Hormone Balance: what you need to know about your hormones and your weight

ACSM Certified Personal Trainer Rachael Lewis interviews Dr. Becky Lynn, gynecologist and menopause specialist on hormonal balance, how hormones affect your metabolism leading to weight gain.

Rachael: Hi Dr. Becky, we are so excited to learn more about your business, Evora! Can you briefly explain your background?

 Dr. Lynn: Yes! I am a board certified gynecologist and a specialist in menopause and female sexual health with over 20 years in practice. I am also a North American Menopause Society(NAMS) certified physician and a certified sexual counselor.

  Rachael: What do you specialize in?

Dr. Lynn: I specialize in menopause and sexual health and these commonly go hand in hand.  Menopause encompasses everything from preventative care and cancer screening, to treatment of hot flashes, weight gain, mood swings, brain fog and sleep disorders.  When it comes to sexual health, we treat low libido, painful sex, orgasm and arousal difficulties in women of all ages. Couples counseling is another service I provide as often patients need help explaining the process to their partner, discussing sexual concerns, and maybe working through difficulties or communication issues in their relationship.  Because weight gain is so common in menopause, I also offer a weight management program.  I help women lose weight in conjunction with you and our nutritionist Katie.  We have had many happy customers.

 Rachael: How are our hormones affected as we age?

Dr. Lynn: Our hormones change throughout our lifespan and this can significantly affect how we feel.  Estrogen levels starts to change in general in your 40s.  This can lead to irregular periods, mood swings, sleep problems and weight gain.  Our testosterone levels start to decline in our late 20s, and early 30s, leading to fatigue, low libido and a decrease in muscle mass.  Getting your hormones in balance can help with these symptoms.   

Rachael: Why are so many women today at younger ages already experiencing hormone imbalance symptoms?

Dr. Lynn: We always think of menopause happening at age 50 but the symptoms can start in your early 40s and for some women it starts even earlier. 

Rachael: How does diet and lifestyle relate to hormone imbalance?

Diet and exercise can sometimes help rebalance certain hormone levels. For example, some women have polycystic ovarian syndrome(PCOS).  Their ovaries may make too much testosterone and estrogen not enough progesterone if/when they don’t ovulate.  People with PCOS are more likely to have insulin resistance, meaning your pancreas has to put out more insulin to get glucose into your cells.  Insulin makes you deposit fat and gain weight.  When you gain weight, you become more insulin resistant and you fall into a vicious cycle of more weight gain.  Lifestyle changes, like a healthy, protein-based diet and exercise can help break the cycle. Many times, when women with PCOS lose weight, their hormones go back into balance. 

Rachael: Is there a relationship you find between metabolic rate (ability to burn calories/expend energy) and Hormone Balance?

Dr. Lynn: Absolutely! This is so important to menopausal women because when you go through menopause your ovaries stop making estrogen. Low estrogen levels lead to insulin resistance.  Similar to PCOS, insulin resistance leads to your body making more insulin which makes you gain weight.  Hormone replacement therapy in women has been shown to improve insulin resistance, which is so important to a healthy body weight. 

 Also, when estrogen levels decline, women’s bodies tend to be less muscular and more fat than when their hormones were at normal levels.  This leads to a lower metabolic rate than previously, making it harder to lose weight or making it so you have to eat fewer calories to maintain your weight.

 Lastly, after menopause, women tend to deposit more fat around their middle and less on their hips and bust.  This leads to a higher risk of cardiometabolic diseases, like diabetes and high blood pressure. 

 Rachael: What do you wish all women knew related to our health or hormones specifically?

 Dr. Lynn: I feel like there is still so much misinformation concerning hormone therapy out there.  Women don’t know who to trust or what to believe.  I want women to know that hormones have incredible benefits to your health.  Like all medicines, they have side effects and risks too and they aren’t the answer for everything or everybody. 

This is why it is so important to find a physician who is a hormone specialist and a NAMS certified one! 

Rachael: What made you decide to start your own business?

