The Surprising Ways Testosterone Impacts Women’s Health

TL;DR
Testosterone plays a crucial role in women's health, impacting energy, mood, muscle mass, and sexual function. Both high and low levels can lead to various issues, from acne and hair loss to reduced libido and fatigue. As women age, testosterone levels naturally decline, affecting overall well-being. Monitoring and potentially treating imbalances through hormone therapy can improve quality of life but requires careful management to avoid adverse effects.

Table of Contents

When you think of testosterone, you might picture well-muscled men, but the influence of this hormone extends beyond male biology.

Testosterone is a key player in women’s health, often overlooked or misunderstood. Understanding testosterone in women is crucial to unravelling the intricate tapestry of hormonal balance.

From the adrenal glands’ mechanisms to the normalcy of testosterone levels, a comprehensive look at this hormone’s function lays the foundation for recognising its significance.

Understanding Testosterone in Women

While often associated with men, testosterone also plays a key role in women’s health. It influences a range of aspects, including:

• Energy levels
• Mood regulation
• Muscle mass maintenance
• Sexual function

As women approach menopause, testosterone production, influenced by adrenal gland health, can decline. This hormonal fluctuation can lead to:

• Decreased libido
• Challenges in muscle mass retention
• Variances in mental focus

Meanwhile, unusually high testosterone levels in women may cause:

• Acne
• Excessive body hair growth
• Hair thinning on the scalp
• Menstrual irregularities

Testosterone is crucial for sustaining body functions such as:

• Bone density
• The health of reproductive tissues
• Cognitive function

From their 30s onward, women experience a gradual decrease in testosterone which necessitates maintaining appropriate levels for the sake of well-being and health.

Testosterone is an essential hormone for women, with physiological actions mediated directly or via aromatisation to oestradiol throughout the body.

S. Davis et al. (2015)

Symptoms or health issues related to low or high testosterone can often be managed with therapeutic strategies such as hormone replacement therapy. It’s essential for women to monitor hormonal balance to avoid adverse effects and ensure optimal physiological function.

The Role of Testosterone in Women’s Health

While testosterone is traditionally viewed as a male hormone, it also plays an essential role in women’s health. Testosterone in women works alongside oestrogen, influencing a myriad of bodily functions. It’s crucial for maintaining bone density, ensuring the health of reproductive tissues, and supporting cognitive function.

Imbalances of testosterone, either too high or too low, can impact health, affecting everything from blood cell production to libido enhancement. Importantly, testosterone assists in the regulation of reproductive hormones and can stimulate red blood cell production.

When testosterone levels are properly balanced, women often experience an improved sense of well-being. However, as women age, androgen levels, including testosterone, tend to decline, with a significant decrease occurring by the time a woman is 40 years old. This decline can affect a woman’s libido, energy levels, and mood. Testosterone can be an important element of hormone replacement therapy, particularly for enhancing sexual well-being and treating conditions like hypoactive sexual desire disfunction.

For women undergoing testosterone therapy, close monitoring of testosterone levels is vital. Baseline measurements should be taken and regular follow-ups are recommended to cheque both the effectiveness of treatment and watch for signs of androgen excess, which could lead to unwanted effects.

Adrenal Glands and Testosterone Production

In women, the adrenal glands play a significant role in the production of testosterone, contributing to approximately 25% of its overall production.

Hormonal precursors like DHEA-S, DHEA, and androstenedione, which mainly originate in the adrenal glands, are critical to the creation of androgens such as testosterone. These precursors are then converted into active hormones like testosterone and dihydrotestosterone in various tissues, including the ovaries and adrenals.

The process of hormones transforming into their more potent forms occurs via enzymatic reactions. For instance, testosterone in the bloodstream can be converted into dihydrotestosterone (DHT), a more powerful androgen, through these enzymes. Overall, about a quarter of androgens are produced by the ovaries, with the rest synthesised by peripheral tissues.

Normal Ranges of Testosterone in Women

Testosterone levels in women tend to be much lower than in men, with a normal range between 15 ng/dL and 70 ng/dL. Women produce roughly ten to twenty times less testosterone compared to men.

Having a testosterone level that falls within the normal range is still critically important for maintaining various physiological functions.

For women, especially those who are perimenopausal or postmenopausal, testosterone replacement therapy may be suggested if their levels drop below the healthy range. Such a decrease can have a profound impact on a woman’s health, affecting not just the sex drive but also the overall energy levels and vitality.

As with any hormone therapy, monitoring these levels is crucial to provide an effective and safe treatment plan, allowing adjustments to be made as necessary to restore balance and mitigate adverse effects.

The Effects of Testosterone on Women’s Bodies

Testosterone is often overshadowed by oestrogen when discussing female hormones, yet it is essential for various physical functions and overall well-being in women.

