Testosterone After Menopause
Changes in sex drive, energy, and outlook may not be inevitable results of aging – they could be a sign of testosterone deficiency. “If women just don’t feel interested in sex – especially when they’ve had a normal, healthy, active sex life – then that’s a real clue that there’s a hormonal factor involved.” says women’s health specialist Dr. Elizabeth Lee Vliet.
The Overlooked Hormone
Testosterone is the strongest of the male sex hormones, or androgens. During the reproductive years, in addition to estrogen and progesterone (the female hormones), our ovaries are the primary producers of testosterone, which is an androgen. Other androgens, as well as a small amount of testosterone, are produced by the adrenal glands and fat tissue, along with small amounts of estrogen.
At menopause, the ovaries no longer release eggs and stop producing the potent forms of estrogen (estradiol and estrone) and progesterone. They also slightly decrease production of testosterone. The word slightly is important here because the lower amount of testosterone is less important than the fact that the ratio of testosterone to estrogen and progesterone changes.
Testosterone is important because it activates the sexual circuits in the brain for men and women, Dr. Vliet explains. It helps maintain normal energy levels, muscle tone, and a sense of wellbeing. And it actually helps in the formation of new bone.
Preventing osteoporosis, a disease in which the bones lose mass at an excessive rate and break easily, is a primary reason for adding testosterone to hormone replacement therapy after menopause, Dr. Vliet states.
Sex And The Older Woman
One woman in her sixties told Dr. Vliet: “My doctor said that’s just part of what happens when you get older, but I’ve just gotten married and I want to enjoy my sex life!”
When Dr. Vliet measured that woman’s testosterone level, it was less than 10 nanograms per deciliter of blood. Serum-normal levels in women range between 30 and 50 ng/dl when measured in blood and 20 – 50 picograms per milliliter when measured in saliva. (A nanogram is one billionth of a gram; a picogram is one trillionth of a gram).
“That doesn’t sound like much of a difference,” Dr. Vliet says, but “when you start dropping down below 20, it really is a significant decrease in the sexual arousal of the brain, physiologically.” (For comparison, normal blood levels for men range from 500-1,000 ng/dl.)
If a woman has a testosterone deficiency, many physicians start by prescribing a testosterone cream applied vaginally twice weekly. Dr. Vliet usually starts her patients on 1.5 to 2 mg of testosterone per day, in capsules or a cream or lotion rubbed into the skin, Side effects of testosterone may include: anxiety or irritability, dark hairs on the chin or upper lip, excess body hair, oily skin and acne. If these side effects occur with testosterone, your dosage may need to be adjusted.
Most research on testosterone is done on men, but there is evidence that women who take testosterone in addition to estrogen and progesterone slow the rate of bone deterioration, and actually build new bone. Adding small amounts of testosterone to a hormone replacement therapy regimen can provide important protection against osteoporosis. In addition, women who take testosterone also report feeling renewed energy and well-being.
- Screaming to Be Heard: Hormonal Connections Women Suspect and Doctors Ignore, E. L. Vliet, M.D., New York: M. Evans and Company, 1995.
- “The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men,” S. Bhasin et a1., N Engl J Med 335:1-7, 1996.
- “Sex hormone status and bone mineral density in men with rheumatoid arthritis,” L. Mateo et al., J. Rheumatol, 22:1455-60, 1995.
- “Androgens in postmenopausal therapy?” R. L. Young, Menopause Management, 27-24, May 1993.