What about Testosterone

What About Testosterone?
By Michael Born, M.D.
Gynecologic Surgery
(904) 953-2230

Testosterone is the "male hormone," right? Well, yes . . . and no. Testosterone is the primary reproductive or sexual hormone for men, just as estrogen is for women. However, women also produce small quantities of testosterone from their ovaries and adrenal glands. Despite the fact that normal testosterone levels in women are much lower than in men, the hormone plays an important role in maintaining a woman's health and well-being.

Testosterone levels decline in both men and women with advancing age. A woman's testosterone level begins to decline in the perimenopause (five to 10 years before menopause) and tends to stabilize at lower levels several years after menopause. Should a woman undergo a hysterectomy and removal of both ovaries, the decline in her testosterone level may be abrupt and steep. The contribution of total testosterone made by the ovaries and adrenal glands varies from one individual to the next. Consequently, not all women experiencing menopause will develop symptoms of testosterone deficiency. These symptoms include diminished libido, fatigue, decreased vigor and continued hot flashes despite adequate estrogen therapy. The symptoms of testosterone deficiency are sometimes vague and nonspecific. As an example, loss of libido, or interest in sex, can be caused by a number of factors other than low testosterone levels. Domestic or economic stress, medication and depression are just a few of the other possible causes of diminished libido. The same could be said for the other symptoms as well.

If the symptoms are nonspecific, how is a woman to know if they are caused by a declining testosterone level? Quite simply, by measuring the blood level in the laboratory. Your doctor can order a blood test for total testosterone, as well as free testosterone. Both values are important, but the free testosterone value is most important. The vast majority of testosterone is bound or attached to a protein in the blood. This combination of testosterone and protein is biologically inactive. It is the small amount of unbound or "free" testosterone that is biologically active. It is possible to have a total testosterone level within a normal rage, but at the same time have a free testosterone below normal. Under these circumstances, a woman could have symptoms of testosterone deficiency despite a normal total testosterone report. Conclusion: both total and free testosterone levels should be determined.

If the total and/or free testosterone levels are low, testosterone supplementation may be prescribed. Testosterone can be administered orally, by intramuscular injection, subcutaneous pellets or with creams or gels applied to the skin. Testosterone most frequently is given in combination with the standard estrogen and progesterone hormone replacement.

Benefits of appropriate testosterone replacement therapy include the reversal or marked improvement of the deficiency symptoms. One would expect to see a return of normal libido, decreased fatigue, increased vigor and possibly fewer hot flashes and improved sleep patterns. In addition, testosterone has been shown to augment the bone-building benefit of estrogen.

If given in high doses or to individuals who are particularly sensitive to testosterone, hair growth on the lip or chin, or deepening of the voice could occur. Generally, these effects are reversible once testosterone is discontinued. Changes in the lipid profile, specifically, lowering of HDL-cholesterol, tend to be small and not significant. However, if a woman has an elevated cholesterol, very low HDL or a strong family history of heart disease, she may not be a good candidate for testosterone therapy.

As we now know, testosterone is not just the "male hormone." It is clearly an important part of the hormonal makeup of both men and women