Women make testosterone in the ovaries and testosterone precursors in the adrenal glands. Testosterone is important in female development. It stimulates the growth of axillary (underarm) and pubic hair. There are testosterone receptors in the nipples, vagina and clitoris. Testosterone is important for sexual responsiveness. Testosterone levels can decline as a result of: childbirth, endometriosis, oral contraceptive use, psychological trauma, depression, surgery that removes or injures the ovaries and adrenal stress (insufficiency). Finally, the normal aging process including the menopause will result in reduced levels of testosterone.
Testosterone supplementation, when indicated, may be beneficial in improving health and vitality for women. It may be helpful in preventing or reducing the severity of a variety of illness conditions including:
Signs of Sexual Dysfunction:
Psychological/Mental Functioning:
Musculoskeletal Symptoms:
Metabolic and Vascular Problems:
Other Physical Problems:
The basic tests involve testosterone blood levels, DHEAS, estradiol, progesterone and sex hormone binding globulin. These are blood tests best done in the morning when testosterone levels are highest. In complex situations I may order a 24-hour urine test that measures the sex hormones and their metabolic by-products in order to understand how best to individualize therapy. Knowing the level can help direct therapy for the individual. One size does not fit all; one treatment does not fit all. Individualization of therapy is the key to an optimal outcome. Monitoring hormone levels, physical findings and patient symptoms should be done at 3-4 month intervals while on hormone replacement therapy.
I have not found salivary levels particularly useful in monitoring therapy. The results do not match the clinical picture once therapy has started. Salivary hormone measurements may be useful in screening or early diagnosis.
Androgen excess can occur in women who are not using supplementation. In this case there may be an underlying disorder (Polycystic Ovary Disease) that may be resulting in over secretion of androgenic products. Women on supplements of testosterone can also experience side effects of excess. These symptoms and signs may include:
Only kidding on the last two!!
What is the point of spending money on expensive medication and going to the trouble of monitoring its effect if you are not going to make the life style changes that will optimize a therapeutic outcome?
Diet should be individualized using the principles of our metabolic typing program. At the very least follow our general guidelines on diet and exercise as outlined on this website.
Supplementation with vitamins, minerals, therapeutic nutrients and herbal products is also an important part of a comprehensive program. Supplementation recommendations are individualized.
Testosterone is used as a transdermal cream. The potency of the cream is adjusted to achieve an optimal blood level of testosterone. Blood levels are checked at 6-8 week intervals until an optimal level is achieved. After that I recommend checking blood levels at 3-4 month intervals. Hormonal therapy is most effective when the complex interactions of all the hormones are taken into consideration and supplementation is balanced with this in mind. Diet and exercise issues are always important.