Sunday, August 31, 2014

To Use or Not to Use Testosterone: That Is the Question

Many women throughout life do not experience the sexual desire and responsiveness that they would like. Some will consider using testosterone (T), "the male hormone", to help them enjoy sex more. It frequently does help, but it doesn't work in isolation and it's not the only thing testosterone does for women. When searching the Web, its possible to find the occasional article about a woman who describes that her upper body strength got better, her balance and coordination improved, her attitude and ability to take on challenges returnedall after beginning testosterone therapy; however, most of the articles focus on enhancing sexual desire and responsiveness.

Testosterone is every bit as much a women's hormone as it is a man's hormone. Men have a small amount of estrogen; women have a small amount of testosterone. There's a reason for this. It benefits all of us. Women actually have much more testosterone in their bodies than estrogen. Testosterone is the building block from which humans make estradiolthe strongest estrogen in the body; however, if one were to count the number of molecules of testosterone compared to estradiol, women have a ten times more testosterone than estradiol. A small amount of either one is very potent.

When may women experience testosterone deficiency?
Some women never develop the ability to make sufficient amounts of testosterone. They will always be somewhat thin, have poorly developed muscles, dry skin, little or no body hair, and have an underdeveloped sex drive and sexual sensitivity. They may be very submissive and lack authority. They may also be anxious and have little self-assurance. They will tend to avoid sports and physical activities. They may have a higher childish voice and a smooth, thin, childlike face. They are testosterone deficient from puberty forward.

Many women develop testosterone deficiency later in life. This has many causes. It may be due to birth control pills, patches or rings, profound stress, surgical menopause (ovaries removed) or natural menopause in their early 50s. These women will notice that they are losing muscle bulk and strength, pubic hair, sex drive and sensitivity. They may be able to achieve orgasm, but it will be increasingly difficult, and they may experience significant itching or pain during sex. They may find themselves getting more passive, and they may lose interest in physical activity and the sports they previously enjoyed. They may become nervous and irritable, have lengthy bouts of depression, and begin to worry excessively. The fatigue pattern is all day long and gets worse with exercise; so many of these women avoid exercise. They are pale and fragile, appear older, and gain weight in their breasts, abdomen, and hips. And if that wasnt enough, they may develop more cellulite and varicose veins.

Laboratory Levels
It is important to get laboratory testing to document T levels. The normal range for serum total T is between 30 and 80 ng/dL.  But T levels have to be interpreted for the individual woman. Women who have had higher T levels for  decades will need higher testosterone levels when they start experiencing T deficiency. Women who have always had lower T levels may need just a little boost in their testosterone level in order to feel normal again.

Historically low T women may only need a level between 20 and 40. Chronically high T women may need to be in the 75-100 range.

A physician also needs to determine the level of sex hormone binding globulin (SHBG). This is a protein that binds to and carries testosterone and estradiol in the blood. The amount of testosterone or estradiol that is not attached to SHBG is the free estradiol or the free testosterone, respectively. Only free T molecules are available to stimulate the cells. The total testosterone measures both the free and the bound testosterone. So, if SHBG is high, less estradiol and testosterone will be delivered to the cells. This is how birth control pills work to get rid of acne. They contain a strong chemical estrogen that raises SHBG that then binds up natural testosterone. This eliminates acne and, sometimes, sex drive and sexual responsiveness.

On the other hand, as menopausal womens estrogen levels drop, the ovaries frequently continue to produce some testosterone. As estrogen drops so does SHBG, thus more testosterone is released from SHBG to activate the cells. This is why some women get more facial hair and begin losing hair on the top of their head and at their temples as they progress through menopause.

Beyond Sex
While experts on the Web talk about sexual function as the primary benefit of testosterone replacement, testosterone does many wonderful and critical things for a woman's body. Testosterone stops hot flashes and night sweats. Testosterone is necessary to build bone. Estrogen preserves the bone that a woman has, but testosterone and progesterone strengthen bone. Testosterone builds muscle and enhances coordination. It gives women vitality, self-confidence, self-esteem, and the ability to embrace lifes challenges.  It corrects urinary incontinence. Many integrative doctors have witnessed that testosterone and other androgens reduce a womans risk of osteoporosis, depression, atherosclerosis, anxiety, and arthritis.