Dr. Rebecca Dunsmoor Su Weighs in on Testosterone Therapy in Menopause
We at Gennev get a lot of questions about testosterone levels in menopause and testosterone therapy. Women are (rightfully) confused as some providers tout it as the missing link, and others are giving them dire warnings. Is the truth somewhere in between?
Yes and no. First, I think it helps to know a bit about testosterone in menopause and what happens. And as I often counsel patients to “know your sources” when it comes to health information I will tell you who my sources are:
- North American Menopause Society (NAMS) and their clinicians guide as well as position statements
- The International Society for the Study of Women’s Sexual Health (ISSWSH) and their position statement on testosterone use in women
- The Global Position Statement on Testosterone use in women from the International Menopause Society and endorsed by the organizations above as well as all major menopause organizations
Why do I tell you this? Because these organizations have huge panels of research along with physicians who analyze all of the available data to make recommendations. They have no vested interest and make no money from their recommendations.
First, physiology: What happens to testosterone in women? It is an important hormone, but is at a relatively low level compared to men. In women and men testosterone gets lower over time at a slow steady pace. There is no sudden change in testosterone at menopause. We know this by testing and because we see a big drop in testosterone if women have their ovaries removed, even after menopause. It is also good to know that testosterone is made by ovaries, but also the adrenals, and some is made in the “target tissues” such as the vulva and breasts.
It is also important to know that the general testosterone levels sent to a lab are not sensitive enough or reliable enough at female levels to be useful. They may show no testosterone. This isn’t diagnostic and is unrelated to wellbeing or sexual function. There are much more sensitive tests, but most doctors don’t know to send them and they are hard to find.
Many people advertise testosterone therapy as a “fountain of youth” or “great for weight loss”, “improve your sex drive”. Testosterone is an anabolic steroid. It is banned in sports. Why? It does temporarily increase performance, but you require more and more to maintain effect and as the levels go up it has cardiovascular harm. What other side effects do women see with too much T?
- Chin hairs or beard growth
- Hair loss
- Deepening of the voice (this does not go back after stopping T)
- Clitoromegaly (the clitoris grows into a small penis, this also doesn’t go back)
- Increased LDL and lower HDL
- Possible increased heart disease and death
Is there a role for T in women? Yes, sometimes. There are small studies showing short term low dose T with careful monitoring can improve sexual function in postmenopausal women. It showed an increase from 2 to 3 sexually satisfying encounters per month.
As there is no safe and FDA regulated women’s dose T in the US, this has to be done in person with an experienced provider using male products or compounds (not our favorite at Gennev) with every 3-6 month blood levels to be safe. T is also a controlled substance so you need a local doctor with a DEA license to prescribe it. The biggest bang for the buck in terms of sexual function is to use books such as A tired woman’s guide to passionate sex by Dr Laurie Mintz and apps like our friends at Rosy to work on the underlying issues behind the loss of desire.
The last caution I would give is to stay far, far away from pellets for T (or any hormone). These are unregulated compounds with a lot of problems and reported cancers, which the FDA has warned against using. The levels of T from they tend to be very high and we see a lot of side effects. The people who sell them promote them as safe and effective, but really all they are is a money maker.
I hope that helps to explain testosterone in women. We are always happy to talk about it at Gennev, but it would be inappropriate to prescribe this via telemedicine. If you think you might need testosterone therapy, the NAMS physician finder can help you find a local NAMS certified physician to discuss it with.
We can help you get answers about menopause therapies
- Meet with a Gennev Doctor - our board certified gynecologists are menopause specialists who can help you understand your symptoms and their impact on your overall health and wellness, and prescribe the therapies that support your needs
- Partner with a Health Coach to learn about actionable lifestyle solutions that can help relieve many menopause symptoms
- Vitality –our most popular supplement is a nutrient-packed multi-vitamin that supports mood, energy, stress response, immune health, joint pain, and inflammation
The information on the Gennev site is never meant to replace the care of a qualified medical professional. Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev's telemedicine doctors before beginning any new treatment or therapy.
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