Testosterone is typically thought of as a male hormone and to be writing about it in the context of women’s health and menopause may seem for many as totally inappropriate.
Except that it is NOT.
Testosterone has been in the UK media A LOT over the couple of months and I wanted to help you make sense of why there is so much media hype, the medical facts and fiction around testosterone and the role it plays in midlife women.
Firstly the basics:
Testosterone is a master hormone – that means it is an essential part of our hormone system and necessary for creating other hormones, specifically for women, eostrogen.
This biological fact means that women actually have MORE testosterone in their bodies then eostrogen – the famed feminine hormone. Research suggests that young women’s ovaries actually produce approximately three to four times more testosterone than estrogen daily 1.
It is Important to note that we do have lower testosterone levels than men, but for women testosterone is an important part of their reproductive cycle. Just FYI - In general men have about 15 times the amount of circulating testosterone than women at any age.
Testosterone is part of the female menstrual cycle. We are usual aware of it when women encounter fertility issues such as PCOS. In these cases, testosterone (more specifically the androgen hormone) levels are out of balance with the other menstrual hormones causing a range of symptoms including irregular periods.
The chemical compound make-up of testosterone in men and women is exactly the same, what is different is WHERE is it produced. Men mainly produce testosterone in the testes, whereas women produce testosterone in the ovaries, adrenal glands, fat cells, and skin cells.
Testosterone levels natural decline as we age – both in men and women! And as women navigate menopause and their ovaries stop producing testosterone, production shifts to the other organs. This is similar to eostrogen fluctuations and can explain why levels may drop dramatically for both hormones if production from adrenal glands and fat cells is not efficient enough.
One more thing…….
Did you know that Studies have shown that testosterone may protect the breast from cancer. As early as 1937, it was recognized that testosterone was ‘antagonistic’ to estrogen and was used to treat breast cancer as well as other estrogen sensitive diseases including breast pain, chronic mastitis, endometriosis, uterine fibroids and dysfunctional uterine bleeding. More recently, studies using exogenous Testosterone have shown that Testosterone in combination with estrogen may reduce the risk of breast cancer 2.
Understanding this, we have to ask if the role of testosterone in men and women is different?And what happens in both sexes when testosterone declines.
In general Testosterone in both sexes plays a vital role in the development of secondary sex characteristics. For example, deep voices and facial hair for men, and higher voices and breast development for women.
However more significantly, both in male and female adults, testosterone leads to
· improved energy,
· strong cognitive and mental function,
· a much stronger sex drive,
· better sleep,
· increased muscle tone,
· emotional stability and more.
We also see the long term benefits of testosterone in preventing chronic illness and disease, particularly for your heart, brain, and bone health.
If any of this is sounds familiar to you as a midlife woman, that’s because many areas that testosterone actually support our health are areas where midlife women experience symptoms.
So the next question is if testosterone is so important, why is there so much controversy around it?
Let’s start with the fact that Testosterone is still perceived in Western Medicine as The Male Hormone. It’s role in women’s health is either not understand, ignored and definitely not researched enough.
Next, there is no FDA approved testosterone products for female use and in the UK testosterone for menopause symptoms can only be prescribed off-label or prescribed by knowledgeable doctors as a % of male dosage. Australia is the only place where testosterone is available for female use.
Both NICE (National Institute for Health and Care Excellence) and the BMS (British Menopause Society) have put out a position paper about the use of testosterone saying it should be offered to women in specific situations based on their symptoms (typically low libido). Unfortunately, the paper does limit the extent to which testosterone may be beneficial for women in midlife and beyond in other areas. However, that fact that it is included and given importance by these two reputable organisations is significant. 3
Prof. Susan Davis, President of International Menopause Society has spent years researching the benefits of testosterone for women in menopause and in post menopause and summarises the overall state of knowledge of the role of testosterone in these women in this 5 min. podcast review. 4
The fact that this is being talked about in a female context is important, but in my opinion her position is very conservative. However three things are very clear:
There is not enough research or data on the benefits or impacts of testosterone on women’s health in general and into post-menopause.
Testosterone has clear benefits for post-menopausal women in treating low libido.
There are very limited risks for women in supporting their testosterone levels, especially if there are no other contra-indications.
So why the media hype in recent months?
In February 2023 a very disparaging article came out in the Independent newspaper 5 charting the dramatic increase in testosterone prescriptions for females. This line only added confusion to the testosterone debate:
“Women are being led to believe that it’s the missing piece of the jigsaw, that it’s going to be the solution to their relationship problems, and I think we have to be much more scientific about how that information is provided for women.”
And that was only the start of it.
An article in The Guardian newspaper in July 2024 6 also had some serious fear-mongering click-bait headlines when it claimed that women had unfetted access to testosterone and were using it inappropriately.
The article itself actually laid out the complicated case of testosterone hormonal treatment, mainly that there is no FDA approved testosterone products approved for women and that both medical practitioners and women themselves often don’t understand female appropriate dosage and the application to get the most out of it. But the mixed messaging in the article was another example of the lack of understanding on this topic.
In addition to news articles, the Testosterone debate is filling Women’s Health and Menopause podcast episodes, morning talk shows and social media posts.
In my opinion, we have to get a little granular here when understanding the testosterone debate, the pros and cons, the myths and the facts.
I see two main areas for nuance and gaining a deeper understanding on this topic:
1. The biological role testosterone plays in our health journey during menopause and beyond. The knowledge base here is definitely hampered by the limited research available and preconceived ideas about testosterone as a male hormone. The role of Testosterone in women needs to be taken seriously and funding for research needs to be expanded.
However, the basic premise by menopause and hormone experts is that testosterone could potentially play an important role in supporting specific symptoms in midlife and women’s health long term.
2. Where you stand on the general HRT debate and how you choose to support yourself during menopause and beyond is going to impact that way you view testosterone hormonal support. When you follow someone with a pro or anti testosterone support point of view, make sure to take a look at how they view HRT in general and you will find they fall in the same camp regarding testosterone.
We need to be able to debate these two issues separately and without just assuming that admitting women need testosterone support that means it has to come in the form of HRT.
Based on all of this, this is my personal opinion on this debate:
In all my studies and with the experts I have spoken to, testosterone is definitely underrated by conventional medicine in the role it plays in supporting women’s health in general, the role it plays in our larger hormonal system and the role it plays in treating specific menopausal symptoms.
There is NOT enough research, data and case studies. We need to understand the role of this hormone in women’s health much more and in broader ways than just treating low libido.
Whenever we talk about declining hormones in midlife, the next automatic step in the conversation by many menopause specialists and patients is – “well obviously you are going to need HRT to ensure that you are supporting your hormonal deficiency”.
HRT is ONE way to support your during menopause and to be used as a symptom treatment option. There are many natural, integrative or lifestyle ways to support your hormones that in many areas can have excellent results. We need to be talking about this more and offering women a range of treatment options.
The recent interest in testosterone and the controversy around its role for menopausal women seems to be going the way of much of the menopause debate – it is being present as a black and white situation, pros verse cons, HRT support verse suffering with symptoms. As we have seen with so much of the menopause conversation things are much more complicated and nuanced. What works for one woman may not for work another. Understanding each woman’s specific situation and her needs is essential for supporting her the right way.
One final point…. I want to mention Dr Angela DeRosa, who I interviewed as part of The Menopause Summit 2024. She shared her insights and expertise in my interview with her on how health protective testosterone is for women. She has a deep knowledge of the role that testosterone plays in women’s health and menopause support, understands the research available and she is someone I absolutely recommend people follow to understand the issues more.
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