By Michael Gerber, MD, HMD
A common misconception about testosterone is that it is only a guy thing. Nothing could be further from the truth. Women also make testosterone, much less than men of course, and it is very important for their health. Testosterone (T) does many things for us. It gives muscle tone, promotes bone integrity, artery health, good mood, libido (sex drive), joint health and is great for heart strength.
The Adrenal Connection
The adrenal glands, the pyramidal shaped structures which sit atop the kidneys are important for our overall health in many ways. They give us our energy, control our mineral levels are anti-inflammatory and modulate our response to stress. In women half of their T is made in the adrenal cortex (outside portion of the adrenal gland) and when they are under stress the T can be converted to cortisol (cortisone) which allows them to have enough energy to get through the day but can also rob them of their libido. It is lack of libido which is the most frequent complaint of women with low T. Osteoporosis, thinning of the bones, shows up on bone scans and lab tests but is generally more of an issue for the elderly and fracture prevention and can be improved with supplementing T. Women who are under stress, sleep deprived, working in a stressful job, taking care of children and family, worrying about finances, not getting vacations frequently describe their sex drive as blah at best or zero. Some women have never had a libido and engage in intimacy just to accommodate their partners. It is easy to advise patients to simply reduce their stress and take a vacation, everyone is generally friendlier on vacation when the stress is down, but life makes this impossible for many of us.
T Cream to the Rescue
All of the bio-identical hormones are important to replace for energy and libido. Thyroid as I have often written is important, adrenal hormone support such as DHEA (dehydropepiandrosterone) which the body converts into T, progesterone also has a fairly direct pathway to manufacture T. The bio-identical T in the women’s size dose, about 1/10th the male dose, is very effective to restore libido and good mood. Men can use from 5% to 10% T cream and women can use .5% to 3% cream. The cream can be applied vaginally several times per week and to the pelvic floor to improve incontinence and prolapse of the bladder and uterus. As in all hormone replacement therapy the dosage is empirical, see what dosage relieves symptoms without side effects. Side effects include acne, facial hair or breast hair and in extreme cases it can cause hoarseness. Thankfully, jaw line acne is usually the first sign of taking too much T and it resolves with reduction of the dose. Blood tests and 24 hour urine collections for all the hormones and specifically T and DHEA can be a good starting point but don’t really reflect the dosage level ultimately needed by the patient.
We have many happy patients and partners when the libido, mood and energy are restored with the proper bio-identical hormone balance including testosterone when needed.
• The Miracle of Bio-identical Hormones by Michael Platt, MD Clancey Lane Publishing 2007
• Textbook of Endocrinology edited by Robert H. Williams, MD W.B. Saunders Company 1974