Dr. Lynn: I love taking care of patients, especially women in midlife. There are many important topics to cover during a visit that are important to your overall health, well-being and quality of life. I feel strongly that women need more than a 10 minute visit with their doctor in order to meet their health needs.  I found that I could not do this as an employed physician working in a large practice.  My schedule was always over booked and I would be running behind.  Starting my own business has allowed me to limit the number of patients that I see and give my patients all the time, information, and discussion that they need during a visit.  At Evora, we never rush.  We listen, evaluate the issues and then come up with a plan personalized just for you. 

 Rachael: How does your service differ from a traditional doctor office visit?

 Dr. Lynn: We differ from traditional medicine in numerous ways:

1. My practice focuses on your overall health and well-being, not just your symptoms. 

2. We spend an hour with you on the first visit so we can address both prevention and all of your concerns. We always give you the time that you need.

 3. We devote all of our time directly to you. Because of this, we do not accept insurance for doctor visits.  You can still use your insurance for any testing or imaging that we order.  You can always submit to your own insurance for reimbursement or you can use a health savings account or flexible spending account to pay for services.  We give you all of the documentation that you need to submit. This way all of our resources are devoted to you, not to collecting from insurance. 

 Rachael: Last one, what is your favorite thing to do when you’re not at the office treating patients?

Running! I love running.  It takes me to my happy place, not to mention exercise is so good for your moods and it keeps my weight in check.  My family knows, early in the mornings if mom is not home, she is out running!

Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in Chesterfield just outside of St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife wellness program helping women lead healthy lives. Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com

Rachael Lewis is a fitness professional who has touched the lives of countless women - helping them move forward in their health and wellness. Rachael currently is an American College of Sports Medicine Certified Personal Trainer who has worked for ten years in multiple sports, corporate and community settings. Rachael believes that every body adapts and responds to exercise differently. Her goal is to create a sustainable exercise regimen that you are able to maintain through the rest of your life. Rachael is the founder of A Perfect Fit, a concierge culinary service. Offering in home cooking and personal grocery shopping, A Perfect Fit allows you to stop stressing over preparing whole meals for you or your family. A Perfect Fit takes care of it for you!

How to lose weight during menopause! Meet Katie Heaney, RD.

 Link: https://www.youtube.com/watch?v=9s9UNax-QQ0

 Dr. Lynn: Hello, I’m Dr. Becky Lynn. I am here with Katie Heaney, RD. I’m a gynecologist, and a menopause and sexual health specialist.

 Katie: I am Katie Heaney. I’m a registered dietitian working with Dr. Lynn. I specialize in weight management, obesity interventions, nutrition for the whole family, and some sports nutrition.

 Dr. Lynn: Well, fantastic! One of the reasons I wanted to bring Katie here today is because I see so many menopausal women who tell me that when they go through menopause, their metabolism slows down, and they’re gaining weight. They tell me that they watch what they eat, they make healthy choices, they exercise, and they just can’t lose weight.

 Katie: This can be really frustrating because menopause is a big transition in life. I see many menopausal women struggling with those last 15 pounds! As women journey through the lifecycle, their bodies naturally shift in response to hormonal changes that usher them out of the fertile phase of life.  Menopause is frequently accompanied by weight gain, muscle loss, and lack of energy, making it challenging to achieve a healthy weight.  Many women who have gone through menopause or are going through menopause come to us to help them with weight loss and muscle gain. 

 When people see me and want to make healthy changes and lose weight, I start by getting as much information as I can about their current eating habits. I discuss what healthy weight loss looks like and realistic timelines.  There is so much that goes into healthy eating and weight loss.  It isn’t just about calories in and calories out. I do a deep dive into what they’re eating, when they are eating it, do they exercise, and if they are getting enough sleep. Sleep is so important. It is one of the first things we talk about. We are more likely to make unhealthy choices when we are sleep deprived.

 Dr. Lynn: During the years before your periods stop (the perimenopause) and then for a few years after they stop, many women have night sweats and they can’t sleep at all or have awakenings in the middle of the night. This is not good for those carbohydrate cravings!

