There are many misconceptions about hormone replacement for women. If you consulted five different doctors for treatment of menopause you would probably receive five different hormone plans. I often consult with women who have been to other doctors for hormones and are not happy with their results.
One of the most common misconceptions I see is the oversight of the importance of testosterone (T) for women.
Myth #1 Testosterone causes hair loss
Approximately one third of women experience hair loss and thinning with aging, also suffer T decline. Research studies have shown that two thirds of women treated with subcutaneous T implants (pellets) have scalp hair re-growth on therapy. Women who did not re-grow hair on T were more likely to be hypo or hyperthyroid, iron deficient or have elevated body mass index. In addition, none of 285 patients treated for up to 56 months with subcutaneous T therapy complained of hair loss, despite pharmacologic serum T.
There is no evidence that T or T therapy is a cause of hair loss in either men or women. Although men do have higher T levels than women, and men are more likely to have hair loss with age, it is unreasonable to assume that T, an anabolic hormone, causes hair loss.
Hair loss is a complicated, multifactorial, genetically determined process that is poorly understood.
Myth #2 Testosterone causes aggressiveness
Although anabolic steroids can increase aggression and rage, this does not occur with T therapy.
In women, studies have reported that subcutaneous T therapy decreased aggression, irritability and anxiety in over 90% of patients treated for symptoms of androgen deficiency. This is not a new finding: androgen therapy has been used to treat PMS for over 60 years. Testosterone therapy decreases anxiety, irritability and aggression.
Myth #3 Testosterone is dangerous in breast cancer
Testosterone is breast protective and does not increase the risk of breast cancer. As early as 1937 it was recognized that breast cancer was an estrogen sensitive cancer and that T is ‘antagonistic’ to estrogen and could be used to treat breast cancer as well as other estrogen-sensitive diseases including breast pain, chronic mastitis, endometriosis, uterine fibroids and dysfunctional uterine bleeding.
Clinical trials in primates and humans have confirmed that T has a beneficial effect on breast tissue by decreasing breast proliferation and preventing stimulation from Estradiol.
Myth #4 Testosterone causes heart disease
There is overwhelming biological and clinical evidence that T is cardiac protective. T has a beneficial effect on lean body mass, glucose metabolism and lipid profiles in men and women; and has been successfully used to treat and prevent cardiovascular disease and diabetes.
T acts as a vasodilator in both sexes, has immune-modulating properties that inhibit plaque formation, and has a beneficial effect on cardiac muscle, helping it contract more strongly. Low T in men is associated with an increased risk of heart disease and mortality from all causes. In addition, low T is an independent predictor of reduced exercise capacity and poor clinical outcomes in patients with heart failure.
Similar to men, T supplementation has been shown to improve functional capacity, insulin resistance and muscle strength in women with congestive heart failure. Testosterone is a diuretic. However, T can aromatize to Estradiol, which can have adverse effects including edema, fluid retention, anxiety, and weight gain. Medications, including statins and anti-hypertensives, increase aromatase activity and elevate Estradiol, indirectly causing side effects from T therapy.
Myth #5 Testosterone is a “male” hormone
Men do have higher circulating levels of T than women; however, quantitatively, T is the most abundant active sex steroid in women throughout the female lifespan. Despite any clear rationale, estrogen was assumed to be the hormone of ‘replacement therapy’ in women. However, as early as 1937, T was reported to effectively treat symptoms of the menopause.
Despite many recent publications, T’s role in sexual function and libido is only a small fraction of the physiologic effect of T in women.
Testosterone and the pro-androgens decline gradually with aging in both sexes. Pre and post-menopausal women, and aging men, may experience symptoms of androgen deficiency including dysphoric mood (anxiety, irritability, depression), lack of wellbeing, physical fatigue, bone loss, muscle loss, changes in cognition, memory loss, insomnia, hot flashes, rheumatoid complaints, pain, breast pain, urinary complaints, incontinence as well as sexual dysfunction.
Testosterone receptors are located throughout the body in both sexes. to assume that androgen deficiency does not exist in women, or that T therapy should not be considered in women, is unscientific and implausible.
Testosterone is essential for women’s physical and mental health and wellbeing!
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