Explaining the difficulties and challenges female patients can face when discussing testosterone replacement with their doctor.
Changing the beliefs of anyone, especially people who believe they are experts in their field, is an amazingly difficult task, especially when the new information clashes with society’s gender ideas. In medicine we battle this truism every time new information comes to light that advances the overall practice of medicine to treat conditions that have not been conquered or ignored up to now.
The last 25 years or more has been the dawn of knowledge about gender differences in medicine. Integrally knitted into the middle of this process is the finding that women make testosterone from their ovaries, like men make testosterone in their testes. This new truth has men worried about their own identity and it flies in the face of the baseless beliefs that Testosterone is a “man’s hormone” , that only men have a sex drive, that only men are stimulated by visual cues, and that testosterone levels determine the level of sex drive in women, not estrogen!
Today we are going to talk “heresy” to those men and women over 40 who have believed throughout their lives that men are superior in every way because they make testosterone, and women don’t. We do make testosterone, and although our genetics cause us to use it differently than men, due to our receptor site programming, we make 3 times as much testosterone as we make estradiol and that means testosterone is women’s dominant sex hormone when we are young and fertile.
For women presenting with androgen (testosterone) deficiency, in contrast, the symptoms are often not pathognomonic solely for hypoandrogenism, but can have diverse etiologies, including psychiatric or psychosocial causes. Another difference between hyperandrogenism and hypoandrogenism states is that the medical community universally accepts hyperandrogenism as a distinct clinical entity, whereas many clinicians question the validity of hypoandrogenism as a specific diagnosis. Instead, it is often believed that other etiologies can explain symptoms of low sexual desire and other sexual dysfunctions, a decline in quality of life, including loss of energy and motivation, and other physical symptoms (e.g.,
reduction in muscle mass). In addition, unlike other hormonal measurements, the sensitivity of testosterone assays has not been consistent in the female. Although, in light of these assay difficulties, controversy also exists regarding the range of normal androgen values for women and, therefore, whether there is an absolute level at which female androgen sufficiency exists.
Bachmann. Pathophysiologic overview of hypoandrogenic woman. Fertil Steril 2002.
Many research papers in the Journal of Fertility and Sterility have the best explanations about the fact that women make testosterone and how they use it. The following list from F&S article on “Androgen Deficiency in Women” reveals the vital role testosterone plays in women’s bodies.
Androgen insufficiency = Reduced
Sex motivation
Sex fantasy
Sex enjoyment
Sex arousal
Vaginal vasocongestion
Pubic hair
Bone mass
Muscle mass
Quality of life
Mood
Affect
Energy
Androgen Insufficiency= More frequent
Vasomotor symptoms
Insomnia
Depression
Headache
Bachmann. Pathophysiologic overview of hypoandrogenic woman. Fertil Steril 2002.
However, one of the “labeling mistakes” medical researchers and doctors make is to refer to testosterone interchangeably with “androgens”. Testosterone is an androgen, but not all androgens are testosterone. Testosterone is only made in the ovaries of women and testes of men, and androgens are from both the ovary and the adrenal gland in humans. When we treat women, we don’t use adrenal steroids to make women better when they have an androgen deficiency, because adrenal androgens have many side effects when given to women, including suppression of all of the other activities of the adrenal gland. We use pure testosterone, which is what the ovary produces until menopause. The ovary shrinks and literally dies and cannot be revived at or before menopause, usually around age 40. I replace what is missing in women over 40—testosterone, and after menopause both testosterone and estradiol, the young woman’s estrogen.
Testosterone literally affects every system in the female body. The loss of testosterone has a global impact on the lives and health of women. The most common alterations associated with low testosterone levels in women include a decline in sexual functioning such as decreased sexual motivation, loss of ability to fantasize, and decreased enjoyment from sex, diminished sexual arousal, and decreased vaginal vaso-congestion (vaginal swelling) in response to erotic stimuli. Testosterone deficiency also causes a loss of pubic hair and underarm hair, increased hot flashes and flushing, insomnia, loss of bone and muscle mass, loss of muscle and increase in fat, increased incidence of depression, anxiety and migraine headaches, and a general testosterone deficiency causes a diminution of quality of life.
Thus, you can see the importance of tracking and replacing testosterone in women, particularly postmenopausal women. At BioBalanceHealth® we are committed to making these distinctions so that we can treat the issues women have and up to now has been ignored by current medical practice. Women face many inequities in medicine and life, and I am determined to bring the need for testosterone replacement to women so they can demand treatment for the core problem they encounter after age 40, instead of getting multiple meds that just treat symptoms.
This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC.,Family Counselor, Presenter and Author. www.BioBalanceHealth.com.