As a vital sex hormone, testosterone helps to regulate sex drive (libido), manages the reproductive system, and is even involved in the synthesis of blood cells. When levels fall short, women might experience fatigue, muscle weakness, and mood fluctuations. Such symptoms not only impact day-to-day activities but can also take a toll on a woman’s self-esteem and quality of life.

As women approach menopause, it is common for testosterone levels to wane, mainly because the ovaries, which produce a portion of the body’s testosterone, are less active. This natural decline can lead to the symptoms previously mentioned.

Additionally, factors like early menopause or oral oestrogen therapy can further reduce testosterone production. Imbalances, whether too low or occasionally too high, can lead to a host of issues, including irregular menstrual cycles, lower sex drive, and altered body composition, disrupting a woman’s normal routine and affecting her physical appearance.

Sexual Function and Desire in Women

Testosterone’s impact on women’s sexual health is profound. It fosters sexual desire, arousal, and orgasm, enhancing a woman’s sexual well-being, particularly during the menopausal transition.

The role of testosterone in female sexuality is still controversial, with meta-analytic data showing testosterone treatment in postmenopausal women with hypoactive sexual desire disorder is associated with a significant increase in sexual desire.

L. Vignozzi et al. (2019)

When testosterone is paired with oestrogen in Hormone Replacement Therapy (HRT), women may see improvements not only in sexual functions but also in urogenital health, psychological state, bone density, and cognitive abilities. Androgens like DHEA-S have been positively correlated with measures of sexual function, suggesting that maintaining adequate levels of these hormones is integral for a satisfying sex life.

Testosterone may also be the key to treating conditions such as hypoactive sexual desire disorder (HSDD) in postmenopausal women, offering relief where other treatments may not have succeeded.

Muscle Mass and Strength

Muscle tone, mass, and overall strength in women are also influenced by testosterone. When testosterone levels are restored in women who have experienced a hysterectomy, for example, an increase in muscle mass and strength is often observed.

The benefits are not merely aesthetic; they also incorporate vital health outcomes like improved musculoskeletal health and reduced likelihood of bone fractures, as testosterone receptors are present on bone-forming cells.

Women may find that with balanced testosterone, not only do their contours become more defined, but their energy levels, weight control, and capacity to participate in physical activities all improve.

Bone Density and Health

In the realm of bone health, testosterone has been shown to foster an increase in bone mineral density. This relationship holds particular significance for older women, where higher concentrations of free testosterone correlate with more robust bone health.

By enhancing the protective effects of oestradiol on postmenopausal bone density, testosterone supports the skeletal framework vital for mobility and injury prevention. Testosterone hormone replacement therapy emerges as an ally in bolstering bone health and muscle function, ultimately serving as a preventative measure against osteoporosis and related bone issues.

Energy Levels and Fatigue

Just as a steady engine propels a car, adequate testosterone levels can help in driving a woman’s energy and stamina forward.

Low testosterone can leave women feeling unusually tired, affecting their ability to maintain an active lifestyle and potentially leading to mood disorders such as depression or anxiety.

Testosterone deficiency in women is a condition characterized by blunted or diminished motivation, persistent fatigue, decreased sense of personal well-being, and low libido.

S. Davis et al. (2001)

Conversely, elevating testosterone to a normal range through treatment can have the invigorating effect of boosting stamina, both physical and mental. Women may notice enhanced libido, increased energy for daily tasks, and better mental clarity upon achieving a healthier testosterone balance.

Cognitive Function and Mental Health

Alongside its physical benefits, testosterone touches aspects of cognitive function and mental health. Research suggests connections between testosterone and various cognitive domains, including memory, verbal learning, sleep, and even mood.

While menopause itself does not necessarily result in a notable cognitive shift, the decline in quality of life perceived by some women could be attributed to hormonal changes, including decreased testosterone levels. Yet, studies indicate that testosterone therapy does not have adverse effects on cognition or mood, potentially providing a safeguard for mental acuity and emotional equilibrium into postmenopausal years.

The Impact of Testosterone on Appearance

Testosterone plays a crucial role in shaping the physical appearance of women, though its effects can vary greatly depending on the body’s hormone levels.

Often associated with male secondary sex characteristics, testosterone influences the emergence of features such as facial and body hair, voice deepening, and facial bone contour changes.

Women undergoing testosterone therapy, particularly postmenopausal individuals with vulvovaginal atrophy, may witness improvements in libido, lubrication, and discomfort reduction during sexual activity. However, an excess of this hormone can lead to less desirable side effects including acne, fluid retention, facial hair growth, and masculinisation symptoms such as male-pattern balding and a deeper voice.

