By Dr. Anita Sadaty 1-Minute Read
Welcome to ASK AN EXPERT, a series where we pose your real questions to our menopause experts for the answers you need. Have a question? Post it on The After Party, our private Facebook Group.
Your Question:
“Should I consider taking testosterone as part of my hormone therapy treatment?”
The Answer:
From Womaness Medical Advisor Dr. Anita Sadaty, a board-certified OB/GYN who combines conventional medical training with a functional medicine approach from her trailblazing practice Redefining Health Medical in Roslyn, NY:
“Hormone therapy ideally addresses all the hormone deficiencies that women experience. Testosterone is a significant player in a woman’s hormonal makeup and addresses concerns that menopausal women often experience. Reduced libido, mental focus and concentration issues, irritable mood, reduced ability to support skeletal muscle mass, orgasm quality, and weight-loss resistance are a few.”
More answers to your FAQs on testosterone:
Can I be on both estrogen and testosterone?
“Yes. These hormones act in concert together for brain and sexual benefits.”
I have libido issues. Would testosterone help more than estrogen therapy?
“I think you need both. Libido is a complex issue for women that impacts both brain and genital organs. Estrogen is necessary for improving mood and stress resilience from a cognitive standpoint and is critical for vaginal health, elasticity, lubrication, and blood flow. Testosterone, however, is the next layer of the cake—it adds more desire, drive and motivation to want sex, and enhances sexual function by improving orgasm intensity.”
Does testosterone help with clitoral atrophy?
“Testosterone can have benefits in improving clitoral responsiveness and even size, but there’s a balance between safe levels of enhancement and permanent size increases.”
Does testosterone help with painful sex?
“I think of painful sex as more the purview of estrogen; but, because testosterone has some level of conversion to estrogen, it may also address painful intercourse.”
What tests should I take before trying testosterone? And if I go on the hormone, what type of follow-up should I do?
“Ideally checking a total and free testosterone level by blood work is helpful. If the level is in the bottom half of the reference range with symptoms, then it is reasonable to try a course of testosterone replacement therapy.
Follow-up is also by blood work. Ideally, you want to land in the higher end of the reference range AND see improvements in clinical symptoms. Some women do not feel benefits unless they are above the reference range as well.”
Me.No.Pause.
How is testosterone administered and dosed?
“There are various options: compounded creams, men’s prescription gels dosed at a 10th of a packet, injectable pellets, oral compounded pills, and subcutaneous weekly or biweekly injections, for example.”
Are there any negative side effects to testosterone?
“Excessive testosterone can cause acne, excessive body hair, oily skin, aggressive behavior, and, in severe instances, permanent voice deepening and clitoromegaly (an abnormal enlargement of the clitoris).”
Is hair loss common with testosterone? Are there other male characteristics I should expect?
“1% of women may experience head hair loss, but this is not a common event according to the research. Other side effects are as mentioned above are mostly transient and indicate a dose adjustment.”
Are you finding success with your patients on testosterone?
“I would say that regarding libido, there is a 60% improvement. But as mentioned previously, libido is complicated. It’s not only a testosterone issue.”
How long does it take for testosterone to work?
"It depends on when women get into an optimal range on blood work. That could take weeks to months, as I typically start low on dosing and increase slowly. There’s a lot of serial testing and modifying the dose, so it requires patience to do it safely and correctly.”
Any other tips I should know?
"Be sure to work with someone highly knowledgeable, as it is a bit tricky!”
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