Women need testosterone too

Some facts

Testosterone, a hormone usually associated with being male, can be used to treat reduced libido in menopausal women. Testosterone supplements restored libido in some premenopausal women whose surgically removed ovaries forced them into early menopause. Testosterone is normally produced in small amounts by the ovaries and adrenal glands in premenopausal women. But during menopause, the ovaries’ production of hormones falls off — and that includes testosterone output.

Testosterone testing has come of age as increased testing for androgen deficiency in men and androgen excess in women has become popular.

Getting technical

Only about 2 percent of the total testosterone in the plasma of men is free or nonprotein bound; about 1 percent in women. In most men and women, more than 50 percent of total circulating testosterone is bound to sex hormone-binding globulin (SHBG), and most of the rest is bound to albumin. It is only the free or nonprotein bound testosterone which is the hormonally active form, able to interact with cellular hormone receptors.

Testosterone-bound SHBG is considered biologically inactive. SHBG levels are sensitive to changes in estrogen and testosterone. Thus conditions which affect SHBG will directly affect the serum levels and biological activity. Some interfering effects include:

• Decreased serum testosterone levels stimulate the production of SHBG by the liver
• Increased estrogen levels that occur in pregnancy or with estrogen replacement therapy also increase SHBG production
• SHBG levels can also be increased in patients with hyperthyroidism and liver disease
• Increased SHBG-bound testosterone can result in total testosterone levels in the normal range, despite a clinical deficiency of bioavailable testosterone
• SHBG levels tend to be low in androgen excess states, often resulting in total testosterone levels within normal limits and elevated bioavailable testosterone

It is important to check “free” hormone levels and not just total levels, since the free hormones are the only active ones. Saliva tests for hormone levels are also useful. Also, it is interesting that women going through menopause are usually given only estrogen and a progestin, but not testosterone. Since the ovaries are the main source of testosterone, as well as estrogen, menopausal women are just as likely to be deficient in testosterone as estrogen.

Excess testosterone in women

• First sign of androgen excess in women is the development of male pattern hair growth, which is referred to as hirsutism


• Women with more excessive androgen levels may also experience virilization.


• Many women with slowly progressive androgenic symptoms are diagnosed as having polycystic ovary syndrome (PCOS).

Drawbacks of testosterone treatment

Some researchers believe that this decrease in testosterone affects the menopausal woman’s sex drive. Testosterone treatment has drawbacks women should consider testosterone as a last resort. There are few long-term studies of the use of testosterone in women, and the potential side effects include acne, unwanted facial hair, oily skin, depression, irritability and irreversible deepening of the voice. Testosterone in pill form has been associated with lowered HDL cholesterol (the good” cholesterol), and liver damage is also a potential side effect. Natural progesterone cream should be initially tried as that will frequently restore libido levels after several months.

The danger here is significant. There is no question that testosterone is beneficial, but it rarely is required if one addresses the underlying hormonal imbalances. Testosterone levels become imbalanced when the adrenals are not functioning well. Measuring testosterone, estrogen, cortisol and DHEA levels are a useful way to diagnose the problem. One can use serum levels but there are many practical problems. The most significant one is the timing. Ideally one needs to measure cortisol levels one hour after arising, immediately prior to bed and in the late morning and afternoon. This will provide a cortisol rhythm that will show how dysfunctional the adrenal glands really are. Collecting these timed samples in a routine clinical practice is virtually impossible.

High levels of testosterone

High levels of testosterone interferes with insulin and the manufacturing and metabolising of glucose, thereby causing further weight gain in the upper body, creating more testosterone which further interferes with ovarian function. Thus the vicious cycle.

High testosterone levels has been linked to violence in female inmates. The study, published in the September-October, 1997 issue of Psychosomatic Medicine, measured testosterone levels in 87 female inmates at a maximum security prison. Their criminal behavior was scored from court records and their prison behavior was assessed from prison records and staff interviews. Researchers found that testosterone levels were related both to the violence of the women’s crimes and to the aggressive dominance of their behavior in prison. This finding was further supported by assessing how an inmate’s age corresponded to her behavior and testosterone levels.