Stress

 Katie: Stress plays a role too. Having a lot of stress in your life affects how hungry you feel.

 Dr. Lynn:  Stress hormones like cortisol increase, which leads to insulin increase which makes you deposit fat and crave carbohydrates.   So, how would you define healthy weight loss?

Defining Healthy Weight Loss

 Katie: It depends on where we start. Generally, we say half a pound to a pound a week of weight loss. It is a bit controversial with dieticians – like counting calories or not. I like to discuss mindful intuitive eating. We try to figure out how to be mindful of caloric intake. I also calculate women’s resting metabolic rate and their activity level in order to calculate how much or how little they need to take in to lose weight.  Research show that the average weight gain during menopause is a little more than 1 pound per year.  With reduced calorie needs as women age, weight gain is expected if they don’t eat healthfully and increase physical activity.  Lifestyle factors are extremely important to consider when talking about weight gain. 

Measuring Resting Metabolic Rate

 Dr. Lynn: How do you measure the resting metabolic rate?

 Katie: I use an equation called the Mifflin-St Jeor equation. It is based on an algorithm that uses your age, gender, activity level, and height and weight (of course). It is an estimate, but you can also use a special kind of breathing machine. You breathe into it and based off of your oxygen level and carbon dioxide level, it measures how much energy you use at rest just to run your body.  This is your basal metabolic rate.  It is very useful information.

 Dr. Lynn: It gives you the calories you burn each day?

 Katie: Resting metabolic rate is the total number of calories burned when your body is at rest. From there we use the activity level to calculate how many calories you need for healthy weight loss, because the breathing machine only gives us the calories you would need at rest. Also, I have clients that will take multiple measurements over time, because as you lose weight, there is less of you to feed, so your resting metabolic rate decreases. The way you can increase or maintain your resting metabolic weight is to build muscle as you lose weight. I am not a personal trainer or a physical therapist, but I encourage 2-3 days a week of weight training and building muscle because that can really help boost your metabolic rate. Your metabolic rate tends to go down as we age and as women go through menopause.

 Dr. Lynn: So it is funny that you say that because (and I am not a dietitian), but I always think that when you’re trying to lose weight, you need to do aerobic exercise, get your heart rate up and burn calories. And so, I have said in the past, if you have limited time, concentrate on the aerobic exercise. I have changed my tune on exercise over the years. Now I see the value in strength training, especially for menopausal women because menopausal women lose muscle mass when they lose the hormones their ovaries used to make.

 Katie: Resistance training is great for muscle building!

Resistance Training and Aerobic Calorie Burning

 Dr. Lynn: What would be the optimal mix of resistance training and aerobic calorie burning?

 Katie: That is a really good question. I don’t think it’s either or; it is hopefully both. I would start with looking at what you are willing to do. Many times I have clients say, “yeah I’m just not going to lift weights, but I would like to get my heart rate up and start exercising more.” I focus on where the client wants to start.  If I say to someone, “do all of this,” it can get overwhelming, and they may not start at all.

 I just had a client the other day say “I’ll do ten minutes a week and that is all I will do”.  I have another client who is already doing three days a week of Krav Maga, high intensity interval training, and she said, “I’ll go up to four days a week!” So, it just depends on the person, but ideally the recommendation for adults, is 30 minutes a day, or 210 minutes per week. It can be 30 minutes a day or it can be three 1-hour long sessions a week. I try to choose something that works for each person.  If it were up to me, I would say the 30 minutes a day, because then maybe we can incorporate two days a week of strength training for 20 minutes.

Logging Your Data

 Dr. Lynn: Okay, so you talk about sleep habits, you talk about exercise, but then do you have them write down what they eat?

 Katie: Every client is different. Generally, when they come in, I want to know what they’re eating. Some of them come in with a notebook, and many, many, many clients come in using  My Fitness Pal. I think you’re familiar with it?

 Dr. Lynn: Yes!  My Fitness Pal synchs up with our electronic medical record.   

