The epidemic spread of low testosterone levels in women

Here is a brief summary:

1. The percentage of women between the ages of 18 and 59 who suffer from "sexual dysfunction" is nearly 50%. Much of this sexual dysfunction is related to a lack of testosterone.
2. Women with low testosterone levels often find it harder to build muscle or burn fat.
3. There are several potential causes for such a testosterone deficiency, which include the use of birth control pills, the use of antidepressants, the consumption of soy milk, a vegetarian diet or even psychological factors.
4. Although it can be problematic for women to receive testosterone replacement therapy, there are different possible approaches, which include pharmaceutical approaches, the use of supplements, dietary changes and some simple lifestyle changes.

Have you got it?

Athletes who compete at the highest level, defense attorneys, CEOs of the Big 500 companies: all of them probably have it. Maybe you also know some of the women in your daily life who have it. They're the ones who might dress a little more flamboyantly or even extravagantly. They seem to build muscle faster and lose fat easier at the gym than many other women and there always seems to be one, two or three men trying to hit on them. Compare this to women who don't have it. They may lack ambition and may prefer to let others make their decisions. They may dress more inconspicuously and hope to blend into the crowd rather than stand out. They may not understand all the fuss about sex, and if they do agree to have sex (they rarely take the initiative), they usually don't experience satisfaction. And when it comes to exercise, they find it hard to lose fat or build curvy muscles and never seem to get the results they hope for.

The "it" I'm talking about here is high or at least normal testosterone levels. While testosterone replacement therapy for men has become big business, no one really seems to care about the role testosterone plays in women - at least as far as premenopausal or even young women are concerned.

With this in mind, it's worth remembering that some studies report that the percentage of women between the ages of 18 and 59 who suffer from "sexual dysfunction" is close to 50%. This dysfunction is usually attributed to underlying depression, leading to quick referrals to psychiatrists or psychotherapists, but more and more scientists and doctors are beginning to look at female testosterone deficiency as the culprit - and they may be right, because testosterone plays a major role in the physiology, psyche and sexuality of both women and men.

Hyenas, ovaries, and adrenal glands, my goodness!

One of the reasons that testosterone gets so little attention in discussions of female health is that women simply don't produce much of it, but this is one of the reasons that the whole subject is so often misunderstood. Sure, men usually produce 8 to 10 times more testosterone than women, but that doesn't mean that the average healthy man is 8 to 10 times more masculine than the average woman. No, in women, testosterone is just one part of a complicated chemical profile, which results in them being much more sensitive than men to the effects of testosterone. So a small amount will have a big effect. And even though oestrogen is considered by many to be the only important sex hormone in women, testosterone levels in healthy women are ten times higher than their oestrogen levels. Obviously, the overall hormonal picture is much more complicated than many people assume. About a quarter of a woman's testosterone production comes from her ovaries, while another quarter is produced by the adrenal glands. The remaining half is produced in the peripheral tissues from different chemical precursors produced in the ovaries and adrenal glands. The primary precursor is androstenedione. Much of this androstenedione is converted into estrone - a form of estrogen - but some can also be converted into testosterone.

If you need a real-life example of the power of these chemical precursors, think of a hyena - a matriarchal species in which the females call the shots. Normally, hyenas have perfectly usable levels of an enzyme that converts androstenedione to estrogen. During pregnancy, however, there is a drop in the levels of this enzyme, so that a lot of the androstenedione is converted into testosterone instead.

The resulting high testosterone levels affect the babies so much that females at birth have masculinized external genitalia with a penis-like clitoris and an empty scrotum that they could probably use to store discount stamps, change or hyena make-up. The result is a female mammal who is ruthless with the hapless male hyenas.

Obviously this doesn't happen in humans, but there is still some conversion of androstenedione to testosterone. All of this is important because all of these factors contribute to female health. Without adequate levels of testosterone (and therefore its precursors), women can suffer from declining energy levels and a poorer sense of well-being, regardless of their age.

