Testosterone: A major breakthrough for menopausal women

Hailed as a “prescription for passion” by some and condemned as the “rage steroid” by others, testosterone is the most celebrated, feared and misunderstood of all hormones.

Our culture lauds this substance’s leading role in male virility and casts it as the villain in acts of violent crime. In truth, testosterone is neither miracle nor monster, but rather, a key player in the complex chemistry of human hormones. When balanced by other hormones, testosterone, also known as androgen, plays a lead role in the health and well-being of both sexes.

These days, many menopausal women are turning to testosterone to provide what estrogen alone cannot—renewed sexual desire. Psychiatrist Dr. Susan Rako believes testosterone therapy is a major breakthrough for midlife women. Understanding that testosterone deficiency may be to blame for a loss of interest in sex in an otherwise happy relationship, she points out, could prevent much unnecessary anguish.

Dr. Rako’s book, “The Hormone of Desire: The Truth About Sexuality, Menopause and Testosterone,” is one of a growing wave of publications heralding the importance of this hormone to women’s health. Although androgen therapy is controversial, several small-scale studies and anecdotal evidence from women and clinicians suggest that individualized dosages provide a number of therapeutic benefits.

Testosterone Fuels a Woman’s Desire

Just as men’s bodies manufacture small amounts of estrogen, women’s bodies produce testosterone through the ovaries and adrenal glands. A multitalented hormone, testosterone boosts both libido and energy, maintains muscle mass, strengthens bone and ensures the nipples and clitoris are sensitive to sexual pleasure.

As we age, our bodies produce less androgen (testosterone), estrogen and progesterone. By age 40, women produce about half the testosterone we did in our twenties. These levels drop further still with the onset of menopause or for women who have had their ovaries removed. Many clinicians believe that the diminished energy, decreased sexual desire and “flatness” of mood that some women experience during and after menopause are directly related to declining levels of testosterone.

Hormone Replacement Therapy and Testosterone

Doctors traditionally respond to menopausal complaints by dispensing prescriptions for estrogen and progesterone, traditional “female” hormones that address some of the discomforts of menopause and provide the added advantage of protecting against heart disease, Alzheimer’s disease and osteoporosis. But although estrogen can quench hot flashes and ease vaginal dryness, it does little to enhance libido or energy.

Several studies suggest, however, that small amounts of androgen added to estrogen replacement therapy can restore sexual desire, improve energy and promote a sense of well-being. And that’s not all. Testosterone also helps prevent bone loss, improves body composition (building lean mass and reducing body fat) and supports cognitive function.

Clinicians such as Dr. William Regelson, M.D., author of “The Superhormone Promise,” argue that testosterone is the missing link in hormone replacement therapy. “For many women who feel they are not quite themselves,” he says, “the ingredient missing from the blueprint is testosterone.” He has found that adding testosterone to the hormonal “cocktail,” even for a short period of time, duplicates our “normal hormonal state” and helps women better tolerate estrogen and progesterone.

Finding the Right Balance

Researcher Dr. Barbara Sherwin, a professor of psychology at McGill University, conducted a study on women who had their ovaries removed (ovaries produce nearly half of a woman’s testosterone) and found that when given a combination of testosterone and estrogen, these women were more interested in sexual intercourse.

They also experienced more orgasms and greater pleasure. Dr. Sherwin suggests that short-term therapy is sufficient for some women, while others may need longer-term dosages.

Still, some members of the medical community have not embraced androgen therapy for women. Many physicians are reluctant to prescribe androgen because there are relatively few studies on women and testosterone. The long-term effects are unknown.

Critics point out that without long-term studies to support its efficacy and safety, testosterone should be used cautiously, if at all. That’s because it can have unfavorable effects on cholesterol levels, primarily decreasing HDL “good” cholesterol. This in turn tends to negate the positive effects of estrogen on the cardiovascular system.

Some also argue that fatigue and low libido can stem from any number of nutritional, medical or psychological conditions. Even androgen’s most fervent advocates agree that the hormone should be prescribed on a case-by-case basis to menopausal women who are otherwise healthy. They caution that this therapy is not appropriate for women of childbearing age. Not only do younger women produce sufficient androgen, but also excess levels can cause serious damage to a developing fetus.

The key, agree doctors, is to tailor dosages to the individual needs of women rather than providing a “one size fits all” prescription. This ensures that women can reap the benefits of this therapy without experiencing unwanted side effects such as masculinization, facial hair or acne.

The DHEA Option

Testosterone is available in pills, lozenges, patches, gels and injections. Although there are advantages and disadvantages to each, most clinicians will not prescribe pills, which can increase the risk of liver toxicity and lower levels of HDL (the “good” cholesterol).

A slightly “milder” alternative to testosterone is DHEA (dehydroepiandrosterone). This steroid hormone is a precursor of testosterone, meaning that the body converts DHEA into testosterone. Supplementary DHEA, which is available in pill or cream form, increases testosterone levels by one-and-a-half to two times. So it’s not surprising that DHEA provides many of the same therapeutic benefits, including increased sexual interest and enhanced physical and mental satisfaction.

If both testosterone and DHEA levels are depleted, women’s health pioneer Dr. Christiane Northrup, M.D., recommends replenishing DHEA. If DHEA, which can require about four months to work its magic, is insufficient, she recommends switching to testosterone. For those who choose testosterone, Dr. Northrup favors a natural version over those made from equine estrogens and methyl testosterone.

Formulary, or compounding pharmacies create natural hormones that are customized to individual needs. To learn more about natural hormones, call the Women’s International Pharmacy at (800/279-5708). To locate a formulary pharmacist in your area, contact the International Academy of Compounding Pharmacists at (800/927-4227). Their Web address is http://www.iacprix.org.

If you think you might be a candidate for androgen therapy, here’s what to do:

• Request a health screen from your clinician
  Have your testosterone, DHEA and estrogen levels measured. Normal concentrations of testosterone range from between 25 and 100 nanograms per milliliter of blood. Some clinicians also recommend an at-home saliva test that checks “free” hormone levels (these are the active hormones), not just total levels. You can order a saliva test on your own from Bio Health Diagnostics (800/570-2000), Aeron LifeCycles Laboratory (800/631-7900) or Great Smokies Diagnostic Laboratory (800/522-4762). The results will enable your health care practitioner to fine-tune your hormonal “cocktail” (prescription) so that it is individualized to your specific needs.
• Eat a well-balanced diet to stabilize your hormones
  Fiber and foods rich in minerals, such as potassium and magnesium can help balance hormones. Tofu, tempeh and other soy products are excellent sources of phytoestrogens, plant compounds that behave like mild estrogens in the body, helping relieve menopausal symptoms. Other sources of phytoestrogens include apples, alfalfa, cherries, potatoes, rice, wheat and yams. A diet rich in fruits and vegetables will also help maintain optimal health as you transition into menopause.

If you begin androgen therapy, be sure to report any side effects to your doctor so he or she can monitor your progress and adjust your dosage as necessary.

Although it is not for everyone, emerging research may reveal androgen to be one of the most promising therapies available to menopausal women. Sexuality and vitality need not be passing pleasures of youth.