Case Study of a Woman with Testosterone Deficiency:
Michelle, with her falling sex drive, excessive emotions, and eternal doubting. Michelle is an attractive young lady of 30 years.
Because of her pretty, feminine body, she is sought after by men, but Michelle has one big problem. Although she desperately needs and seeks affection, she does not really feel sexually attracted to men of any type, even though she is not gay. Her libido is near zero, and having sex with men is just such a boring, tiresome activity. She has had very few orgasms. The few times it occurred, it took such a long time and effort to achieve it, that her partner stopped trying to make her orgasm again. Physically, she looks pale and has thin muscles. Sports are not her field of interest, as physical activity tires her easily. Emotionally, she is known for anxiety, hesitancy, and lack of assertiveness.
Michelle is rather short-tempered. From time to time, she explodes into outbursts of anger or anxiety that sometimes approach hysteria. She has taken birth control pills from puberty onward–not for contraception, but to get rid of her painful menstrual cramps. In her late teens, as she had started to have acne, she took a pill that contained a medication that blocked her testosterone activity, which only seemed to aggravate her problems.
What is the source of Michelle’s problems?
Most of Michelle’s problems are typical of a testosterone deficiency. To better understand the impact of this deficiency in women, and what can be done about it, let’s review some basic information on testosterone.
Roles of Testosterone in Women:
Testosterone performs the following important roles in women: Improvement of mood and assertiveness, reduction of depression and anxiety, improvement of bone density, improvement of muscle size and strength, enhancement of sex drive and sexuality, and sexual sensitivity, maintenance of the female genital system, nipples, labia majoras (valvula lips) and in particular, the clitoris size and sensitivity. It also has possible protection against atherosclerosis. In two studies, higher levels of testosterone in women as well as higher levels of DHEA, were found to be significantly associated with thinner intima media of the carotid arteries, which lowers the risk of atherosclerosis.
Progressive Decline of Testosterone With Age:
The decrease occurs earlier and initially at a greater rate for women than men. A study reported that the average testosterone blood level in a woman of age 40 is less than half of that in women of 21 years of age.
Female Testosterone Deficiency–Diagnosis:
From puberty, we see a thin, poorly-developed patient’s muscles, and under-developed sex drive without orgasms. There is anxiousness and little self-assurance. There is inability to achieve orgasm.
Complaints of Testosterone Deficiency in Women:
Depression, excessive anxiety, fears, excessive emotions, low resistance to stress, unnecessary worry, decreased or absent libido, clitoris and nipple sensitivity, and orgasms. There is also vaginal itching at times, as well as painful intercourse.
Physical Signs of Testosterone Deficiency in Women:
The patient appears pale, slumped, fragile, older-looking than she is. There is kyphosis. Often there is overweight and even obesity with accumulation of fat on the breasts, abdomen, and hips. There is loss of height. The face appears pale, with poor muscles, small wrinkles at the corners of the eyes, and small wrinkles above the lips. The eyes are dry, and there is decreased axillary and pubic hair. Muscles show poor volume. There is a flabby belly and increased abdominal fat. Of note, there is usually cellulitis of the thighs and varicose veins of the legs.
Lab Tests for Testosterone Deficiency in Women:
The best tests to evaluate daily testosterone production are total testosterone, free testosterone, and DHEA sulfate, as in women more than 90% of testosterone comes from DHEA.
When to Do Lab Tests for Followup Testosterone Treatment:
I typically perform hormone levels in the female patient days 17 through 21 of the menstreul period.
Female Testosterone Deficiency Treatment:
In my practice, I use bio-identical hormones, such as DHEA, Pregnenolone and natural testosterone. In most patients, testosterone can be initially started at a low dose to bring women into complete relief. I prefer transdermal creams and balance testosterone with another female hormone called DHEA, as well as progesterone.
When a woman has excessive body hair, I tend to be cautious. I start at half the dose of testosterone and gradually work up. In women who have a high tendency to grow body hair, at times I add Proscar or Propecia at a dose of 2-2.5 mg, which is a 5 alpha reductase inhibitor to inhibit the conversion of testosterone to dihydrotestosterone, the hormone that grows body hair. Finasteride or Proscar works well in most women.
Progress with Testosterone Treatment in Women:
How soon are the first improvements noted? Testosterone replacement works slowly. The first improvements are usually emotional and sexual, and appear during the second, third, and fourth month of treatment. Improvements in muscle mass and bone density take more time–4 to 8 months–before any clear signs are seen. Women who eat more foods that increase testosterone levels and efficacy, such as animal protein, and avoid eating meat, which lowers testosterone levels, such as grains, sugars, and alcohol, usually get quicker effects.
Contraindications to Testosterone Treatment in Women:
Absolute contraindications are limited to breast cancer. Because testosterone may be converted into estradiol, I measure all my patients’ hormone levels prior to initiation of therapy. I start with an extremely small dose and gradually titrate up the dose in every female to keep them optimal.
How to Boost Testosterone Treatment in Women:
Follow a paleolithic diet of fruits, vegetables, meat, poultry, eggs, and fish, and eat organic. Avoid alcohol, vinegar, and caffeinated drinks. Avoid sugar, sweets, soft drinks, cookies, breads, pastas, and other cereals, avoid cereal fibers and avoid milk products.
Signs of Testosterone Excess:
The typical signs of testosterone excess include oily hair, acne, oily skin, excessive sex drive, excessive clitoral swelling, excessive muscle development, and excessive body hair.
Testosterone will make your life better, improving many, many symptoms of aging.