Low testosterone levels (just like in men) also play a role in weight gain and the ability to build muscle, and they can also play a major role in libido. In fact, one of the surest signs of low female testosterone levels is HSDD - also known as hypoactive sexual desire disorder - which is characterized by "persistent or recurrent lack of or absence of sexual thoughts and fantasies and/or absence of desire for or receptivity to sexual activity, causing personal distress or interpersonal difficulties."

One of the earliest studies showing a link between female sexual desire and reduced testosterone levels was published in 1959, but acceptance was quite low. I guess this isn't too surprising, as at the time it wasn't even scientifically proven that women had orgasms until Masters and Johnson started fitting women's sexual organs with electrodes.

Fortunately, the link between testosterone and the female sex drive is now quite well established. Studies have shown, for example, that female testosterone levels increase during ovulation and that there is a corresponding increase in the frequency of sexual intercourse during this period. Even if women do not always initiate sex during ovulation, they are at least more receptive to sexual advances. It should also be noted that behavioral endocrinologists have noticed that women dress a little more provocatively during the ovulation phase to attract the attention of would-be sexual partners, although this probably occurs on a subconscious level.

Unfortunately, there is not much data on what "normal" female testosterone levels are, but our current best estimate is that a total plasma level of less than 25 ng/dl in women under 50 can be considered a testosterone deficiency. The problem is that doctors don't typically measure women's testosterone levels. In fact, historically, the only time doctors thought about female testosterone levels was when they suspected that a woman's testosterone levels might be too high, perhaps manifesting in the form of excessive facial hair growth, hair loss, infertility or acne.

But things are starting to change and it's high time, as the number of women with reduced libido (and likely many of the other symptoms of low testosterone levels) is estimated at 10 to 15 million in America alone, and not all of these women are in their forties or above. In fact, many are in their twenties or thirties. If this is true, then this certainly represents an epidemic of low testosterone levels, but what could have caused this epidemic?

The irony of the birth control pill

In 1950, a woman named Margaret Sanger teamed up with a wealthy, like-minded feminist named Katherine Dexter McCormick to initiate and fund the development of the first birth control pill. This was a breakthrough for women all over the world. It liberated them sexually, but paradoxically, the birth control pill also contributed greatly to lowering female libido and inhibiting or even preventing female orgasm altogether. Even though women were now sexually free, they did not use this freedom to their advantage. Sales of cats, yarn and knitting needles increased dramatically. A side effect of the contraceptive pill (and also oestrogen therapy) is that it reduces ovarian testosterone production and at the same time increases the production of a chemical called steroid hormone binding globulin (SHBG) by a factor of 10. SHBG binds a large proportion of the remaining testosterone so that it is not available to the body. The result is a decreasing sex drive and the manifestation of other symptoms of low testosterone levels. Even more worrying, however, is the fact that the contraceptive pill can have long-lasting effects on female libido. A study of 125 young women from a sexual dysfunction clinic showed that women who had been off the pill for a year still had SHBG levels 7 times higher than women who had never used the pill. In America, about 11 million women use birth control pills, but there are numerous other medications that also affect testosterone levels. Tragically, doctors rarely - if ever - mention low testosterone levels as a side effect with these medications, which is especially true when these drugs are administered to women.

These medications include antidepressants - especially selective serotonin reuptake inhibitors (SSRIs), antihistamines, blood pressure medications, antibiotics, gastrointestinal medications and sleep aids. (Recreational drugs and alcohol can also lower testosterone levels).

Women who use these medications often report delayed or absent orgasms, but many probably also suffer from some of the other effects of low testosterone levels (lack of energy, weight gain, an inability to build muscle, etc.) that they might not associate with low levels of this hormone. But there are also non-pharmaceutical causes of low testosterone levels in women that have to do with diet.

