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.
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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.
