What happens to this hormone during menopause and how it can affect you
Testosterone has a significant influence on libido but also brain processing
Levels of this hormone drop during the perimenopause and menopause
Some women find testosterone replacement can help to alleviate their symptoms
Estrogen is the most common hormone used in hormone replacement therapy, also known as menopausal replacement therapy, but what about testosterone?
Testosterone is often referred to as the “male hormone”, but while men have higher circulating levels of testosterone than women, it’s the most abundant biologically active hormone in women. In fact, before the menopause, women produce 3 times more testosterone than estrogen.
As women, we often do not think about testosterone or consider that it is necessary and just as important as estrogen for health and vitality. Testosterone is produced in our bodies along with estrogen and progesterone.
It is perhaps best known for influencing libido, but testosterone has a significant impact beyond this.
Testosterone
strengthens nerves in the brain
contributes to mental sharpness and clarity
strengthens arteries that supply blood flow to the brain, which protects against loss of memory
regulates serotonin levels, which helps improve overall mood
stimulates the release of dopamine, another neurotransmitter responsible for your feelings of pleasure
helps with muscle mass and bone strength, cardiovascular health, and overall energy levels and quality of sleep
Levels of testosterone gradually decline as we enter our 30s, Our ovaries are producing lower levels and many middle-aged women have “low” testosterone levels that drop around the time of the perimenopause and menopause.
If you have a surgical menopause (if you have your ovaries removed, or an operation or treatment that impacts ovarian function), you can experience a more sudden drop in hormones than women who go through menopause naturally.
Signs of low testosterone include:
Low sex drive
Difficulty reaching orgasm
Lack of energy and feeling tired
Loss of strength and muscle tone
Infertility or trouble conceiving
Irregular menstrual cycle
Hot flashes
Vaginal dryness
Urinary incontinence
Depression or anxiety
Thinning hair and dry skin
Problems with sleep
What can be done? Do you need to replace your testosterone?
Just like estrogen, testosterone can be safely used as a hormone replacement therapy during menopause. Still, not many people know that, because it’s not well-studied or officially FDA-approved for women.
The testosterone patch is approved in Europe for treating low sexual desire associated with distress in surgically menopausal women who are also on estrogen therapy, but the United States and Canada are waiting for further long-term safety data before deciding on approval.
Some testosterone products approved for men are prescribed for women (called “off-label” use) but in much lower doses than used for men (usually, 1/10th of the dosage).
There is a good evidence to show that the benefits of testosterone could help many more women in their perimenopause and menopause. Menopause specialists and, increasingly, GPs are realizing the widespread benefits of testosterone replacement for most women.
Testosterone can be considered soon after the onset of perimenopausal or menopausal symptoms, when you go to seek help for your symptoms.
To maximize treatment, a thorough assessment of physiological, psychological, lifestyle, and relational factors is needed.
Before considering testosterone therapy, it is best to evaluate any related health concerns, including a thorough sexual history and physical examination.
It is recommended you look into safe and effective strategies that include a whole body and lifestyle approach to address intimacy needs, desires, communication and relational work in the relationship.
These modalities of support and treatment might include relationship counseling, stress management, sex therapy, and treatment for vulvo-vaginal atrophy, and/or other menopausal symptoms including hot flashes.
Levels of Total Testosterone and SHBG are usually measured before initiating therapy. The blood tests can look at both the total testosterone levels in your body, and also the amount which is freely available by adding a SHBG level (sex hormone binding globulin) to calculate your FAI (free androgen index).
Blood tests are usually needed a few months after starting testosterone treatment to ensure your levels are within the ‘female’ range. The dosage can be adjusted accordingly, depending on both your levels and whether you have ongoing symptoms of low testosterone.
How is testosterone treatment given?
Testosterone is usually given as a cream or gel, which you rub into your skin like a moisturizer. It is then absorbed directly into your bloodstream.
Injections, are not recommended because it is hard to measure out exactly one-tenth of the dose given to men.
Testosterone pellets are another option that are implanted under the skin, but they are given at higher doses which often have more side effects, so a doctor may first recommend starting on the lower dose gel first.
You may have to go to a specialist, such as urologist, because many OB/GYNs don’t regularly prescribe testosterone because they don’t have as much experience with it.
The typical dose of testosterone given to men is about 50 milligrams a day in a gel format, and the dose given to women will be very low: 5 milligrams.
Is there anyone who shouldn’t take testosterone?
Testosterone is contraindicated in pregnancy, as it could increase risk of birth defects. And anyone who already has signs of excess androgens, such as PCOS, may not be the right candidate for testosterone therapy.
Aging does not mean suffering in silence.
Hormones are very safe medications when you think about what types of drugs are given to people, between anxiety and depression drugs, narcotics, and the like.
Hormones are one of the safest medications, in terms of risk profile, to improve your quality of life. Your body is changing and while these are normal changes, you can be better armed with information and so that you have the confidence to talk with your healthcare provider and/or your partner, and identify the best course of action.
Do not be afraid to ask for support, and seek the treatments that suit you and your needs.
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