 Katie: Some people come in and they have it all recorded, so we can go through that. Typically, I get a verbal intake of what you are eating on a typical weekday, and I usually get a couple samples of meals and schedules. For the weekend, schedules change. So, I also get a weekend day. From there, we talk about eating habits. For example, “do you skip meals? Do you eat when you’re stressed, bored, angry…” Emotional eating is common.

 Dr. Lynn [humorously]: That’s me!

Emotional Eating

 Katie:  We have to eat all the time and we are always thinking about food. So, there is a lot of eating that goes with emotions. I also ask about binge eating habits or eating disorders, and I usually refer to a specialized therapist for those.

 Dr. Lynn: Yes 

Katie: I am not a therapist. I sometimes introduce cognitive behavioral therapy(CBT) in sessions as a behavior change technique, but I usually refer to a trained counselor or therapist for more detailed training on CBT.   

Katie: I also talk about hunger with my clients. For instance, I go through the hunger scale. I usually compare fuel for my body to gas for a car, so when the gas is empty, the car stops. When you’re really, really hungry, your body doesn’t work as well as it should. Your brain doesn’t work as well as it could.” I always say 10 is like Thanksgiving Day, when you eat so much, and you can barely move. Ideally, we want to stay between a 4 and a 6, so you don’t allow your body to get too hungry and you stop when you’re at a 6 versus eating until you’re stuffed. Achieving a healthy weight is about eating enough, but not too much. I talk a lot about what people are eating, but I also talk about how much.

Portion Control

Dr. Lynn: Portion control basically. We all know that we have large portions. If you go to a restaurant, there are sometimes a thousand calories in one meal, if not more. I feel like we are used to large portions, so a smaller portion seems too small. If you read labels and look at serving sizes, a serving might be much smaller than the amount you would normally eat.

 Katie: It can be shocking to show what a healthy portion of rice is… it’s half a cup!

 Dr. Lynn: Right, it looks like three bites!

 Katie: Yes! After we calculate your calorie needs, I create a meal plan together with your idea of what that looks like. That way it fits with your lifestyle and habits. I also talk about having all the food groups in a meal, having a healthy amount of carbohydrate, fat, and protein. I focus quite a bit on protein. I try to create meal suggestions that incorporate all the different food groups, like starch (especially whole grains), vegetable, fruit, fat, and a meat or protein.

Katie: Protein is really important in achieving a healthy weight and having energy. If you’re incorporating exercise you have to have enough protein to maintain your muscles, but not too much. I focus a lot on portion size and a tool I have been using lately, which is pretty basic but helps you visualize, is divide your plate into fours.

 Dr. Lynn: I think I’ve seen that before.

 Katie: It is through choosemyplate.gov, which is an updated food pyramid.

 Dr. Lynn: mm-hmm!

Katie: I recommend that women practice mindful eating, control portions, and focus on nutrient-dense foods such as fruits and vegetables.

Fruits and Vegetables

Dr. Lynn: Right. I have a question about that. I tend to eat a lot of fruit, but not as many vegetables. So, if you say 8-10 servings of fruits and vegetables a day and nine of those ten are fruits, am I still missing something? Should I try to balance it out a little bit?

Katie: 2-3 of those servings should be vegetable. You don’t have to go up to 7 vegetable servings tomorrow but try to find some recipes. I see many clients who just don’t like vegetables because the only way they’ve eaten them is boiled or steamed.  I talk a lot about roasted vegetables. They are so much better! If you roast brussel sprouts, asparagus, cauliflower, or broccoli, they don’t quite taste like French fries, but they have a nice crispy texture. Or some people like vegetable soup. Vegetable soup can be store bought or made. If bought, then it isn’t labor-intensive and you still get your vegetable servings.

 Dr. Lynn: We all probably need to eat more vegetables…. Me especially.

 Katie: Amen! I agree!

 Dr. Lynn:  Thank you so much Katie for helping our patients the way you do.  I am lucky to be working with you!

Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in Chesterfield just outside of St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife health program including helping women lose those pesky last 15 pounds! Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com

Katie Heaney is a registered dietician working with Dr. Lynn at the Evora Center for Menopause and Sexual Health. She holds an undergraduate in Nutrition and Dietetics. She completed her dietetic internship at Yale-New Haven Hospital and then obtained a Certificate of Training in Obesity Interventions for Adults. She is a member of the Academy of Nutrition and Dietetics and the national and local chapter of the Academy of Nutrition and Dietetics. Click here to schedule an appointment with Katie.

5 facts about (peri)-menopause you didn’t know!

We aren’t taught much about what happens during menopause and the few years before.

 Read on for some things you didn’t know were related to the loss of estrogen that your ovaries used to make!

1.  Vaginal dryness may be due to menopause!

You may not realize that dryness is related to the loss of estrogen. You may not get aroused as easily during sex. You may not be able to reach orgasm; orgasms are not as strong, or it takes too long and too much work to get there. Sex may even become painful. No worries, low dose vaginal hormones help treat all of these, (and you are normal if this is happening to you)! Giving back the estrogen helps the vagina lubricate. It also makes the vagina stretchy, with good blood flow, and more nerves going to it, which makes sex feel better! The good news is that vaginal hormones don’t have the same risks that go along with other hormone use. They do not increase your risk of breast cancer, heart attack, or stroke.

 2.  Menopause makes it harder to lose weight.

It is not that you are lazy or crazy. During menopause women become more insulin resistant. This means your body needs to pump out more insulin to get the same amount of glucose into the cells. Insulin makes your body deposit fat, which is not good for your waistline. Menopause leads to fat deposition around your middle instead of your hips and bust. This “apple” shape, as opposed to the typical female “pear” shape, leads to an increased risk of cardiovascular diseases like heart attack or stroke. Diet and exercise are the first step to losing weight and making your body less resistant to insulin. Some women may need the help of some of the medicines that are available to help you lose weight.

3.     Anxiety, depression and mood swings may worsen around the time of menopause.

Typically, hormone levels become erratic before periods stop. Women may feel like they are on a roller coaster ride of emotions. Also, this is the time the kids leave the home and women may be dealing with an empty nest or a lost identity. They may also be taking care of aging parents or have financial stressors. There are plenty of ways to manage anxiety, stress, or depression. Some are with appropriately chosen medicines, other times yoga or soothing apps like CALM may be all you need.

4.  Word finding difficulties, forgetfulness happens.

This can be incredibly scary for menopausal women. You can’t seem to remember why you walked into the kitchen or what task you were supposed to complete today. The good news is that brain exercise helps. Learn a new language or learn how to play an instrument. Exercise and diet also keep the brain “fresh”. Be sure to eat a healthy diet, including omega 3 fatty acids which are found in oily fish like salmon or tuna. A healthy lifestyle lowers your risk of Alzheimer’s Disease and delays the progression of Parkinson’s Disease.

5.  Low libido.

Menopause is not all about estrogen. By the time women stop having periods, their testosterone is much lower than it was in their 20s and 30s and this may lead to low or loss of sex drive. Loss of sex drive may significantly impact a women’s relationship, and couples that don’t have sex tend to grow apart. There are plenty of hormonal and non-hormonal ways to improve your sex drive.

Make sure you find a practitioner who is well versed in menopause and sexual health.

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click click here to schedule.

Menopause: 4 things you can do when “down there” feels like sandpaper

Sandpaper. That is what my patients tell me about how their vagina feels during sex after menopause.  There’s good news though--you don’t have to live that way.  There are several things you can do to reinvigorate “down there”.

 What is menopause?

 When your ovaries stop releasing eggs each month, you have entered menopause.  Without the ovulatory cycle, your ovaries are not making estrogen and progesterone like they used to.  Testosterone is also decreasing.  These hormones play a large role in sexual function.

