Debunking the 8 Common Myths about Women and Testosterone Replacement Therapy (TRT)

Testosterone is a fundamental hormone present in the bodies of both men and women. It contributes significantly to maintaining overall health, muscle mass, athletic performance, and sexual desire. Diminished testosterone levels in either sex may detrimentally affect these areas of health and life, prompting medical intervention – specifically, Testosterone Replacement Therapy (TRT).

While TRT application is more prevalent in men, particularly those exhibiting low testosterone due to aging or physical impairment, it isn’t exclusive to them. TRT is also notably used by retired bodybuilders, and crucially, some women may also require TRT. This article aims to dispel eight common myths associated with women using testosterone for TRT.

Despite testosterone often being labeled as the “male hormone,” it’s the most abundant active hormone in women. Men have higher circulating levels of testosterone than women, yet according to scientists Glaser and Dimitracakis, testosterone, rather than estrogen, is the primary sex steroid in women throughout their lifespan.

The duo has published an insightful work in “Maturitas,” highlighting the measurement disparity between women’s estrogen and testosterone levels. They noted that while women’s estrogen levels are quantified in picograms per deciliter, their testosterone levels are gauged in a unit ten-fold higher – nanograms per deciliter. Beyond estrogen, there are even more significant proportions of circulating androgens such as DHEA sulfate, DHEA, and androstenes Diketones, all of which contribute significantly to testosterone amounts.

The androgen receptor gene, upon which testosterone and other sex hormones rely, is located on the X rather than the Y (male) chromosome. Disheartened by the restrictive view of the medical community, Glaser and Dimitracakis bemoan the unjustified preference for estrogen as the default hormone in ‘hormone replacement therapy’ for women.

Ironically, this preference has persisted even in the face of evidence that, as far back as 1937, testosterone was used as the optimal treatment for menopausal women. Why has testosterone been largely dismissed as a potential treatment for perimenopausal women? Unpacking the prevalent misconceptions associated with using testosterone – some myths also deter men from considering TRT – can help answer this question.

Myth 1: Testosterone Turns Women into Men

The inception of this fallacy dates back to around 1970 when “masculine” Olympic female athletes from East Germany and the Soviet Union notably had a part to play. However, the primary factor remains female bodybuilding.

On the path to sculpting amplified muscles, female bodybuilders enroll in strength training regimes like their male counterparts. Extreme muscular development, however, is unattainable without using anabolic/androgenic steroids (synthetic derivatives of testosterone), even for men, let alone women. Consequently, professional female bodybuilders use these exogenous hormones and strength training routines. This often leads to inevitable side effects, societal scrutiny, and moral conflict amidst their bulking physique.

Due to wide media dissemination, these unconventional images and videos of these female bodybuilders have been propagated to the farthest corners of the globe. Consequently, the medical fraternity and patients have developed a legitimate fear of testosterone. However, it is essential to highlight that testosterone’s impact is dose-dependent. For many women, Testosterone Replacement Therapy (TRT) doses essentially enforce feminization, increasing fertility and promoting ovulation. Some side effects sometimes occur; Glaser and Dimitracakis assert “true virilization is not possible at normal doses.” The benefits are often so remarkable that some women prefer to manage the side effects rather than reduce their dose.

Moreover, testosterone was formerly used safely to alleviate nausea during early pregnancy. The authors also recognize that patients undergoing female-to-male transition often use pharmacological and suprapharmacological doses of testosterone. This can increase facial hair growth, general hirsutism, and mild clitoral enlargement. But these effects are primarily reversible upon reducing the dose. It’s also important to note that an enlarged clitoris is not a medical concern per se but a possible cosmetic issue.

Myth 2: Women Only Need Testosterone for Boosting Sexual Desire

Though, indeed, women may often experience a restoration of a previously diminished libido through testosterone replacement therapy (TRT), it needs to be emphasized that women carry androgen receptors across their entire bodies – not only in their brains or genitals. These androgen receptors are ubiquitous in the heart, breasts, blood vessels, lungs, spinal cord, bladder, peripheral nerves, bones, bone marrow, synovium, fat tissue, muscles, and uterine, ovarian, and vaginal tissues.

Similar to men, women’s testosterone levels also commence declining with age. This decline can potentially trigger anxiety, irritability, depression, physical fatigue, bone loss, muscle loss, insomnia, cognitive changes, memory loss, breast pain, urinary tract discomfort, and naturally, sexual dysfunction or a lowered interest in sex. Contrary to the narrow view of testosterone’s role being limited to sexual function, it substantially impacts women’s health. Consequently, its importance extends well beyond the bedroom.

Myth 3: Testosterone Induces Heart Disease in Women

Men have higher testosterone levels than women and are more susceptible to heart disease; testosterone must be the culprit. Yet, when testosterone associates with heart disease in males, it often correlates with lower than higher hormone levels, given that low testosterone is linked to heightened all-cause morbidity and mortality risk.

Contradicting the popular belief, substantial evidence shows that testosterone is a cardioprotective agent, aiding both genders in improving their glucose metabolism and lipid profiles — two critical factors involved in heart disease progression.

Testosterone also has a vasodilatory effect, softening blood vessels and enhancing the blood flow through any existing plaque or partial occlusion. Its immunomodulatory properties may also assist in inhibiting the formation of such obstructions. According to various clinical studies, testosterone enhances functional capacity, insulin sensitivity, and muscle strength in both men and women suffering from congestive heart failure.

