Susan Merenstein, Pharmacist/Owner

(412) 586-4678  •  (412) 421-4996

Testosterone for Women


  • Women make 1/10th as much as men-made in ovaries, adrenals, skin, muscles, and body fat
  • Testosterone is the precursor to Estradiol
  • Perimenopause levels drop slightly from the ovaries, but adrenally by 40%, and in other tissues by 60%
  • Estrogen Dominance increases Sex Hormone Binding Globulin (SHBG)-binds 10x tighter to Testosterone than Estradiol
  • Anabolic hormone essential for building and maintain the integrity of structural

tissue such as skin, muscles, bone, and brain

  • Increases muscle mass and strength
  • Helps maintain bone strength
  • Increases sense of emotional well-being
  • Helps maintain memory
  • Helps skin from sagging
  • Decreases excess body fat
  • Elevates norepinephrine in the brain

(Tricyclic affect)

  • Aids with pain control
  • Increases sexual interest and is important for nipple and clitoral stimulation

Symptoms of Testosterone Loss

  • Muscle wasting and weakness
  • Bone loss
  • Decreased libido
  • Weight gain
  • Fatigue, prolonged
  • Low self-esteem and blunted motivation
  • Depression
  • Decreased HDL
  • Dry, thin skin, with poor elasticity-vaginal dryness
  • Thinning and dry hair
  • Droopy eyelids
  • Sagging cheeks
  • Thin lips
  • Anxiety
  • Memory is not as sharp, memory lapses
  • Mental fuzziness and fog
  • Diminished feeling of wellbeing, no zest
  • Incontinence

Causes of Low Testosterone

  • Menopause
  • Childbirth
  • Chemotherapy
  • Adrenal stress or burnout
  • Endometriosis
  • Depression
  • Psychological trauma
  • Birth control pills
  • HMG-CoA-reductase inhibitors

Treatment Pearls

IMPORTANT- Increasing the level of Testosterone above the normal ranges does not stimulate a further increase in libido

  • Testosterone replacement should be transdermal and should not exceed 1mg/day-most oral Testosterone is destroyed in the GI tract.
  • Use the bio-identical form. Methyltestosterone has been associated with an increase in liver cancer.
  • If used transdermally must rotate sites between labia, clitoris and wrists.
  • In order for Testosterone to work well, Estradiol must also be optimized.
  • Without enough Estrogen, Testosterone cannot attach to brain receptors.
  • If Testosterone is given alone, it may increase plaque formation.
  • Study- showed the safety and efficacy of using testosterone for postmenopausal women with low sexual desire with administration via non-oral routes (e.g., transdermal application) preferred because of a neutral lipid profile.

Islam, R., et al., “Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data,” Lancet Diabetes Endocrinol 2019; 7(10):754-66.

  • This study showed improvement in scalp hair with testosterone use in women with low testosterone levels.

No subject complained of hair loss as a result of treatment casts doubt on the presumed role of testosterone in driving female scalp hair loss.

Reference: Glaser, R., et al., “Improvement in scalp hair growth in androgen-deficient women tested with testosterone: a questionnaire study,” Brit Jour Dermatol 2012; 166(2):274-78.

How to raise Testosterone levels:

  • Decrease calorie intake
  • Increase protein in the diet
  • Take the amino acids arginine, leucine, glutamine
  • Exercise
  • Get enough sleep
  • Lose weight
  • Reduce stress
  • Take Zinc if deficient (Zinc is needed for the metabolism of testosterone.)

Causes of Elevated Testosterone

  • Insulin Resistance
  • PCOS
  • Menopausal Transition
  • Testosterone Supplementation
  • DHEA Supplementation-In one study, DHEA raised Testosterone levels 50-100% from baseline in women

Symptoms of Elevated Testosterone

  • Anxiety
  • Depression
  • Fatigue
  • Hypoglycemia
  • Salt and sugar cravings
  • Agitation and anger and aggressive behavior
  • Irritability and Moodiness
  • Insomnia
  • Facial hair
  • Acne
  • Weight gain
  • Hair loss or unwanted hair growth on the face
  • Increased risk of heart disease
  • Male Pattern Baldness
  • Deepening of voice
  • Clitoral enlargement

Treatment of Elevated Testosterone

  • Saw palmetto
  • Metformin
  • Spironolactone

Measurement of Testosterone Levels in Women

  • Androgens, both in excessive and depleted states, have been implicated in female reproductive health disorders.
  • This study revealed that commercially available androgen assays have significant limitations in the female population. Furthermore, the measurements themselves are not always informative in the patient’s diagnosis, treatment, or prognosis.

References

  • Korkidakis, A., et al., “Testosterone in women: Measurement and therapeutic use,” Jour Obstet Gynaecol Can 2017; 39(3):124-130.
  • Shufelt, C., et al., “Safety of testosterone use in women,” Maturitas 2009; 63(1):63-6.
  • Bolour, S., et al., “Testosterone in women: a review,” Int Jour Impot Res 2005; 17(5):399-408.
  • Hubayter, Z., et al., “Testosterone therapy for sexual dysfunction in postmenopausal women,” Climateric 2008; 11(3):181-91.
  • Glaser, R., et al., “Testosterone therapy in women: myths and misconceptions,” Maturitas 2013; 74(3):230-34.
  • Journal of Clinical Endocrinology and Metabolism, Vol. 82, No. 5, p 1945
  • Oronzo et al, Eur J Epidemiology 2000: 16; 907-912
  • N Engl J Med 2000; 343; 682-88
  • Morales and Yen. J Clin Endocrinol Metab. 1994: 78; 1360-67

Suggested Testing:
Saliva/Blood Spot Combo Kit Test
Saliva 5 Test