Benefits to vaginal health are noted; testosterone induces epithelial proliferation and may increase vaginal thickness post-menopause, with some research suggesting it could potentially be more effective than oestrogen in this regard. Conversely, low testosterone levels can result in menstrual irregularities, increased body and facial hair, frontal balding, acne, an enlarged clitoris, and a deeper voice in women.

Facial and Body Hair Growth

Testosterone has a definitive impact on hair growth in women. Elevated levels of the hormone can contribute to increased body and facial hair, known as hirsutism, which often manifests on the lip, chin, and along the line from the belly button to the pubic area. This condition can be distressing, affecting approximately 2% of women when testosterone levels rise.

High testosterone can lead to frontal balding patterns similar to those seen in men, as well as the development of an enlarged clitoris.

The issues of hair growth related to testosterone levels can also signal underlying health conditions, such as polycystic ovarian syndrome (PCOS), where the ovaries produce abnormally high amounts of testosterone.

Hair Loss and Thinning

The interplay of hormones, notably the ratio of androgens like testosterone to oestrogen, contributes to female pattern hair loss. Testosterone derivatives such as dihydrotestosterone (DHT) can lead to the shrinkage of hair follicles and shorter hair growth phases, both of which culminate in noticeable hair thinning and loss. This condition disproportionately affects areas that are sensitive to androgens, potentially resulting in excessive or coarse facial hair growth in women. Conditions such as PCOS are again relevant here, as they may provoke elevated testosterone production and the concurrent risks of hair loss and unwanted hair growth.

Notably, less than 1% of women undergoing BioTE hormone optimisation protocols report hair loss, emphasising the necessity of thyroid health management in addressing such concerns. While testosterone therapy has its place, it also has the potential to cause acne as it stimulates increased sebum production by the sebaceous glands.

In balancing the levels of testosterone within normal ranges for women, one must cautiously weigh the potential benefits against the risks of adverse effects on appearance, taking into account individual hormonal profiles to ensure a holistic and cautiously monitored approach to testosterone therapy.

Considerations for Testosterone Replacement Therapy in Women

Testosterone replacement therapy (TRT) is gaining attention in the medical community as a valuable treatment to address various symptoms in women. Notably, TRT may alleviate issues relating to sexual health, such as a diminished sex drive, which is crucial for overall well-being.

For those afflicted with hypoactive sexual desire disorder (HSDD), testosterone can be a potent means to improve libido. Additionally, it serves to counteract physical manifestations of testosterone decline like vaginal dryness, low bone density, muscle loss, and an increase in fat mass. Women suffering from persistent fatigue and mood changes may also find relief through TRT.

Diagnosing low testosterone in women typically involves a blood test, with a recommended range of 15-75 ng/dL. Certain specialists suggest that optimal benefits might be achieved with levels at the higher end of this range. However, the utilisation of testosterone therapy must be approached with caution. Experts generally discourage the use of TRT in healthy women for conditions such as infertility, unspecified sexual dysfunction, enhanced cognitive ability, cardiovascular health, metabolic syndrome, bone health, or general wellness.

Particularly for postmenopausal women grappling with sexual dysfunction due to HSDD, the Endocrine Society recommends a trial of testosterone therapy, favouring non-oral routes such as transdermal patches, gels, or creams. Such methods minimise potential liver damage associated with oral preparations and maintain more stable hormone levels. As with any hormone regimen, regular monitoring of testosterone levels is vital to ensure safety and efficacy, and to adjust the therapy as needed.

Monitoring and Managing Testosterone Levels

Maintaining and monitoring testosterone levels within a proper range is crucial, especially for those undergoing testosterone therapy. Women with a Free Androgen Index (FAI) of less than 1% may consider testosterone supplementation. During treatment, aiming for FAI levels below 5% is standard practise; however, symptom relief is a more critical measure of success than hitting a specific testosterone level.

Physicians typically employ blood tests to ascertain the testosterone levels in women. Conventionally, healthy testosterone levels for women are considered to be between 15 ng/dL and 70 ng/dL. Should levels drop below this range, particularly in conjunction with symptomatology, testosterone replacement therapy might be recommended.

As with any treatment involving hormones, careful monitoring is indispensable to ensure optimal outcomes, calibrate dosages precisely, and manage any side effects that might arise.

References

S. Davis et al. "Testosterone in women--the clinical significance.." The lancet. Diabetes & endocrinology, 3 12 (2015): 980-92.

L. Vignozzi et al. "Testosterone in women: are we closing the gender gap?." Nature Reviews Urology, 17 (2019): 67-68.

S. Davis et al. "Testosterone deficiency in women.." The Journal of reproductive medicine, 46 3 Suppl (2001)