Four Common Types of Hormonal Imbalance – Low Androgens
If you have been following this blog series, you know we have covered progesterone deficiency which correlates with perimenopausal patients and those suffering with PMS. We have also discussed estrogen deficiency which is common in menopausal women. This article covers androgen deficiency in women. Even though androgens include testosterone and DHEA, this article will address testosterone. DHEA deficiency is also common but it is an adrenal hormone and best covered in that context.
Typically, testosterone gradually declines so that by age 40 production is about half the amount manufactured during the twenties. However, with an oophorectomy there can be an abrupt decline. Since testosterone is an anabolic hormone essential for building tissue, emotional wellbeing, and supporting energy levels, if it drops to a deficient level women often experience several symptoms. Women can also notice changes if their testosterone is drastically lower than what they have been used to. For example, female athletes often have high-normal testosterone levels in their twenties. If that drops to the lower end of the normal range they may not feel like themselves.
SIGNS AND SYMPTOMS OF TESTOSTERONE DEFICIENCY
Not only do women with low testosterone experience symptoms they are at increased risk for certain conditions. These include increased aches and pain, hair loss, bone loss, muscle loss, fatigue, and thinning, wrinkled skin. Since testosterone is important to the gynecological health if it is low, women may experience vaginal dryness, painful intercourse, and inconteninence and impaired sexual function. Like estrogen and progesterone, their are a lot of testosterone receptors in the brain. Therefore with low testosterone women may notice memory or mood changes such as depression or a lack of motivation.
Causes of Testosterone Deficiency
As mentioned testosterone is expected to decline with age, however levels can drop below normal for a woman’s age range due to other factors as well. Such as:
- Age related decline
- Surgical – removal of ovaries
- Oral birth control
- Ongoing, chronic stress
Role of Testosterone
The role of testosterone is just as important to women’s health as estrogen and progesterone. Women make 10x more testosterone than they do the main estrogen – estradiol. More specifically, women produce around 0.3mg of testosterone daily. Another difference in the production of testosterone is that it is fairly steady during the monthly cycle, different than the rise and fall of estrogen and progesterone.
About 60% of testosterone is thought to be made by the ovaries and other sources such as conversion from adrenal hormones, create the remaining 40%. However, I recently heard one physician teach that only 25% is created in the ovaries, 25% from adrenal hormone and 50% conversion in fat cells. Either way, testosterone is such an important hormone and if deficient patients may be symptomatic.
ACTIONS AND EFFECTS OF TESTOSTERONE
Testosterone plays key roles in a woman’s physical health and emotional wellbeing. Starting with the muscular system, testosterone helps maintain lean body mass, strength, stamina and increases muscle bulk and tone. In the cardiovascular system it lowers cholesterol and decreases arterial cholesterol deposition. Testosterone increases arterial vasodilation and reduces platelet aggregation. It also Improves immunity by decreasing inflammatory cytokines.
In the health of the Central Nervous System, testosterone affects structural integrity of the brain and synthesis of neurotransmitters increasing sense of well being, mood, energy, self esteem, memory and libido.
Testosterone is responsible for the thickness of skin, increases sebum, and affects growth of body and facial hair. It is required for increasing bone mineral density and reducing fractures and helping with insulin sensitivity.
Vaginal dryness, incontinence and Female Sexual Arousal Disorder respond to testosterone therapy.
Some of your patients may be hesitant to take testosterone because many think it is just for men and worry that it will cause side effects such as facial hair. The use of testosterone in women does not have virilizing effects at physiological dosing. Take note, physiological dosing is the key word here to avoid side effects associated with excess. As discussed above, women make approximately 0.3mg of testosterone daily in their younger years suggesting dosing should be consistent with this accounting for absorption.
In the previous articles in the series, we discuss that verifying hormone levels through comprehensive testing should be done prior to prescribing testosterone, not just based on symptoms alone. The recommended forms of testosterone replacement are pellets, cream, gel or troches. Oral is not recommended since it can cause liver toxicity.
The typical symptoms of low testosterone such as low energy and low mood, reduced sexual function and sex drive as well as aches and pains are typically resolved with replacement. By the way, some patients expect testosterone to make them want to chase their man around the house so they may be disappointed in the results. While testosterone can help some with libido and is important for sexual response and arousal, sex drive in women is very complicated. It is affected by other factors such as men unloading the dishwasher, playing with the kids, or giving flowers, chocolate, etc, etc! Beyond addressing symptoms, correcting testosterone deficiency is important for protecting brain, heart and bone health.
To get a handy tool to assess hormone imbalance for your patients – download my Signs and Symptoms of Hormone Imbalance Checklist. It’s an excerpt from the training manual of the BHRT Providers Program online training program. I think you will find it helpful.