Significance of Low Testosterone

Testosterone is a “let’s GO!” hormone. It is important for energy, maintaining strong muscles and bones, libido, self esteem and brain health. Yep you need testosterone for executive brain functions like decision making!

I see several causes of low testosterone:

  1. Menopause is a common cause, however not everyone in menopause has low testosterone. It’s important to test your levels. However make sure you see a provider for interpretation that understands the difference between “normal range” and “optimum”! Good grief—some of the lab companies use a normal range that goes down to ZERO for free testosterone in women!
  2. Surgical removal of the ovaries, oophorectomy, is another cause of low testosterone. Traditional gynecology acknowledges the importance of testosterone therapy for women who have had their ovaries removed prior to menopause. In my years as a gynecologist I witnessed a lot of suffering in young women who needed their ovaries removed that was relieved with testosterone therapy.
  3. A third cause of low testosterone is adrenal dysfunction—high stress will lead to the prioritization of making cortisol at the expense of testosterone (and all the other sex-steroid hormones). We call this “cortisol steal”. I’ve seen stress reduction and adrenal support make a BIG difference for women with low testosterone.

Testing for Low Testosterone

What should you do then? I suggest getting your level tested to verify the suspicion of low testosterone. Make sure you are seeing a provider that knows the difference between “normal range” and OPTIMUM though!

Seriously, this issue of “normal range” is a BIG DEAL! Here are some disturbing (I think…) facts about normal range:

  • Normal range is set by lab companies
  • Normal range is most often set to specifically include 90% of the population
  • Normal range differs across geographic regions in the same lab and amongst different labs in the same region
  • In some labs, the “normal range” for free testosterone in women goes all the way down to ZERO

Ugh… Read that last one again. Some lab companies actually include ZERO/ZILCHO/NADA TESTOSTERONE as normal for women. Well, in that case, there’s no such thing as low testosterone in women, because you can’t have less than zero! Seriously? This was one of my “aha moments” that the traditional way of doing things was sorely lacking.

One more thing… About normal range including 90% of the population. Do you honestly think that 9 out of 10 women are thriving? I don’t! So I’m sorry, but I don’t want to be “normal”… I want to be OPTIMUM!

Strategies to Raise Testosterone

Stress Reduction
This is so important! High stress leads to “cortisol steal”, where your body preferentially makes cortisol with the raw materials at the expense of testosterone.

Get Enough Sleep
This has been shown to increase testosterone levels! How much is enough? 7-9 hours of good sleep is needed.

DHEA Supplementation
In women, DHEA can convert to testosterone and give relief of symptoms. DHEA is an over-the-counter supplement so it’s not a bad first choice.

Testosterone Replacement Therapy
Sometimes you need testosterone therapy. While it’s not usually my first choice, I DO acknowledge that it’s the fastest way to get you feeling better. If you are considering this option here are some things to consider:

  • NEVER take oral testosterone! This is not safe and increases inflammation due to the fact that it goes from the gut to the liver and gets mutilated. You need a route that bypasses the gut–either transdermal cream or pellet therapy…
  • Apply creams only to inner thighs, behind knees, inner labia. Don’t apply testosterone cream to your arms! Testosterone can increase the thickness of hair at the application site. Inner thighs and behind the knees is a good location because you can shave your legs and no-one will notice. Inner labia (non-hair-bearing) is great because there’s no hair follicles here to interact.
  • Start low and go slow. You DON’T want too much.Too much can cause voice deepening, whiskers and even inappropriate enlargement of your lady parts.
  • Consider pellet therapy. This is a great way to get 4-7 months of replacement with a single 15-minute procedure.

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