Why Women Need Testosterone

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TweetNumerous studies show that maintaining youthful blood testosterone levels in aging men confers such anti-aging benefits as improved muscle mass and strength, prevention of insulin resistance and Type II diabetes, improved libido, reduced heart attack and stroke risk, improved bone density, reduced waistline girth and body fat levels, improved exercise performance, and improved recovery from physical training.

In men with existing coronary heart disease, testosterone improves heart muscle function, relieves angina pectoris symptoms and prevents recurrent coronary events. In addition, over 30 referenced articles have been published since the 1940′s showing testosterone replacement has powerful anti-depressant effects in men and women.



Aging women have a precipitous drop in estrogen at the time of menopause. However, as many as 10 or more years before the ovaries begin to shut down, there are significant gradual declines in both progesterone and testosterone. Both are rarely measured in the course of normal physical examinations, yet both have extremely important roles in preventing the epidemic of estrogen-dominant diseases in the USA (reproductive and breast cancers, autoimmune diseases, reduced bone density and osteoporosis, reduced libido and sexual insensitivity).

Testosterone in particular has a very similar role in the female body as it does in men and has been largely ignored in our alpha male world. This article will discuss the role of testosterone in the female body, what causes low testosterone levels and simple replacement strategies to restore youthful levels in women. We feel routine measurements of estrogen, progesterone, testosterone and DHEA along with Vitamin D should be part of every periodic physical examination starting at age 20 and every 5 years thereafter.The importance of measuring testosterone correctly and intervening with bioidentical testosterone replacement no matter what age when deficiencies are identified will be discussed. Being young is no guarantee that one’s hormone levels are youthful.

Benefits of Testrosterone Therapy in Women
While it is well known that a surge of testosterone production in the testes brings about changes that lead to manhood, less well known is that women also produce testosterone in their ovaries and adrenal glands at about 1/10th the level that men do. Testosterone level peaks in the 20′s just as it does in men, and gradually fades away thereafter with each decade as does another adrenal hormone, DHEA. More and more evidence over the last decade has suggested testosterone is a very important hormone in women, especially in terms of staying fit, lean and sexually active.

A double-blind placebo controlled study of 75 women aged 31 – 56 who underwent hysterectomy and bilateral oophorectomy (ovary removal) found dramatic decreases in circulating testosterone levels. Over 12 weeks, the women were given a placebo patch, a patch containing 150 mcg of testosterone or a patch containing 300 mcg of testosterone. It was found the 300 mcg dose made significant improvements in sexual function, mood and general well being. Many women have also found testosterone improves cognitive function and helps them compete more effectively in a male dominated corporate world.



Perimenopause and menopause create the same kind of decrease in testosterone levels as hysterectomy albeit more gradually over a period of a few years. In the years before menopause and in spite of normal monthly cycles, or cycles with varying degrees of progesterone insufficiency (irregular periods, sore breasts, increased PMS, heavy bleeding, cramping etc.), many women also have reduced testosterone levels and feel less energetic, weaker and have a reduced libido much to their chagrin and that of their husbands.The reasons for reduced testosterone production in younger women involve a dysfunction of the ovaries and adrenal glands. For reasons not completely understood, but probably related to our increasingly toxic xenoestrogenic environment, we see more women of younger ages in our clinic with low testosterone levels, even as young as 18 years old! (xenoestrogens are chemicals that have quite similar chemical structures to estrogen and include virtually all pesticides, fungicides, herbicides and many soft plastics).

Testosterone seems to be quite important in maintaining a woman’s energy level and sense of well being regardless of her age, and low levels can diminish motivation, induce fatigue and contribute to a low libido. Most all women with sexual dysfunction and lack of libido with low testosterone levels will benefit from restoration of adequate blood free testosterone levels via a topically compound cream. Women who exercise regularly will also experience what men do when they train and exercise…….improved fitness, energy and recovery. Published studies have also shown obese women given testosterone or an analogue of it called nandrolone lose more bodyfat and subcutaneous abdominal fat while gaining muscle weight.

