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Menopause
Women’s Health
Testosterone and women's health

Testosterone and women's health

Yes - as women we do have testosterone in our body. In fact, we have more testosterone in our body than we do estrogen (about 3-5x the amount). So, needless to say, testosterone plays and important role - and when hormone levels begin to change as a women approaches menopause, this includes testosterone.

What does testosterone do?

About 50% of the testosterone in our bodies is produced by the ovaries, the rest is produced by our adrenal glands which sit right above our kidneys. We mostly discuss testosterone in relation to men, as it is seen as a very masculine hormone. It is therefore commonly associated with its role in strengthening bones and muscles, and maintaining sperm and libido (sex drive). However, testosterone actually plays a very similar role in women. It increases dopamine levels (a chemical messenger in the body) and is therefore very important for sexual function, boosting libido, and sexual arousal. At younger ages, testosterone also contributes to the development of the reproductive organs. There is also evidence for its role in metabolic function (maintaining bone and muscle mass), and lower levels have been linked to low mood and feelings of depression.

How do testosterone levels change in women overtime?

When a women is still fertile (still having her period), testosterone levels will peak during menstruation in a very similar way that estrogen will. This is because testosterone plays an important role in the development of follicles - this is where the egg develops during ovulation. At the end of menstruation, testosterone will fall to baseline levels again, as does estrogen.

During menopause, testosterone will similarly change dramatically alongside estrogen. This is because 50% of the testosterone in our bodies is produced by our ovaries. So, when the reproductive cycle begins to slow down, all the hormones that the ovaries produce will also decline. Estrogen will still remain the hormone that decreases most significantly, however, testosterone will fall as well. Furthermore, the decreasing levels of estrogen will also directly impact the levels of testosterone, causing them to decrease more.

Premature ovarian failure or surgical menopause will have a more significant impact on testosterone, causing it to decline more than it would during a natural menopause. As such, one may feel the effects of low testosterone to a greater extent.

How does testosterone come into play during menopause?

As mentioned above, menopause will have the biggest impact on testosterone levels in the body, and the decreasing levels can cause menopausal symptoms. Just as the body needs to adjust to the decreasing levels of estrogen and progesterone, it also needs to adjust to the changing levels of testosterone.

The most prevalent symptom that is experienced as a results of low testosterone is a decreased sex drive and decreased sexual arousal. It is important to keep in mind, however, that there is an overlap between the symptoms associated with testosterone and those associated with estrogen and progesterone. We cannot simply denote specific symptoms to a decrease in testosterone. It is often the combination of all the reproductive hormones decreasing together that will drive menopausal symptoms. If, however, you are already on HRT, but are unable to shake certain symptoms, this may be a reason to evaluate your bodies testosterone levels. Symptoms that may prevail whilst on HRT as a result of low testosterone include:

  • Low libido
  • Headaches
  • Depression
  • Difficulty concentrating

What else may cause low testosterone?

Stress. Testosterone is also produced by the adrenal glands, the same glands which produce the stress hormone cortisol. When our stress levels are in overdrive, however, our adrenal glands will favour the production of cortisol, thus decreasing their overall output of testosterone. Chronic and prolonged stress will therefore ultimately result in less production of testosterone.

How can we measure testosterone levels in the body?

It can be helpful to measure your bodies testosterone levels - this can give you an idea of whether your testosterone levels are higher or lower than they should be. This can be especially important during menopause if you are looking to take additional testosterone. In fact, a blood test is needed before you start any form of testosterone replacement medication so that you have a baseline. You should always consult with your doctor before making this decision.

Measuring your testosterone can be done with a simple blood test. Something to be aware of, however, is that testosterone can be bound to a specific protein when travelling in the blood, known as sex hormone binding globulin (SHBG). When it is bound to this protein, the testosterone is inactive. This means your body can not use this hormone, and so it does not have an effect in your body. Free testosterone (not bound to a protein) will have an effect. If your free testosterone is low it can cause of symptoms - and so this is what you want to measure. Getting a test for free testosterone which is measured directly can be expensive. However, you can use a calculated measure as effectively. Your free testosterone can be calculated from a reading of your total testosterone and your SHBG. Both total testosterone and SHBG are relatively inexpensive tests, so ask for those two. The calculated reading is called a Free Androgen Index (FAI).

What can you do about low testosterone?

Currently, there are no testosterone products that are licensed for female use in the UK. We're hoping this is something which will change - and there are some amazing campaigners trying to make this happen.

The NHS and the NICE guidelines recommend that systemic HRT (with estrogen and / or progesterone) be tried primarily to address menopausal symptoms. If this HRT is unsuccessful, however, there are unlicensed testosterone products that meet the safety and efficacy requirements, and that women can use if deemed appropriate by a doctor. These come in the forms of gels and creams, and include:

  • Androfeme - Testosterone cream
  • Testogel - Testosterone gel
  • Tostran - Testosterone gel

You can also try and combat low testosterone through lifestyle interventions if you are unable to, or would prefer not to use medication.

  • Strength training and weight loss - Excess weight can interfere with your bodies natural production of hormones.
  • Dieting - but you want to be careful here. Extreme dieting can also interfere with hormone production in your body. The best approach would be to maintain a balanced and healthy diet.
  • Reducing alcohol consumption

Deciding on any treatment course for your menopause can be a difficult decision. And, testosterone is not often discussed as a treatment option. It requires a baseline blood test, and a consultation with a doctor who understands testosterone prescribing.

References
  1. thriva, 2021. S3 E6. [podcast] How does testosterone affect women's health?. Available at: https://thriva.co/hub/podcast/testosterone [Accessed 2021].

  2. 2020. Testosterone explained - a British Menopause Society video.

  3. British Menopause Society. 2021. Testosterone replacement in menopause | British Menopause Society. [online] Available at: https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/ [Accessed 2021].

  4. Hirschberg, A., Elings Knutsson, J., Helge, T., Godhe, M., Ekblom, M., Bermon, S. and Ekblom, B., 2019. Effects of moderately increased testosterone concentration on physical performance in young women: a double blind, randomised, placebo controlled study. British Journal of Sports Medicine, [online] 54(10), pp.599-604. Available at: https://bjsm.bmj.com/content/54/10/599 [Accessed 2021].