If you thought Testosterone was only a male hormone, then think again! Although typically thought of as a male hormone, women also produce testosterone (T), but in much smaller quantities. an androgen hormone, is produced in the ovaries of women, as opposed to the testes in men. The adrenal glands also kick in a small amount in both sexes. The majority of testosterone produced in the ovaries is converted to estradiol, the biologically active form of estrogen, by a process known as aromatization. This process is named after the chief enzyme, aromatase, which facilitates the conversion to maintain homeostasis.
Symptoms of Low Testosterone in Women
Symptoms of low T in females can often be overlooked and unfortunately most doctors do not test women for this important hormone since it is not considered an immediate health risk.
1. Bone Loss
Testosterone, in tandem with estrogen, vitamin D, vitamin K, minerals and other hormones helps to modulate bone loss. As a woman, it is especially important to reduce the risk of osteopenia or osteoporosis (1). Women with osteoporosis are more susceptible to bone breaks and fractures which can cause severe complications especially in older patients. Bone loss in the face also occurs with the aging process. A testosterone deficiency may accelerate this bone loss and result in premature aging of the facial structures as illustrated in the figure below:
2. WEIGHT GAIN & DIFFICULTY LOSING WEIGHT
Most doctors look to the thyroid when weight gain is an issue for women. Although this must be addressed, it often overshadows other hormone imbalances, including low testosterone, high estrogen and insufficient progesterone. Muscle mass burns more calories fat and keeps the metabolism in check, so a decrease in lean muscle tissue can lead to weight gain if the diet and exercise are not changed accordingly. Women with diminishing testosterone levels also experience changes in muscle tone and bone density, which can have a significant impact on the appearance and character of the body. These symptoms usually start to appear when women are in their mid-30s, but all too often, they’re chalked up to simply being a part of getting older when in fact, they are treatable and in many cases, reversible(3). Body toxins such as plasticizers, heavy metals and environmental toxins should also be evaluated for their known endocrine disruption properties.
3. DEPRESSION & MOOD SWINGS
Unexplained mood swings, sustained low mood and even bouts of depression are linked to low levels of testosterone. This hormone helps with mental focus and mood stabilization, and motivation so it is of no surprise that these symptoms can be misdiagnosed and treated with antidepressant medication (4)
4. LACK OF ENERGY
The body’s energy systems are rather complicated and a single “smoking-gun” is often not the case. If you struggle to get through your day, have a hard time getting out of bed or feel exhausted after activities that normally don’t cause fatigue, Testosterone deficiency may be to blame. Of course you should have a thorough examination and testing of the adrenals, thyroid and mitochondrial dysfunction also, but low testosterone often goes undetected in women.
5. LOW LIBIDO
Although low libido is most commonly associated with low testosterone in men, woman experience more sudden and extreme sexual changes. These may include reduced libido, vaginal dryness, and a general disinterest in sexual relations. But there is a solution as Dr. Davis states: “It is the clinical experience of the author that a subset of pre-menopausal women with sexual dysfunction and reduced circulating androgen [T] levels significantly benefits from judicious parenteral testosterone replacement.”
What are the Side Effects of Excess Testosterone?
If testosterone is included in your hormone replacement program, it is is important to start low and go slow. Fortunately, since the dosage in women is much less than men, when given proper dosages of testosterone, there are very rarely any negative side effects. Excessive testosterone can cause acne, body hair growth and scalp hair loss in women. Excessive testosterone supplementation, such as with anabolic steroids used by athletes, also tends to drop high-density lipoprotein cholesterol levels (HDL), the “good” cholesterol. Lower HDL levels increase the risk of heart disease. If you’re experiencing any of these symptoms, the next best step is to consult with your doctor or consult with us. We’ll discuss your symptoms, check your levels and determine if testosterone or bioidentical hormone replacement therapy is right for you.
What are the Treatment Options for Low T?
1. Take a deep dive into potential causes.
There are many reasons why you may have low testosterone. Through a functional medicine approach, we do a thorough investigation into your body systems from. This may range from diet, exercise and stress management, identification of endocrine disruptors such as heavy metals, mycotoxins (mold), glyphosate and phthalates – to functional nutrient deficiencies and adrenal gland dysfunction.
2. Testosterone Replacement
We offer three testosterone replacement programs in our office. Testosterone replacement in women is often, but not always, done in conjunction with bio-identical progesterone and estrogen replacement therapy.
Cream, Injections and Pellets. Which Method is Best?
Each format of replacing hormones has their benefits and disadvantages. We discuss the most common below.
Topical Creams or Gels
- Non-invasive. No need to worry about needles as these are applied directly to the skin
- Convenience. Easy to travel with. Fits into cosmetic bag/pouch. No need for refrigeration.
- Easy to use. This format is dispensed in a clicker format. Simply turn to the prescribed number of clicks and apply to the skin.
- Messy. Topical creams and gels can get a little messy. It is essential to make sure that the compounded medication is rubbed into the skin well for absorption.
- Accidental Transmission. Since these are applied topically, they can be transferred to unwanted recipients such as children or a spouse. Thorough handwashing after application is necessary.
- Weekly Dose. No need to apply topically every-day like creams or gels. Injections are done into the muscle (usually the glute) once per week.
- Flexible Doses. The delivered dose of testosterone is easily able to be changed.
- Reduced need to Estrogen. In most cases, testosterone aromatizes to estrogen without the actual need for estrogen. This mean one less hormone to take.
- Invasive. Injections obviously involve a needle. For some people this is not an acceptable method.
- Availability. Few pharmacies offer testosterone at female dose concentrations. With higher dose concentrations that men typically take (100mg or 200mg/ml), a small error in volume injected can mean a big difference in delivered dose. Fortunately, we have 2 that we source from at either 20mg or 25mg/mL which significantly reduces this potential error.
- Low Frequency Treatments. On average, the procedure is only required 3 times per year. Pellets for most of our female patients lasts for 4 months before needing to be replaced.
- Convenience. No daily or weekly applications are required. This is a one time procedure every 4 months or so.
- Cost. This is the cost effective testosterone replacement treatment option we offer.
- Unable to Change Dosage. Once the pellets are inserted below the surface of the skin, they cannot be taken out. If too much testosterone is
- Invasive. The sterile pellets are inserted below the surface of the skin. Therefore, a small incision is made and may leave a small scar.
- Downtime. For a period of 10-14 days post procedure, it is not recommended to lift heavy weights, squat or soak in a bathtub or hot-tub.
If you would like to schedule an appointment to have your Testosterone levels checked, please give us a call at (305) 448-2600
- National Osteoporosis Society. https://www.nos.org.uk/healthy-bones-and-risks/~/document.doc?id=1368. Accessed September 23, 2016.
- Androgen replacement in women: a commentary. Davis, S. J Clin Endocrinol Metab. 1999 Jun;84(6):1886-91.
- Exogenous androgens influence body composition and regional body fat distribution in obese postmenopausal women—a clinical research center study. Lovejoy JC, Bray GA, Bourgeois MO, et al. J Clin Endocrinol Metab. 1996 Jun;81(6):2198-203.
- “New insights on hormones and mood” Elizabeth Lee Vliet, MD; Menopause Management, June/July 1993.