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Testosterone: What You Should Know

Testosterone is a hormone found in men and women of all ages. Women typically have levels of testosterone between 1/10 and 1/20 of that found in men. In women, androgens like testosterone work in concert with estrogen and progesterone on receptors found throughout the body to affect reproductive tissues, cognition and mood, breasts, bone, muscle, blood vessels, skin, hair, and other systems. Other hormones in the androgen family that can be found in women include dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione, and dihydrotestosterone.

Testosterone is produced in both the ovaries and adrenal glands. As a result, even after menopause, testosterone levels do not rapidly decline like progesterone and estrogen. Instead, the decrease in testosterone and other androgens is progressive throughout a woman's life until it rises again a slight amount after age 70. The reduction is age-related, not menopause-related. The primary source of testosterone before and after menopause is the adrenal glands, but even though the ovary stops releasing eggs after menopause, the tissues around the ovary (specifically an area called the theca) continue to make testosterone and other androgens because their production is driven by luteinizing hormone (LH) levels, which are steady and not fluctuating, as well as higher than during reproductive years. As expected, women who had their ovaries removed have lower levels of testosterone.

Testosterone is not part of menopause hormone therapy (MHT). Studies do not support that testosterone is an effective treatment for hot flashes, night sweats, depression, mood changes, osteoporosis, or cognitive changes.

The only evidence-based indication for testosterone therapy for women is for the treatment of hypoactive sexual disorder (HSDD). That conclusion is supported by major endocrine, gynecology, sexual health, and menopause professional societies. Blood testosterone levels are not a reliable way to diagnose HSDD since many women with low systemic testosterone levels do not complain of distressing low libido or other symptoms. Similarly, some women with higher testosterone levels suffer from low libido. Compounding matters, most laboratory tests are not sensitive enough to measure the low levels of testosterone in women. Before starting testosterone therapy for HSDD, all women should undergo a thorough examination so that causes of HSDD like medication side effects, mood disorders, relationship concerns, or the genitourinary syndrome of menopause (GSM) can be addressed first.

There are no FDA-approved testosterone options for women, but doctors can prescribe it off-label, at a much reduced dose (approximately 1/10 of the dose for men.) I often have Testosterone prepared by a compounding pharmacy due to the lack of availability of this medication. This method of prescribing is supported by the Global Consensus Statement for females. The best way to use testosterone is transdermally (via patch, cream or troche) because it causes fewer negative effects on the liver and cholesterol than oral preparations. Because high levels of testosterone can cause potentially irreversible side effects in women, like enlargement of the clitoris, head hair loss, body hair growth, acne, and deepening voice, your doctor should discuss testin your testosterone levels regularly to ensure you are not receiving a dose that exceeds normal physiological levels. Injections and subcutaneous implants (pellets) should be avoided because they can result in extremely high levels of testosterone that cannot be counteracted. Further, it can take as long as 6 months before your levels return to normal. Every relevant medical association advises against using testosterone pellets.

Although vaginal estrogen is the most effective treatment for vaginal atrophy, itching , and pain during menopause, vaginal DHEA, which is an androgen, also has shown efficacy in reducing symptoms. However, some studies have found no statistical difference between vaginal DHEA and vaginal moisturizers lacking DHEA. Prasterone (Intrarosa), a DHEA variant, is the only FDA-approved non-estrogen vaginal treatment to"treat moderate to severe pain during sexual intercourse caused by changes in and around the vagina that happen with menopause." Women using vaginal DHEA do not have to have their androgen levels monitored since studies show that it doesn't increase systemic levels significantly. I typically recommend that my patients with menopausal vaginal symptoms start treatment with a non-prescription vaginal moisturizer like Bezwecken Hydration Ovals 2X Plus that contains cocoa butter, vitamin E, and beeswax mixed with low doses of DHEA and estriol. Bezwecken also sells moisturizers without DHEA or estrogens. If symptoms are not fully relieved, I switch them to vaginal estrogen or prasterone..

In summary, testosterone is a type of hormone called an androgen. Although levels of testosterone are much higher in men, women produce testosterone throughout their lives, and it has physiological impact on many body systems. The decrease in testosterone in women is age-related, not menopause related like estrogen and progesterone, primarily because most testosterone in women is made in the adrenal gland. There are two primary uses for menopausal women of prescription androgens - testosterone for HSDD and vaginal DHEA for vaginal symptoms. In both cases, it is preferable to use FDA-approved drugs instead of compounded ones to ensure efficacy and safety.

Disclaimer - Information on this website is provided for informational purposes only. The information is a result of years of practical experience and formal training by the author. This information is not intended as a substitute for the advice provided by your physician or other healthcare professional or any information contained in any product label or packaging. Do not use the information on this website for diagnosing or treating a health problem or disease, or prescribing medication, or other treatment. Always speak with your physician or other health care professional before taking any medication or nutritional, herbal, or homeopathic supplement, or using any treatment for a health problem. If you have or suspect that you have a medical problem, contact your healthcare provider promptly. Do not disregard professional medical advice or delay in seeking professional advice because of something you have read on this website. Information provided on this website and the use of any products or services mentioned on this website by you do not create a doctor-patient relationship between you and any of the physicians affiliated with this website. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.

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