Testosterone Replacement in Women - Should I Raise My "T"?
What is Testosterone?
Testosterone belongs to a group of hormones known as androgens and is often thought of as the male sex hormone that gradually decreases with age. One of the main consequences of “low T” in men is a declining sex drive, also known as libido. As a result, men may be treated with FDA-approved testosterone products to improve their sex drive and also other symptoms.
While males have more testosterone than females, women do require a certain amount of testosterone, as it is important to women’s sexual health. Female adrenal glands and ovaries produce small amounts of this hormone in order to make estradiol, a form of estrogen. The main reason why some women are interested in taking testosterone is for improvement of sexual function. It also may improve muscle strength, bone density, and mood although this remains controversial. Unfortunately, no testosterone products are currently FDA-approved for women.
Causes of "Low T"
The two main causes of low testosterone in women are (1) diminishing levels of the hormone as a result of menopause and aging, and (2) problems with the ovaries, the pituitary gland, or the adrenal glands.
As women age, testosterone levels decrease, along with other hormones such as estrogen. This is because around the time that menopause begins, the ovaries are producing fewer hormones. Furthermore, a woman may have reduced levels if her ovaries have been removed or if she has adrenal insufficiency.
It is important to keep in mind that there are many factors that can lead to a loss of libido. Some of these include chronic pain (including headaches), depression, fatigue, stress, relationship issues, lack of adequate stimulation during sexual intercourse, menopausal symptoms such as vaginal dryness and thinning of the vaginal lining, thyroid problems, and medication side effects. Of course, these should be addressed and treated (if possible) before considering testosterone replacement.
Symptoms of "Low T"
In women, levels of testosterone affect fertility, sex drive, red blood cell production, muscle mass, and fat distribution. Symptoms of low testosterone can cause one or more of the following symptoms:
- Muscle weakness
- Weight gain
- Fertility issues
- Irregular menstrual cycles
- Sleep disturbances
- Reduced sex drive
- Decreased sexual satisfaction
- Vaginal dryness
- Loss of bone density
Treatment of "Low T"
Some estrogen products used for hormone replacement therapies (HRT) in women contain testosterone. However, the quantity in these products may not be enough to raise testosterone levels or for the body to absorb them sufficiently. Some women try an over-the-counter supplement or gel form of DHEA, a hormone that the body converts into both female (estrogen) and male (androgen) hormones. However, evidence of DHEA’s effectiveness in treating sexual problems in women is mixed. Some women ask their doctors for a "quick fix" they’ve heard about on TV or online such as testosterone injections, patches, or pellets.
Testosterone Use in Women
Some studies of postmenopausal women have found that taking testosterone, often in addition to the HRT already prescribed to treat symptoms of menopause, slightly increases sexual drive and pleasure compared to placebo. However, most of these studies were short-term and only lasted six months, making the long-term safety of testosterone in women unknown.
Testosterone therapy might be appropriate in women:
- With reduced sex drive, depression, and fatigue after surgically-induced menopause with no relief of symptoms from estrogen therapy
- That are postmenopausal and still experiencing low sex drive despite estrogen therapy and no other identifiable causes
Side Effects of Testosterone
At high doses, testosterone can have negative effects. These include acne, deepening voice, hair growth on the face and chest, lower HDL ("good" cholesterol), and male-pattern baldness. Although it has not been proven, there is also some concern that testosterone can lead to the development of breast cancer and heart disease.
Personalized Compounded Therapies
While there are many commercially available estrogen and progesterone HRT products for women, none are currently FDA-approved for testosterone. However, compounded therapies are advantageous in this regard since they can be individualized for each patient. For example, very small increments can be made in order to alleviate menopausal symptoms while minimizing side effects associated with testosterone. Furthermore, while the hormones used in commercial HRT products are derived from horses, the ones used in compounded products have the exact same chemical structure of the body’s natural hormones.
The majority of compounded HRT products are in the form of creams, troches, or capsules. It is important to keep in mind that as with many compounded medications, there are not many large studies on the efficacy of these products. Nonetheless, compounding pharmacists continue to be a valuable resource for many patients.