ideas that testosterone therapy in women will cause heart attacks, strokes, liver disease or breast cancer.
Testosterone Therapy Options for Women
Testosterone use in women dates back in 1937. It was found to be beneficial in treating vaginal dryness and other symptoms of vaginal atrophy in post-menopausal women. Despite this long-standing evidence, there is still no FDA-approved testosterone product for women.
But fear not! When you find a board-certified specialist with expertise in hormone optimization, testosterone therapy for women can safely be prescribed.
Similar to men, there are three main options for testosterone therapy in women:
- Injections
- Topical therapies
- Pellets
Even more so in women than men, bio-identical pellet therapy is the preferred option for many reasons:
- Consistent testosterone levels
- Safety
- Fewer side effects
- Convenience
Click here to learn more about BioTE® bio-identical pellet therapy.
Side effects from testosterone pellet therapy are mild and uncommon. Hirsutism or unintended hair growth is seen in <5% of women. This can be managed with laser hair removal or decreasing the testosterone therapy dose in women. Acne can also occur at a similar rate and is usually managed conservatively.
Closing Thoughts on Testosterone Therapy in Women
Hopefully you feel a bit more comfortable about testosterone therapy in women. Not only will you just feel better, more importantly you should feel reassured that no serious side effects will occur.
The best way to think about testosterone therapy in women is that we are going to bring your testosterone levels back to where they were 20 years ago. With bio-identical pellet therapy, you’ll receive 100% natural therapy at consistent, safe levels.
Say goodbye to mood swings and the baby weight. Say hello to a renewed energy level and interest in sex. Maybe now you’ll be the one asking for sex and your husband will be saying “he’s too tired” and would rather snuggle . . . let’s be honest . . . that probably won’t happen.
But if it does . . . let’s get him some testosterone as well.
Happy health!
Dr. Pazona