Disruption of Testosterone Usage
Another factor contributing to low bioavailable testosterone levels is the presence of higher levels of sex hormone binding globulin ( SHBG). As its name implies, SHBG is a protein transporter in the bloodstream that “ties up” hormones in order to transport them to other parts of the body. Up to 99% of testosterone produced is bound to SHBG and this makes it inactive. Only unbound ”free” testosterone that is not attached to SHBG is biologically available and is able to act on cells throughout the body. Therefore measuring total testosterone without measuring free testosterone is not an accurate assessment of one’s testosterone level and is essential to assess true testosterone status. This is true for men as well as women.

Other factors that can increase SHBG levels and tie up testosterone include:

- Oral estrogen including birth control pills, or synthetic, non-bioidentical estrogen replacement like Premarin
- Increasing age
- Alcohol
- Smoking
- Some anticonvulsant medications
- Pregnancy
- Reduced liver function

Bio-identical estrogen administered through a cream or gel does not raise SHBG levels and will allow testosterone levels to be optimized. Other drugs that reduce sexual desire independent of testosterone levels are the antidepressant drugs in the SSRI and tricyclics family, synthetic progestins (Provera), Clonidine (anti-spasmodic), Spironolactone (diuretic), Danazol, Benzodiazepines (valium), beta blockers, H2 antagonists like Prilosec, Ketconazole (antifungal) and gemfibrizol (lipid lowering) to name a few. Adding these drugs to a women’s regime with an underlying low free testosterone will pretty well squash one’s desire for sex. Fortunately these factors can be changed and testosterone levels optimized very easily and safely.

Does Testosterone Inhibit Breast Cancer?
It has been postulated for some time that estrogen contributes to breast cancer risk. That myth was laid to rest in a previous article we wrote which showed bioidentical estradiol and/or estriol have never been shown to cause breast cancer, only synthetic non-bioidentical drugs such as Prempro do. Since exogenously administered testosterone can raise estradiol levels via conversion in the fat cells by the aromatase enzyme, some researchers have proposed testosterone replacement may increase breast cancer risk. Several studies have found this is NOT the case and in fact, testosterone by competing with estrogen at receptor sites can inhibit breast cancer cell growth. One study looked at the effects of testosterone and tamoxifen (a widely used estrogen receptor blocker used to treat breast cancer) on breast cell stimulation. It was found testosterone inhibits growth stimulated by estrogen. Another study also found testosterone inhibits breast cell growth and has beneficial progesterone-like benefits to the uterus.

Other research suggests testosterone administered to women with a hysterectomy dramatically reduces cardiovascular disease risk which is three times higher in these women than those with a normal menopause. Of course, testosterone stimulates bone building and mass dramatically when combined with weight bearing exercise, progesterone and estrogen if need be as an excellent alternative to risky bone stimulating drugs such as the bisphosphonates and SERM’s (selective estrogen receptor modulators). We once treated a 45 y/o female bodybuilder who had used testosterone derivatives on and off for over 20 years. Her bone density was 3.0+ and she was an extremely healthy vigorous woman. Conversely, we have prescribed testosterone for a woman as old as 92 to help combat frailty and bone loss with excellent results .

Testosterone replacement in women is an excellent therapy to help them regain or develop more vigor, energy, strength and a better sex life when the quality of their life is suffering from low levels of this hormone. There is no FDA approved testosterone product so compounded creams or gels provide an easy and inexpensive method of delivering bioidentical testosterone in an amount far less than what men need. This is determined by a combination of clinical symptoms and laboratory free testosterone measurements. For women who suffer from painful sexual intercourse, a combination of testosterone and estriol in a suppository form will improve lubrication and “toughen” the endometrial lining within a week or two making sex pleasurable again. Improving blood testosterone levels will simultaneously improve libido and sexual sensitivity while keeping bones and muscles strong. The most frequent “side effect” question women often ask is “will I grow facial hair?” In our experience that happens relatively infrequently and can be managed by dosage adjustments in most cases.

David Mitzner DO is a board certified family practice physician and the founder/director of
Vintage Medical Group, a bioidentical hormone replacement clinic started over 10 years
ago to improve the quality of life in aging men and women.

Randy Ice PT, CCS is the clinical coordinator of Vintage Medical Group and a cardiopulmonary
physical therapist for many years. He is constantly surveying the latest medical literature for
methods of slowing or arresting the aging process…………because he is getting older!

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