Testosterone: not just for men
Many of us think of testosterone as an entirely male hormone. But it’s also one of the sex hormones women produce, along with oestrogen and progesterone.
It’s an important female hormone. In fact, a healthy young woman’s ovaries produce approximately three to four times the amount of testosterone than oestrogen. This amounts to half of their testosterone, with the other half deriving from their adrenal glands.
Throughout a woman’s lifespan, her testosterone levels naturally decline. Some women don’t notice this, while others are more sensitive to the changes and sometimes benefit from extra testosterone.
What is the role of testosterone in women?
Testosterone contributes to libido, sexual arousal and orgasm by increasing dopamine levels in the central nervous system. It also helps to maintain normal metabolic function, muscle and bone strength, urogenital health, mood and cognitive function.
What is the impact of testosterone deficiency?
A deficiency can lead to a number of distressing symptoms such as low sexual desire, arousal and orgasm.
It can also contribute to a reduction in general quality of life, including tiredness, depression, headaches, cognitive problems, osteoporosis and sarcopenia, or muscle wasting.
What other effects can it have on long-term health?
After the menopause, oestrogen falls to undetectable levels. Consequently, the small amount of remaining testosterone may predispose to androgenic symptoms – or male characteristics. These can include acne, increased facial hair growth and male pattern baldness. Personal genetics are usually behind susceptibility to these issues.
Why use testosterone?
A low dose of testosterone can sometimes help to improve your energy, mood, concentration and libido – although it doesn’t work for everyone. It can sometimes take a few months for the full effects to work, so you may need to take it for 3-6 months in the first instance.
Is it available on the NHS?
The NICE guidance on menopause states that testosterone can be considered for those that need it, but there are no testosterone products for female use licensed in the UK.
It can be prescribed on the NHS if the prescriber is familiar with it and is willing to prescribe it ‘off licence’. Some prefer not to do this and refer to a specialist for advice before prescribing. Other GPs will have prescribing restrictions which mean they are not able to offer it.
Lower doses of products licensed for men such as Tostran and Testogel are prescribed off label in female doses. AndroFeme, which is a female testosterone cream is not currently available on the NHS. However, it is being imported from Western Australia by special license from the Medicines Health and Regulatory Authority (MHRA), part of the NHS for ensuring the safety of medicine use in the UK.
Do I need a blood test?
A blood test can’t diagnose whether or not you need testosterone. But it can be a good idea to have a blood test to check your hormones before you start any treatment. This can show if your symptoms are being caused by anything else. For example, an underactive thyroid can often give fatigue symptoms similar to low testosterone.
“Informing yourself with a blood test to evaluate your hormones overall would be helpful to identify suboptimal hormone levels, which might be causing problematic symptoms,” explains endocrinologist Dr Nicky Keay.
Are there any adverse effects of testosterone replacement therapy (TRT)?
The way women respond can fluctuate, probably due to varying absorption, metabolism and sensitivity to this hormone.
If you use the recommended dose, ie a small amount over a week or more, side effects are very few. There is a lack of long-term data, but data from up to five years shows no adverse effect in healthy women after menopause.
A review published in the Lancet
Analysis of 36 randomised trials including 8,480 participants concludes that testosterone is effective for postmenopausal women with low sexual desire which is causing distress.
Making some changes to your lifestyle can often be a good idea during menopause. This can also have an impact on your testosterone levels.
Exercise, particularly resistance exercise, is one of the most effective ways to prevent many lifestyle-related diseases. Interestingly, it can also boost your testosterone.
Resistance training, such as weight lifting, is the best type of exercise to boost testosterone in both the short and long-term. High-intensity interval training is also good, although, all forms of exercise may help.
2. Eat protein, fat and carbohydrate
What and how much you eat has a major impact on your hormone levels.
It’s all about finding the right balance: don’t overeat but equally don’t restrict calories too much for too long. Constant dieting or overeating may disrupt your hormone levels. Try to eat balanced amounts of carbohydrates, fat and protein.
3. Minimise stress and cortisol levels
High levels of stress are bad for your long-term health and can disrupt your sex hormone levels. Research is always highlighting the dangers of long-term stress which can elevate the hormone cortisol, often termed the “stress hormone”.
We need cortisol which follows a natural diurnal rhythm, highest in the morning and slowly declining throughout the day, being at its lowest at night.
However. we don’t need it to be constantly elevated because it opposes other hormones and reduces their level. Unnatural elevations in cortisol can quickly reduce testosterone. These hormones work in a seesaw-like manner: as one goes up, the other comes down.
Stress and high cortisol can also increase food intake, leading to weight gain and the storage of harmful body fat around your organs. In turn, these changes may negatively impact your overall health.
For both optimal health and hormone levels, you should try to reduce repetitive stressful situations in your life. Sometimes easier said than done. But introducing some relaxing practices such as meditation, mindfulness and yoga can help. A simple walk can also do wonders for reducing your stress levels.
4. Vitamins and minerals
Research has shown that vitamin D has various health benefits. It promotes the absorption of calcium, regulates bone growth and plays a part in immune function and may also work as a natural testosterone booster.
Your skin produces vitamin D when exposed to sunlight. However, it can be difficult to get enough, especially during the winter months. Dietary sources include fatty fish, fish oils, egg yolks, butter and liver. But anyone over the age of one year is recommended to take 10 micrograms of vitamin D a day.
There are two forms of vitamin D:
- D2, derived from plants and fortified foods
- D3, only found in animal sourced foods
They work differently: Vitamin D3 seems to be more effective so consider choosing this as your supplement.
If you are supplementing remember to either use a fat-based supplement or to take it with a fat source as its what’s known as a fat-soluble vitamin.
- Zinc is a powerful little mineral, which blocks the enzyme aromatase, that converts testosterone to oestrogen. More zinc = less converted oestrogen = higher testosterone. Good sources of zinc include oysters (hence their reputed aphrodisiac abilities) and other seafood, pumpkin seeds, red meat (especially beef and lamb), and spinach.
- Magnesium is also believed to increase your testosterone by inhibiting testosterone from binding to its binding protein, sex hormone binding globulin (SHBG). As a result, you have free testosterone the biologically active type of testosterone floating around in your blood.
Great sources of magnesium include: fish, beans, nuts, and leafy green vegetables.
If you are low in vitamin D, zinc or magnesium, you may wish to speak to your doctor about supplementing.
5. Get plenty of restful, high-quality sleep
Getting good sleep is just as important for your health as diet and exercise It may also have major effects on your testosterone levels.
Although some people seem to do fine with less sleep, research suggests around 7–10 hours of sleep per night is best for long-term health and your testosterone.
Getting the balance right
In summary, while testosterone replacement therapy (TRT) may be an option, lifestyle contributes significantly in maintaining a healthy balance of hormones, including testosterone.
Quality sleep, physical activity and weight management support healthy testosterone levels, and they all go hand in hand. If you lack sleep, you find it harder to exercise and easier to gain fat. When you exercise you find it easier to sleep and to keep a healthy weight. If your weight is healthy you find it easier to exercise and easier to sleep.
A diet rich in healthy fats to support hormone production is essential and together with good levels of Vitamin D, magnesium and zinc we can go some way to boosting our flagging testosterone levels.
And finally, have more sex!
There is a correlation between testosterone levels and sexual activity for women. While it is believed that individuals with higher testosterone levels tend to have higher libidos, some research studies indicate that it is the sex itself that may be increasing women’s testosterone.
Several studies showed that sexual arousal leads to a small increase in testosterone levels of women.