Part 1: Testosterone Therapy Does Not Just Mean Pellets!
For those of you that have spent anytime with me on my blog, FB page, Tik Tok, you’ve likely heard me rail against, I mean, mention my dislike of testosterone supplement pellets. Seeing patients get sold testosterone pellets without proper discussion of all menopausal treatments and options is partly why I got into blogging and posting on social media about menopause. I was frustrated that women were so desperate for treatment of their symptoms that they were ending up prey to hormone health clinics that were implanting pellets in everyone and charging them hundreds of dollars. I see the women being overdosed with testosterone and suffering from physical changes like hair growth, hair loss, increased rage/irritability, withdrawal symptoms between wildly varying testosterone levels, and even permanent clitoral enlargement.
Are there some doctors that judiciously use pellets after a full discussion of treatment options at appropriate doses or after a trial of other therapies? Yes, I’m sure there are, but I hear from patients their experiences and so many times they are primarily steered toward pellet therapy. Just saying, there’s a huge financial incentive for the clinic to push pellets.
I attended a dinner last year sponsored by a pellet company because I wanted to better understand the studies and science behind the pellets to make sure I wasn’t missing something that I should be offering to my patients. Guess what? The talk was given by the company VP of sales who for 2 hours talked about why their pellets were better than their competition and how we could make more money with them. Oh, and he kept showing us his back where he was all scarred up from a competitor’s pellets. Ick. ‘Nuff said.
There is no FDA-approved testosterone for women in the US. The only country that has one is Australia, and it’s called Androfeme 1. When we prescribe testosterone therapy, it is off-label, but we use a lot of other medicines off-label in this country safely. When I propose using testosterone as a therapy, I use a product that is an FDA-approved prescription for males, but use it at a much lower dose for my female patients to restore them to a NORMAL premenopausal physiologic level. It would be rare for them to reach high enough levels to produce side effects, but I follow testosterone levels to check for this.
Part 2: Why We Would or Should Consider Testosterone Therapy
Most perimenopausal and menopausal symptoms will improve and even resolve with standard menopausal hormone therapy with estrogen and progesterone if a woman still has her uterus. I still think this is the best regimen to start with, but for some women, they may still struggle with decreased libido, mood-related symptoms, anxiety, sleep disturbances, decreased concentration, decreased energy, and memory issues. In this situation, it’s reasonable to try testosterone therapy after discussion of risks and benefits, of course. There are studies that show testosterone improves sex drive in some women, but we have few studies looking at testosterone’s effects on the other issues I’ve mentioned. Testosterone is produced by our ovaries and starts declining in our late 30s, and for women undergoing surgical menopause (removal of both ovaries), there is a precipitous decline. I’ve seen testosterone help a lot of my patients with their symptoms. I’ve also seen patients where it didn’t help, and we moved on to other treatments after an adequate trial of testosterone. Managing menopause symptoms has to be individualized and a lot of days it feels like the Wild West y’all!
A recent study published in Maturitas in July 2023 by Kamal et al looked at 905 women using testosterone cream or gel in addition to their standard menopausal hormone therapy and found further improvements in their sex function scores, mood-related related symptoms, anxiety, sleep, improved concentration, improved energy and memory. It certainly suggests testosterone can be beneficial, but we need more studies including studies that compare testosterone to placebo. We also need studies looking at long-term use of testosterone and its risks/benefits.
Part 3: Some Challenges with Testosterone
Testosterone levels are low in women, and blood levels are more difficult to measure. Testosterone is bound to proteins and can also be free in the blood which is the form that is most biologically active. Some women have higher levels of a protein called sex hormone-binding globulin that can reduce their response to testosterone. Some women simply won’t notice a difference in their symptoms after 6 months of “adequate” therapy.
Testosterone levels don’t necessarily correlate with symptoms. Sometimes we find super low levels of testosterone in women with no issues, and we can see normal levels of testosterone in women with many symptoms. It’s important to rule out other causes of things like fatigue, sleep disturbance, and sexual dysfunction before just assuming it’s a testosterone or menopause problem. Recently, I considered starting testosterone therapy on myself to see if it would help with my muscle mass and low bone density, fatigue, and sleep issues, and I discovered I actually have elevated testosterone, cortisol, high blood pressure, and borderline high blood sugars! So now, I’m working with my docs to figure out why. Maybe my muffin top is an adrenal problem!
Dosing testosterone can be challenging. The testosterone I prescribe comes in tubes for male patients to use 1 tube per day. For my patients, I start with 1/10 of a tube daily or 5 mg of testosterone daily, and it can be challenging to draw that exact amount out of the tube’s small nozzle! It’s an inexact science and using a small amount daily that varies slightly does not seem to be problematic.
Bottom Line:
- I don’t recommend testosterone pellets.
- Testosterone may be helpful for menopausal symptoms that don’t respond to other treatments.
- Find a medical provider who will look at all of your symptoms and evaluate you for other causes besides perimenopause and menopause and then offer you evidence-based treatment options.
- We need more studies!!
If you want to discuss this and other menopausal issues, come and see me in my clinic https://www.adventhealth.com/find-doctor/doctor/suzanne-weber-md-1003914599. If you’re not in Colorado, we can have a virtual consultation but I can’t provide medical treatment. https://healthiermenopause.com/contact/
You can also find a certified menopause practitioner in your area through The Menopause Society (formerly North American Menopause Society) at https://menopause.org/