Soy milk and vegetarian diets

I don't know if it was the ad execs, the granola munchers, or a mass conspiracy perpetrated by a bunch of diabolical yoga teachers that convinced women that daily consumption of soy milk was healthy. The truth seems to be that chemicals found in soy milk, called isoflavones, play around with hormone levels in women (and men). Although it seems safe to say that soy may have some benefits in menopausal women, as it mimics some of the effects of estrogen and can relieve menopausal symptoms, some scientists have shown that soy, like the birth control pill, increases SHBG levels and negatively affects testosterone levels in younger women. In addition, there is some evidence that a vegetarian diet in general - whether or not it contains soy - may also affect testosterone levels. Many plants contain chemicals such as daidzein (which is also found in soy), enterolactone and equol, which dock onto hormone receptors and block them for testosterone (and also estrogen). Part of the reason for low testosterone levels may also have to do with zinc deficiency, which is commonly seen in vegetarians, as low levels of this mineral often correlate with low testosterone levels. While medication and diet can be clear potential causes of low testosterone levels in women, simply being overweight or not exercising could also cause low testosterone levels. There are also psychological and emotional correlates, and simply not being in a loving relationship and/or suffering from a chronic lack of intimacy can be enough to lower testosterone levels.

And of course, there are also numerous medical causes - some less serious, some more serious - which include adrenal gland insufficiency, hypopituitarism and premature ovarian failure.

How to get your testosterone mojo back

The pharmaceutical approach

Admittedly, treating low testosterone levels in women in their twenties and thirties is controversial, but considering the important role this hormone plays in physical and mental wellbeing, it may be worth considering given the numerous pharmaceutical, dietary or lifestyle factors that can contribute to low testosterone levels. In the pharmaceutical field, there are a number of different products that can be used by doctors to treat low testosterone levels. These include creams, patches, injection solutions and pellets that are implanted under the skin. Traditional testosterone injections have numerous disadvantages, including a common phobia of injection needles and regular visits to the doctor every 2 to 6 weeks. In addition, some women metabolize the depot solution faster than others, which would necessitate more frequent injections.

Dosages are also a bit problematic as there are no defined standards yet. Some doctors might inject 75 to 100 mg of a depot testosterone every 4 to 6 weeks, while other women might do better with just 15 mg every 2 weeks. Finding the perfect dosage would require some trial and error and perfect cooperation between doctor and patient.

Another alternative is the use of testosterone creams, which were actually developed for testosterone replacement therapy in men. These are products that contain a low amount of testosterone of 1% and are applied to the shoulders, upper arms or abdomen after showering. These creams provide a constant supply of testosterone for about 24 hours.

Ultimately, however, the treating physician must decide on the right form of potential testosterone replacement therapy.

The supplement approach

Another possible approach is to take testosterone precursors in supplement form. However, although there are numerous supplements that can increase testosterone levels in men, almost all of these supplements work by either directly or indirectly stimulating the testicles to produce more testosterone. In women, however, nothing equivalent exists to stimulate the ovaries or adrenal glands to produce more testosterone.

However, women have the option of using DHEA. This substance is a hormone secreted by the adrenal glands and is a precursor of oestrogen and testosterone. As with testosterone, levels of this hormone peak in the twenties and begin to decline each decade thereafter. However, the use of a DHEA supplement can rapidly increase inadequate testosterone levels. A 2002 study of women between the ages of 35 and 55 reported increased desire, increased arousal, increased wetness and more intense orgasms in women who took 50 mg of DHEA daily.

An article published in 2002 in the World Journal of Urology suggests that women with low testosterone levels should start taking 50 mg of DHEA every morning. If there are no improvements after 2 to 3 months (the authors of course recommend that testosterone levels be measured by a doctor), the dosage can be increased to 75mg or even 100 mg per day if necessary.

DHEA is not a panacea for low testosterone levels. It may just as easily fail to significantly increase testosterone levels, or most of this chemical may be converted to estrogen instead of testosterone.

