TESTOSTERONE COULD BE THE ULTIMATE FEEL GOOD HORMONE FOR WOMEN

There are tons of misconceptions about peri. Tons! Often, people think it means early menopause. It does not. Peri can begin in your mid/late thirties and last for over a decade. It’s not, we repeat not, a rapid descent into old age. In peri, your levels of estrogen and progesterone change, leading to physical and mental changes including, but not limited to, a change in your period cycle, mood issues, and about a gazillion other things. Testosterone drops with age, too.

Another massive misconception is that testosterone is just a male hormone. Actually, sir, women produce this hormone as well.

When T drops, boy, oh boy, do we feel it. Brain fog, lack of motivation, and low energy may all be attributed to a decline in testosterone, yet it is only approved to treat one symptom: low libido. There isn’t even a licensed version approved for women in the US.  We already make testosterone and if our levels dip, shouldn’t we be as entitled as men are to replace it with a testosterone that’s approved for women? God forbid! No, if a woman wants to use an FDA-approved testosterone, she has to use the men’s one.

The issue is dosing.

It’s the exact same hormone, so that’s not the issue. The issue is dosing. A single male dose is one small sachet, but a female dose is one-tenth of this, so you have to divide this gel into 10 parts. Yes, it’s as annoying as it sounds. It’s difficult to figure out a tenth of a gel substance. There’s an FDA-approved injection too, but again, women take only one-tenth the dose. Basically, it’s hard to get the precise dose simply by eyeballing it.

Doctors may suggest a “pea-sized” amount. The question is, what kind of pea? A tiny frozen pea? A juicier, larger canned pea? This vagueness is exactly why women need an FDA-approved testosterone.  

Board-certified urologist Dr. Kelly Casperson has a mega-helpful testosterone tip: “Some people will buy a syringe on Amazon with a little cap. You can just put it in there, put the cap on it, and use your precise dose every day. Some people will buy an essential oil dropper. You can get a dropper that has the markers on it.” 

Some doctors prescribe compound testosterone so the dose is precise, but because compounds are unregulated, the purity may not be. That means you could be getting too much of the hormone or too little, depending on the quality of the compound.

The second issue is that testosterone is approved solely for low libido, a.k.a. Hypoactive Sexual Desire Disorder. The American Sexual Health Association defines HSDD as “the absence of sexual fantasies and thoughts, and/or desire for, or receptivity to, sexual activity that causes personal distress or difficulties in her relationship.” 

Studies have shown that women taking testosterone also report a significant return of vitality, good mood, brain power, motivation, and concentration. Yet, she won’t be prescribed testosterone unless she wants to have sex with someone else/be in a relationship. There’s something very wrong with that picture. 

“The only [approved] indication for testosterone is sexual,” says urologist Dr. Kelly Casperson. “That is ridiculous. Why is your interest in sleeping with somebody else the only reason your body should use testosterone? It's legitimately patriarchal.” 

Dr. Casperson prescribes testosterone “multiple times a day”, and her patients report not just a return of libido, but loads of other positive effects, too. “At three months on testosterone, women say, ‘I have better energy, and get up and go. I have more motivation to get stuff done. I'm recovering from my workouts better; my lean body mass has improved. I think quicker.’ This is the exact same thing that men say when you put them on testosterone.”

Unlike the guidance for prescribing progesterone and estrogen, a doctor will do a blood test before a woman begins testosterone treatment. “I always get a baseline, just because I want to make sure you have low testosterone,” says Dr. Casperson. “I've never checked a woman's testosterone and found it to be high, but I just do that to make sure that I’m treating you for low testosterone. I just kind of want to prove it. I get a baseline and then I re-check your testosterone in about 2-3 months.” 

Dr. Casperson generally prescribes testosterone cream or gel, which keeps testosterone at physiologic (aka “normal”) levels. “It's therapeutic. I'm not shooting anybody into the low male ranges, like with pellets.”

Testosterone pellets are a type of unregulated compound hormone that is implanted under the skin and absorbed into the body over several months. Once they’re in, they’re in, and unless you want a scar, they’re not coming out. Women who use pellets may be catapulted into a supraphysiologic (super-high) level of testosterone, and that’s when all hell breaks loose. When levels are too high, a woman may experience hair loss, or her voice may deepen. Although it’s rare, she may even experience clitoromegaly, which is an enlargement of the clitoris and is irreversible.    

“Because doctors are so poorly educated, women are being prescribed pellets”

“Because doctors are so poorly educated, women are being prescribed pellets,” says Dr. Casperson. “Which is a problem for two reasons. The first is cost; You shouldn't have to remortgage your house to be on hormones. Number two; pellets shoot you to supraphysiologic doses, and that's where you get bad side effects.”

These side effects are rare. It is not uncommon to experience acne or hair growth on the patch where you apply the gel, but that doesn’t happen to everyone.

Situations like the potential of a gigantic clitoris give compound hormone therapy a bad name, but although the FDA-approved gel is precise in purity and is very affordable, many doctors will still prescribe a non-FDA-approved compounded cream.

Dr. Casperson currently leans more towards compound cream testosterone because of embarrassing situations happening to women at the pharmacy when they attempt to pick up their FDA-approved testosterone prescription. Apparently, some pharmacists don’t realize testosterone can be prescribed to a woman!

"A big problem is our untrained pharmacists"

“A big problem is our untrained pharmacists, the gatekeepers,” says Dr. Casperson. “They're being obstructionist and asking very personal questions in the pharmacy. ‘Are you transitioning? I don't know if this is safe. Do you know what you're doing? This must be an error. Let me call your doctor.’ They get these flags and warnings on their computer systems. I think it's completely unacceptable.”

Dr. Casperson goes on: “I want to use an FDA-approved product because the price is great -- $50 and it lasts for months -- but I've been switching to a compounded cream because my compounding pharmacies don't give my women a hard time about being on testosterone. I can't have them fight at the pharmacy.” 

Testosterone surely sounds like the answer to many peri problems, but not everyone should take it. Dr. Casperson says for women with polycystic ovarian syndrome, testosterone probably isn’t right for you, as PCOS is a sign of excess androgens (the group of sex hormones that includes testosterone). It’s also not recommended for pregnant women. 

There are limited studies on testosterone use in women (what a surprise) but Dr. Louise Newson, the UK’s foremost specialist in peri and menopause, and her fellow menopause specialist Dr. Alice Scott studied the use of testosterone in over 900 women, with the findings appearing in the British Journal of Medical Practice in 2022. Dr. Newson also assembled an easy-to-read factsheet, which can be read on her website. 

 The fact sheet concludes that “Testosterone can be taken safely alongside estrogen HRT and vaginal estrogen. Long-term use of safely prescribed testosterone is not associated with any adverse health risks and is shown to be beneficial for the health and strength of your muscles, bones, cardiovascular health, and brain health.”