10 Myths of Testosterone Therapy in Women
10 Myths of Testosterone Therapy in Women
Although testosterone therapy is being increasingly prescribed for men, many questions and concerns about testosterone (T) and in particular, T therapy in women remain. Testosterone (T) therapy is being used more and more to treat symptoms of hormone deficiency in pre and postmenopausal women. Below are 10 Myths & Facts to help you better understand the science behind testosterone therapy.
Myth #1: Testosterone is a male hormone.
Testosterone is generally referred to as the “male hormone” when in fact, testosterone is the most abundant active sex steroid in both men and women. The Testosterone numbers appear to be less than Estrogen on your lab report, but that’s just because the units of measurement for Testosterone are 10-fold higher.
Fact: Testosterone is the most abundant biologically active hormone in women.
Myth #2: The only role of Testosterone in women is sex drive and libido.
Testosterone’s effect on sex drive and libido is actually only a small part of its role in women. Androgen(testosterone) receptors are located in almost all tissues in the female body. This means that with the gradual decline of testosterone and other androgens that happens with age, both men and women may experience anxiety, irritability, depression, lack of well-being, physical fatigue, bone loss, muscle loss, insomnia, hot flashes, joint pain, urinary complaints and incontinence, as well as, sexual dysfunction. Functional, biologically active, androgen/testosterone receptors are located throughout the body in both sexes and testosterone therapy is crucial for both.
Fact: Testosterone is essential for the physical and mental well-being of women.
Myth #3: Testosterone masculinizes females.
It has been recognized for decades that Testosterone is dose dependent and at lower doses it can actually make you more feminine. While large doses of Testosterone may cause some side effects, true masculinization is not possible. Unwanted androgenic effects of T are reversible by lowering the dose, although most women are so happy with the benefits that they prefer to treat the side effects rather than lower the dose. And, most unwanted effects are seen with synthetic androgens rather than the bioidentical Testosterone used in our pellets.
Fact: Apart from supra-pharmacologic doses of synthetic androgens, testosterone does not have masculinizing effects on females.
Myth #4: Testosterone causes hoarseness and voice changes.
There is no evidence that Testosterone causes hoarseness and no mechanism physiologically by which it could. In fact, Testosterone deficiency can be a cause of hoarseness, likely due to the anti-inflammatory effects of T.
Fact: There is no evidence that testosterone therapy causes hoarseness or irreversible vocal cord changes in women.
Myth #5: Testosterone causes hair loss.
Hair loss is poorly understood and is the result of a combination of many factors including genetics. There is no evidence that Testosterone or T therapy is a cause of hair loss in either men or women. Dihydrotestosterone or DHT, not Testosterone, is believed to play a role in hair loss in men and this is often seen along with many other factors that increase conversion of Testosterone to DHT and factors that lower Testosterone and increase Estrogen. This includes obesity, insulin resistance, age, alcohol, medications, stress, nutritional deficiencies, and a sedentary lifestyle. Many women treated with Testosterone Pellets experience scalp hair regrowth.
Fact: Testosterone therapy actually increases scalp hair growth in women.
Myth #6: Testosterone has adverse effects on the heart.
There is no evidence that bioidentical Testosterone has adverse effects on the heart. In fact, evidence overwhelmingly suggests that it is cardioprotective. This is because Testosterone is beneficial for glucose metabolism and lipid profiles. It increases lean body mass and has a beneficial effect on cardiac muscle. It has also been used to treat and prevent diabetes and CV disease and it acts as a vasodilator, which is the same effect of some blood pressure medications. On top of that, Testosterone calms the immune system and therefore decreases the formation of atherosclerotic plaques.
Fact: There is a great deal of evidence that testosterone is cardiac protective and that adequate levels decreases the risk of cardiovascular disease.
Myth #7: Testosterone causes liver damage.
While high doses of synthetic androgens taken orally are absorbed into the liver circulation and cause adverse effects, Testosterone pellets or patches actually bypass the liver and cause no problems with the liver, liver enzymes or clotting factors.
Fact: Non-oral testosterone does not adversely affect the liver or increase clotting factors.
Myth #8: Testosterone causes aggression.
The increase in aggression and rage seen with anabolic steroids does not occur with Testosterone therapy. In fact, there is a good bit of evidence that links aggression and hostility to Estrogen, not Testosterone. A study conducted in 2011 actually showed decreased aggression, irritability and anxiety in over 90% of women treated for symptoms of androgen deficiency.
Fact: Testosterone therapy decreases anxiety, irritability and aggression.
Myth #9: Testosterone may increase the risk of breast cancer.
It has been long recognized that breast cancer is an estrogen-related cancer and that Testosterone, as an ‘antagonist’ to estrogen, could be used to treat many estrogen sensitive diseases including breast cancer. One study showed that testosterone, given with an aromatase inhibitor (to prevent the conversion of testosterone to estrogen) caused tumors to shrink or even disappear. (2)
Fact: Testosterone is breast protective and does not increase the risk of breast cancer. It may even prevent it.
Myth #10: The safety of Testosterone use in women has not been established.
Testosterone pellet implants have been used safely in women for decades and there is ample data to support the effectiveness, safety, and tolerability for up to 40 years of treatment. Many safety concerns of Testosterone are related to the use of oral formulations or are related to the conversion of Testosterone to Estrogen by aromatase in the body. We know that the activity of aromatase is increased by factors such as obesity, alcohol intake, insulin resistance, medications, drugs, processed diet and sedentary lifestyle and we monitor these factors closely, along with estrogen levels and symptoms of elevated estrogen.
Fact: The safety of non-oral testosterone therapy in women is well established, including long-term follow up.
For more information on Testosterone Pellet Therapy or other BioIdentical Hormone Replacement at Foundations Medical Center, contact our office at (850) 269-9000.
(1) Glaser, R., & Dimitrakakis, C. (2013). Testosterone therapy in women: myths and misconceptions. Maturitas, 74(3), 230–234.
(2) Glaser, R., & Dimitrakakis, C. 2015. Testosterone and breast cancer prevention. Maturitas, 82(3), 291–295.