How do doctors decide when to start testosterone treatment in women?
I only diagnose women with testosterone deficiency (TDS) only when they have both symptoms and low blood levels of free (active) testosterone. Prior to the first appointment, I evaluate a new patient’s lab work and medical history before I meet with them. This process allows me to make logical medical decisions without pressure from patients who want testosterone even if it is not medically necessary for their particular problems. When I see new patients, I make sure both of us make the most of our time and their money. As with everything in medicine, I not only look for and diagnose the hormone deficiency I am looking for other illnesses that may masquerade as testosterone deficiency, and for those patients, I meet with them but give them the option to see their primary care doctor about the other diagnoses but don’t treat them with testosterone unless that is also evident.
For those women who do need testosterone, I choose only to treat them with bio-identical testosterone pellets because it is the most effective and least likely to cause side effects, than the other forms of testosterone. Prior to founding BioBalance Health LLC in 2002, I had been treating my patients with a variety of other delivery systems for bio-identical testosterone, with limited results, and many side effects. When I discovered the amazing outcomes with testosterone pellets, I decided to my repertoire to T pellets only.
Symptoms of testosterone deficiency are individually discussed in our book, the Secret Female Hormone, but in my office I look for three or more symptoms of TDS: Loss of libido, fatigue, loss of muscle mass and exercise stamina, migraine headaches, memory loss, depression, anxiety, belly fat and weight gain, muscle and joint pain, and insomnia. Because these symptoms can be caused by various other medical conditions, I also look for age of onset, loss of ovaries from menopause or surgery, and other endocrine disorders that may cause low testosterone.
Then I review the lab results of a potential patient. The most important lab tests that I order are free testosterone, estrone, estradiol, FSH and LH levels. None of these levels will be called “abnormal” even if they are inadequate to prevent the symptoms of TDS. There is so much controversy over what the normal is for women, that the free testosterone levels are based on the average levels for the woman’s age. Because testosterone decreases with age, the level of testosterone when we are over 40 is not adequate, so the printed level is not a “healthy” level but a low “average” level.
In addition to the free testosterone level, other hormonal abnormalities affect the free testosterone levels, and are important to adjust them when treating TDS. Normal levels of the hormones, prolactin, 8 am cortisol, thyroid free T4 and free T4, as well as TSH and reverse T3, are important to women’s well-being as we age. Knowing the normal young healthy levels of all hormones that decrease with age, are critical to diagnosis of TDS.
Unlike men, it is difficult to stimulate the production of testosterone after 40 with supplements, and exercise than it is in men. Our ovaries actually stop producing testosterone long before menopause, and leave all androgen production to the adrenal glands. Adrenal androgen hormones do not attach to the testosterone receptors and do not produce the same youthful qualities as ovarian testosterone. In reality ovarian testosterone increases the production of adrenal estrone which makes women feel old and impairs metabolism and energy.
Another difference between how women and men experience TDS, is the age that we develop symptoms of the deficiency. Women lose their testosterone and become symptomatic about ten years before men. More importantly, women cease to make ovarian testosterone in any significant amount but men never stop producing testosterone completely, and therefore may maintain an adequate level into their 60s by continuing optimal exercise, good diet and ideal weight management. Women rarely are able to “manage” their ovaries as well as men do their testicular function.
If you are a woman under 40 years old and are becoming testosterone deficient, the best plan is to replace it so you can get on with your life, and remain as healthy as possible. If you are younger than 40, and are experiencing the TDS symptoms then the following methods will help you maintain your testosterone levels as long as possible and delay the symptoms:
- Trade your BCPs in for a Mirena IUD which will increase your testosterone production, and decrease the abnormal bleeding that sometimes comes with loss of regular progesterone that also decreases with age and stress.
- Exercise aerobically at least four days a week. The more vigorous the better.
- Decrease carbohydrates in your diet and increase protein and fresh fruit and vegetables.
- Eat 6 small meals a day, decreases SHBG. Eating only one meal a day increases SHBG and binds up testosterone.
- If you are low on thyroid please replace it.
- Try to achieve your ideal weight.
- Manage stress with prayer, yoga, exercise, or creative activity.
Once your have irreversibly stopped making testosterone, are over 40, or if you have had your ovaries removed then having your testosterone replaced in the ONLY way to get your life back to normal.