As the hormone level decreased in older prisoners — testosterone declines with age — so did the aggressive dominance. But the study concluded testosterone, not age alone, was the significant factor; older inmates who had high hormone levels were not less aggressive or dominant. As the hormone level decreased in older prisoners — testosterone declines with age — so did the aggressive dominance.

The study’s findings indicate testosterone plays an important role in the female criminal population, but variables such as age, social factors and other hormones must also be considered.

Androgen therapy

Some members of the medical community have not embraced androgen therapy for women. Many physicians are reluctant to prescribe androgen because there are relatively few studies on women and testosterone. The long-term effects are unknown.

Critics point out that without long-term studies to support its efficacy and safety, testosterone should be used cautiously, if at all. That’s because it can have unfavorable effects on cholesterol levels, primarily decreasing HDL “good” cholesterol. This in turn tends to negate the positive effects of estrogen on the cardiovascular system.

Some also argue that fatigue and low libido can stem from any number of nutritional, medical or psychological conditions. Even androgen’s most fervent advocates agree that the hormone should be prescribed on a case-by-case basis to menopausal women who are otherwise healthy. They caution that this therapy is not appropriate for women of childbearing age. Not only do younger women produce sufficient androgen, but also excess levels can cause serious damage to a developing fetus.

The key, agree doctors, is to tailor dosages to the individual needs of women rather than providing a “one size fits all” prescription. This ensures that women can reap the benefits of this therapy without experiencing unwanted side effects such as masculinization, facial hair or acne.

DHEA alternative

A slightly “milder” alternative to testosterone is DHEA (dehydroepiandrosterone). This steroid hormone is a precursor of testosterone, meaning that the body converts DHEA into testosterone. Supplementary DHEA, which is available in pill or cream form, increases testosterone levels by one-and-a-half to two times. So it’s not surprising that DHEA provides many of the same therapeutic benefits, including increased sexual interest and enhanced physical and mental satisfaction.

If both testosterone and DHEA levels are depleted, women’s health pioneer Dr. Christiane Northrup, M.D., recommends replenishing DHEA. If DHEA, which can require about four months to work its magic, is insufficient, she recommends switching to testosterone. For those who choose testosterone, Dr. Northrup favors a natural version over those made from equine estrogens and methyl testosterone.

How does progesterone fit into the picture?

Progesterone is a steroid hormone, often referred to as a sex hormone. Steroid is a generic name for dozens of body regulators (hormones) made from cholesterol. Cholesterol, the basic building block for the steroid hormone, gives them all a similar structure. Switch a few atoms around and the role of the hormone can change dramatically. Without sufficient cholesterol, we can’t make sufficient steroid hormones. Some of the more familiar steroids are estrogen, progesterone, testosterone, the corticosteroids, and DHEA.

Progesterone is a precursor (or building block) to many other steroid hormones such as cortisol, testosterone and estrogen (estriol, estradiol, estrone). Because it is a modulator, its use can greatly enhance overall hormonal balance.

Our Network’s observation of women using combination hormone troches has been quite illuminating. We concluded that, rightly or wrongly, that if a woman learns to use progesterone successfully in conjunction with nutritional support, particularly phytosteriods, diet, and lifestyle modifications, and has intact ovaries, she does not necessarily qualify for hormone cocktails.

We argue along the lines that progesterone, being a precursor to other steriod hormones, will go on to building and balancing the other hormone naturally, in most cases. Very few women need estrogen replacement, and those that do are usually the osteoporotic or post menopausal women. Often if a women has had a hysterectomy, is post menopausal and her progesterone doesn’t contribute towards building testosterone through the steroid pathway then a little testosterone and/or estrogen can been of benefit.

Therefore, we suggest women work with one hormone first, monitor its impact on your body BEFORE you introduce other hormones into the equation. Because you might not need to supplement these hormones once you adopt a holistic approach to your health.