However, it’s worth noting that a certain percentage of testosterone undergoes aromatization (chemically transforms) into estrogen, which in excess, can induce adverse side effects such as swelling, anxiety, and weight gain in both heart-diseased individuals and their healthy counterparts.

Moreover, several medications commonly utilized in heart disease management can increase the rate of aromatization, indirectly contributing to the side effects of testosterone therapy. However, the prime takeaway should be that testosterone generally acts as a heat protector, and standard or ample levels diminish cardiovascular disease risk.

Myth 4: Testosterone Harms Women’s Livers

The belief that testosterone triggers liver damage is misconceived. While it’s true that bodybuilders and certain strength-training professionals habitually ingest massive doses of oral synthetic testosterone, which the liver metabolizes and could inflict liver damage over the long haul, that doesn’t mean it’s the testosterone itself harming.

In standard therapeutic procedures, testosterone isn’t consumed orally, rather, it is either injected, implanted, or topically administered as a cream. These administration methods allow testosterone to circumvent the liver, keeping the organ from unnecessary stress or “duress.” In this way, the testosterone, in appropriate doses and through the appropriate routes, doesn’t inflict any damage to the liver.

Myth 5: Testosterone Prompts Hair Loss in Women

Hair loss is a complex process influenced by multiple factors, including genetics, and is not fully understood. However, little to no evidence demonstrates that either elevated testosterone levels or testosterone replacement therapy directly cause hair loss in women. Although women with PCOS (Polycystic Ovary Syndrome) exhibiting insulin resistance often have higher testosterone levels and experience hair loss, this isn’t a clear-cut cause-and-effect relationship.

Insulin resistance, often associated with obesity, is common in men and women experiencing hair loss. This condition elevates levels of an enzyme known as 5-alpha-reductase, which can convert some testosterone into dihydrotestosterone (DHT), an androgen linked to pattern baldness.

However, this isn’t the case in healthy women. Interestingly, a substantial portion of women (about a third) lose hair as they age, corresponding to declining testosterone levels. Contrary to popular belief, even amongst many healthcare professionals, around two-thirds of women undergoing testosterone therapy start to see hair regrowth.

Those who don’t often have associated medical conditions such as hypoparathyroidism or hyperparathyroidism, iron deficiency, or obesity. Supporting the theory that testosterone therapy does not induce hair loss in women, none of the 285 patients who underwent testosterone treatment for up to 56 months reported hair loss.

Myth 6: Testosterone Provokes Irritability in Women

When men exhibit aggressive behavior, it’s often incorrectly attributed to a “testosterone surge” or a “steroid rage.” This misattribution tends to occlude any underlying emotional instability. Nevertheless, such outcomes are either infrequent or entirely non-existent with Testosterone Replacement Therapy (TRT), especially in women, due to the substantially smaller administered doses. Moreover, substantial evidence spanning multiple species suggests that estrogen, not testosterone, plays a critical role in aggression.

It’s important to note that some testosterone aromatizes or enzymatically converts into estrogen in both men and women. However, the estrogen levels produced via traditional doses of testosterone replacement therapy do not engender a ‘Hulk-like’ irascibility in women. Studies have demonstrated that for 90 percent of women treated for testosterone deficiency, subcutaneous implants of testosterone granules alleviated aggression, irritability, and anxiety, showing a calming rather than aggravating influence.

Myth 7: Testosterone Increases the Risk of Breast Cancer

Though breast cancer is widely known to be sensitive to estrogen, various clinical studies have demonstrated that testosterone benefits breast tissue by inhibiting the proliferation of breast cancer cells and preventing their stimulation.

The balance or ratio of these hormones – testosterone and estrogen – endows testosterone with a specific protective influence on the breast. Once the androgen receptor is activated, it induces pro-apoptotic effects (leading to cancer cell death), exerts anti-estrogenic properties, and inhibits growth in both standard and cancerous breast tissues.

True, some testosterone can aromatize into estrogen, potentially disrupting the body’s hormonal balance if not adequately monitored. Nonetheless, even considering this, testosterone administration still seems to lower the risk of breast cancer in women treated with estrogen. This insight reiterates the need to maintain a balanced hormonal environment for optimal health benefits.

Myth 8: Testosterone Replacement Therapy for Women Is Unproven Treatment

The use of testosterone therapy in women is anything but new – it has been offered to women in the UK and Australia for nearly seven decades. Testosterone implants have been utilized safely in women since as early as 1938. Substantial long-term data exist concerning the safety and tolerability of testosterone treatments in women at doses reaching up to 225mg, an amount deemed relatively high for women.

To wrap up, it’s crucial to mention that the activity of the enzyme aromatase, which transforms testosterone into estrogen, is known to increase with factors such as aging, obesity, alcohol intake, presence of breast cancer, insulin resistance, certain medications, recreational drugs, sedentary lifestyle, and unrestricted consumption of processed foods.

In conjunction with the potential to create more estrogen through testosterone therapy, this fact raises the risk of an imbalance in the hormonal environment. Given this, it’s vitally important for medical practitioners to carefully monitor the levels of aromatase in women undergoing testosterone therapy. Doing so helps maintain the testosterone-to-estrogen ratio within a safe range, ensuring patient health is not compromised.


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