 Vaginal changes after menopause

 We call the changes to the vagina vaginal atrophy which is part of the genitourinary syndrome of menopause (which includes changes to the urinary tract).   Vaginal atrophy doesn’t usually appear until about 5 years after the last menstrual period.  Many women don’t realize that vaginal dryness is due to menopause.  They feel like something is wrong with them when sex hurts. Many times, their partner is concerned because they don’t appear to be lubricated or aroused and the couple is unaware that this is a normal change of menopause.

 Lack of estrogen causes some major changes to the vagina.  Before menopause, estrogen  makes the vaginal walls thick, moist and stretchy.  There is good blood flow to the vagina and plenty of nerves (just ask anyone who has had a baby!).  There are small folds (rugae) in the vagina that allow the vagina to stretch so a penis can fit into it or a baby can come out of it.  All of this leads to pleasurable sex. But after menopause, the vaginal walls become thin and dry.  They lose their rugae, stretchiness and they don’t naturally lubricate during sex.  This loss of elasticity combined with lack of natural lubrication can lead to painful sex.

 4 things you can do about vaginal dryness.

Lubricate:  There are several types of vaginal lubricants: water based, silicone based and natural oils like olive oil.  If you are menopausal and have vaginal dryness, throw away the water based lubes. Although they sound “natural”, water based lubes pull moisture from the vaginal tissues and make dryness worse. Pick a silicone based lube like Uberlube or Wet Platinum.  Water based lubes do not affect the integrity of a condom but some silicone based lubes do.  If you are using condoms, the silicone based Uberlube is a good choice because it does not affect the condom.  Put some on the outside of the vagina, which is called the vulva, and before sex, put some on your partner too.  This will help things glide a lot more smoothly.  

Moisturize

Just like you put lotion on your hands, you can also moisturize the vagina.  There are a variety of products on the market for this, like Lubrigyn or Hyalo Gyn.  I tend to recommend coconut oil (solid) or wait for it. . . .Crisco.  You can use as little or as much as you want.  You can put some on the vulva morning and night, or every time you pee.  You can even freeze chunks in an ice cube tray and then insert them into the vagina with your finger.  This does not increase your risk of infection.  

 Low dose vaginal hormones

 Low dose vaginal hormones replace what the vagina is lacking during menopause- estrogen.  Before you say no to hormones, remember that low dose vaginal hormones do NOT increase your risk of breast cancer, blood clot, heart attack or stroke.  Vaginal hormones restore the elasticity to the vagina, allowing it to stretch without pain and return its ability to lubricate itself again. Sex becomes pleasurable again as there is more blood flowing to the vagina allowing for more sensation and engorgement. 

 Vaginal laser

There are some several studies evaluating vaginal laser for the treatment of genitourinary syndrome of menopause.  Thus far, they show some promising results.  Vaginal laser breaks down old collagen and your body replaces it with new healthy collagen and elastin. After laser, the tissue appears more like premenopausal tissue with more superficial cells and women report less dryness and less pain. 

Go ahead, reinvigorate the vagina! No need to have painful sex when there are so many treatment options.  You will be so pleased with your results!

DOES THIS SOUND FAMILIAR? CLICK HERE FOR MORE INFORMATION

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click click here to schedule.

Testosterone for Women: Miracle Drug or Bogus Science?

Testosterone.  That lovely hormone of desire, of sex, of muscles and power and strength.    We think of manly men with hairy chests when we think of testosterone. But did you know women have testosterone too?  They even make more testosterone than they do estrogen. Testosterone is one thing that controls sex drive in women and does a whole host of other things.  It starts to decline in your late 20s. This can contribute to low libido in women. So should testosterone be replaced? I hope to answer this question for you with answers based on scientific studies- not bogus internet marketing claims.  Let’s get started.

Does testosterone make for better sex?

If you are a midlife woman, peri or postmenopausal, then in some instances the answer is yes!  Testosterone has been shown to definitively improve several aspects of sexual functioning. Testosterone improves sex drive, arousal, helps you have more and better orgasms, and increases pleasure and responsiveness.  Who wouldn’t want all this at a time when your sex life tends to get a little dull and unsatisfying and in some women, a whole lot of work as well. When a midlife woman is suffering from low sex drive, testosterone can be used to improve it.  This is a big deal for many women because low sex drive is uber common in midlife women and many are very distressed by it. Low drive can add a lot of stress to a relationship. 