The lifestyle approach

There are several fairly simple lifestyle changes a woman can make that could increase her testosterone levels. The most obvious of these is to stop taking the birth control pill and use another method of contraception if a woman feels that her birth control pill may be causing a problem. She could also review the need for using the different medications I have mentioned and perhaps talk to her doctor about alternatives that do not affect testosterone levels. For example, there is evidence that some antidepressants can increase female libido, although it is not yet known whether this is related to an increase in testosterone levels or some other mechanism.

Exercise - more specifically, training with weights - is also reported to increase testosterone levels in both men and women. However, this increase is not long-lasting and only lasts for a few hours, but even a temporary increase in testosterone levels, if it occurs almost every day, could have far-reaching effects.

Sex itself can also increase testosterone levels, but whether this increase is more pronounced in women who are in a stable relationship than in women who only have a one-night stand is not known. However, it is known that women who are in a committed relationship often experience an increase in testosterone levels, while testosterone levels often drop significantly in men who are in such a relationship (perhaps to ensure that the man does not cheat).

There are also somewhat less clear psychological approaches to increasing testosterone levels in women. Men often experience an increase in testosterone levels after winning a competition of any kind. Also, when men lead a stress-free life and are satisfied with themselves, testosterone levels rise accordingly.

Self-esteem also seems to play a role in testosterone levels in women and although there is not as much research to support this, my experience leads me to believe that it is the same for women. Winning a competition should also lead to an increase in testosterone levels in women, even if only fleeting. In fact, anything that reinforces the feeling of being a "winner" should work in this direction.

It's time to recognize the important role that testosterone plays in women

However you look at it, despite its reputation in literature, folklore and popular culture, testosterone is not just for sweaty men for whom grunting has replaced several hundred words. It also plays an important role in female health, psyche and libido, just as it does in men.

FAQ on testosterone replacement therapy for women

Q: What specific benefits could I get from testosterone replacement therapy if my natural testosterone levels are low?

A: In general, women who increase their testosterone levels may experience an increase in bone and muscle mass, a reduction in excessive body fat and increased sexual desire, as well as increased sexual satisfaction along with more energy, more ambition and more enjoyment of life.

Q: Are there any dangers and risks associated with the use of prohormones or testosterone?

A: If a woman uses too much testosterone or testosterone precursors, this can result in unwanted growth of body hair and in extreme cases (when using too much testosterone over a long period of time) deepening of the voice, growth of the clitoris, acne, shrinking breasts, hair loss and increased aggression. Such an overdose can also result in more serious side effects, as often happens when you challenge Mother Nature too much. However, in studies of women using testosterone in clinical quantities, no adverse side effects have generally been observed with regard to blood lipid levels, carbohydrate metabolism, blood pressure or cardiovascular health in general. Nor have there been any reports of an increased risk of breast cancer associated with testosterone replacement therapy.

Q: Can testosterone help women build muscle and burn body fat?

A: Yes, women with low testosterone levels often find it harder to build muscle, burn fat or be successful at exercise. It's also worth bearing in mind that female bodybuilders, figure class athletes and even bikini athletes use varying amounts of anabolic steroids, which are ultimately little more than synthetic testosterone derivatives. Obviously, almost all female bodybuilders use amounts of steroids that cause socially undesirable and generally irreversible physical changes such as those mentioned above.

Q: Can using testosterone affect my fertility?

A: This can only happen if testosterone levels are raised above normal for a prolonged period of time. However, testosterone replacement therapy could very well affect the sex of the child. At least one study came to the conclusion that women who have professions that typically correlate with high testosterone levels - e.g. criminal defense lawyers - have 58% male children. In contrast, women with occupations that typically correlate with high estrogen levels and low testosterone levels - such as beauty queens - usually have twice as many female babies as male babies.

Q: Are there women who should not consider testosterone replacement therapy under any circumstances?

A: Women who are pregnant or may become pregnant should avoid any type of testosterone replacement therapy. The same applies to women who suffer from high cholesterol levels, heart or liver disease or breast or uterine cancer. Irrespective of this, testosterone replacement therapy should only take place under medical supervision.

From TC Luoma
Source: https://www.t-nation.com/training/female-low-testosterone-epidemic