What are the benefits of testosterone?

Apart from improving your sex life, some data shows that testosterone may also help build muscle mass, improve fatigue and help with weight loss.  The data isn’t definitive though and it isn’t recommended to use testosterone for these reasons.  

What are the risks of testosterone?

There are no medicines without risks or side effects so don’t believe anyone who tells you a medicine has no risks.  Testosterone is a hormone. It gets converted to estrogen in the body. Like estrogen, it increases your risk of blood clot.  The medical term for a blood clot is deep venous thrombosis (DVT). DVTs can be quite dangerous because the clot can break away from the blood vessel and travel to your lungs and prevent you from getting oxygen.  Good news though, if you don’t have a clotting disorder, are a normal weight, don’t smoke and don’t have certain other medical conditions, your risk of having a blood clot is very low. It is much lower than when a woman is pregnant or on birth control pills.  

What about bioidentical hormones?  Do they have risks?  

Even “natural” things have risks, so don’t be fooled by the term bioidentical.  Bioidentical means that whatever you are getting has the same chemical structure as the hormones that your own ovaries used to make or are currently making. Compounded “bioidenticals” are no safer than standard prescription hormones and on the flip side, there are prescription hormones that are bioidentical.  Stick with the prescription ones. The companies that make them have to prove to the FDA that they are effective and safe. Compounding pharmacies don’t. 

What are the side effects?

When appropriately replaced, some women on testosterone will develop acne or a little bit of facial hair.  If the testosterone level in the blood gets into the male range, way too high, there can be some significant and permanent side effects like a lot of facial and body hair, deep voice, male pattern balding, and an enlarged clitoris. Your prescribing physician should be checking your blood levels to make sure you stay in the correct range.  Most women do not have these side effects.  

How should testosterone be given?

Testosterone should be given in a topical form, either a gel or a cream that gets absorbed through the skin daily.  I prescribe testosterone as a topical cream for my patients. Women put some of the cream on their calf. This mode of delivery gives a very steady blood level of testosterone and if there is a bit of local hair growth, you can just shave it off.  I don’t like the intramuscular injections of testosterone because they give you a very high dose right after you inject, then your body metabolizes it and the level goes down until your next dose when you get a whopper dose again. This creates a lot of ups and downs in your hormone levels.  Not my favorite.  

What about hormone pellets?

I don’t recommend certain hormone pellets-namely BioTe. Some of these tend to give women very high levels of hormones.  I have seen numerous women with the same blood levels of testosterone as a man would have.  At these levels, women grow beards, have deepening of the voice, male pattern balding and the clitoris grows.  These changes can be permanent. 

Also, pellets have not been studied in women in peer reviewed published medical studies.  They haven’t been proven to be any better, safer or more “natural” than anything that has been studied.  The North American Menopause Society and the American College of Obstetrics and Gynecology specifically do not recommend treatment with pellets because their safety has not been proven.  For BioTe, go to their website and check out the disclaimer at the bottom of the website. It says these are not intended to treat or cure anything! 

I will say women come to me feeling fantabulous on their testosterone pellets.  They have amazing libido! That is because they have as much if not more testosterone floating around in their blood as their male partners and maybe as much facial hair too.  Just keep in mind the permanent changes pellets may cause.

What's the best way to find out if testosterone is a good option for me?

If you are in your 40s or 50s, peri or postmenopausal, testosterone may be a good choice for you to boost your libido, barring certain medical conditions.  Make sure to see a provider with experience in treating sexual conditions. A sexual medicine specialist will also look for other factors that may be contributing to your low libido like a not-so-nice partner, depression or certain medications. Testosterone is not going to improve your libido if your partner is a jerk.  

TO SEE IF TESTOSTERONE IS RIGHT FOR YOU CLICK HERE

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click click here to schedule.

Where did my 20 something sex drive go?

I was recently watching the Netflix series “You” which deals with an intensively obsessive 20 something man, falling for a somewhat clueless, innocent, sexy 20 something woman.  But it’s not the obsession that struck me(or the unusually nefarious plot), it is the crazy, throw me up against the wall, rip off my clothes and have passionate sex with me that caught my attention.  That is because in my gynecology and sexual medicine practice, I see women every day who tell me they have lost their sex drive.  Some women are desperately missing it.  They say they “want to want” again.  Others tell me they would be completely happy if they never had to have sex again in their entire life.  Had to have it?  Where do our 20 something sex drives go as we age?  Why do we lose them and most importantly, how do we get them back? 

When does sex drive peak?

Sex drive peaks in women’s early reproductive years.  Nature’s drive to find a mate and reproduce is super strong. Over time, we tend to settle down, have children, lead busy lives and our children become our main priority, right? Our spouse or partner, who we know is going to be there at the end of the day, becomes our last priority as we raise our kids and/or try to succeed in our careers. Sex lives become stale, boring, and we succumb to you guessed it-Duty Sex.

 What is duty sex? 

 Duty sex is the sex we have because our partner wants it and we do it to fulfill their needs, not ours.  Is it rip-roaring, bed-banging, need you NOW sex?  Not at all!  It is hurry up and get it over with sex.  Our partner has needs right? But what are we, as women, getting out of duty sex?  Intimacy and closeness, maybe.  Pleasure?  Not so much.  When it comes to our pleasure during sex play, we say, “oh don’t worry about me”, “you can get me next time” or “I don’t need an orgasm today”.  So we skip it, and from our standpoint, the sex is not so great.  Next time, we want to do it even less, and the sex is even less great. In fact, it is kind of bad, so we don’t want to have sex the next time and the next time and the next time.  You get the point.  Our drive tanks because in order to want to have sex, it has to be sex worth wanting!!

 Boring sex isn’t the only thing that can lower your sex drive.

 Low libido is almost never due to just one thing, like duty sex.  When I see my patients, I do a complete and detailed history to uncover anything that might remotely be contributing to low drive. If we only see and treat one thing, drive isn’t going to improve because all of the contributing factors weren’t addressed.  I ask about depression, anxiety, medicines, pain during sex, communication and relationship problems, body image, what your family taught you about sex, history of sexual trauma, partner sexual dysfunction like erectile dysfunction or premature ejaculation.  (I know I am being heteronormative here, but the majority of my patients are in heterosexual relationships).  The list is long.

 But is there treatment or should I just give up?

 YES! There is treatment.  Don’t give up.  Women may never get back to that same drive they had in their 20s but yes, they can “want” again.  My general approach to treatment is to first educate women about what is normal.  Many of us operate under certain assumptions about how sex should be, how we should be and how much sex we should want.  What is normal for one relationship is different from what is normal for another. Second, we discuss how to mitigate all the contributing factors.  For example, if the antidepressant someone is on is contributing to low libido, we discuss possibly changing it.  If the relationship needs some help, maybe some counseling is in order.  I generally recommend a good regimen of erotic reading if a patient is open to it.  The idea behind erotic reading on a regular basis is to get those neurons in the brain that think sexual thoughts firing again and again and again.  Those neurons may be out of shape, so to speak.  So go ahead, pick up that smutty novel, and exercise your erotic brain. 

 There are medicines that are FDA approved to treat low drive in women like Addyi and Vyleesi.  There are medicines that are not FDA approved for women, like testosterone, that have been shown in scientific studies to improve low sex drive in women.  They work in a variety of ways.  Each one has its own set of risks, benefits and side effects.  One may work for one woman and not for her sister or best friend.  None of them will give a woman the sex drive of a 15 year old boy reliably and usually not at all.  But for a percentage of women they work! And a good sex sex life is important to a relationship and to overall well-being. Sexual harmony so to speak!

 Stay tuned for my next blog with more information on medicines.

 Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click here to schedule.

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