Don’t believe the hype—menopausal women don’t all need to check—or increase—their testosterone levels

Ever heard “low testosterone” blamed for low temper, mind fog and lack of vitality? Regardless of all proof on the contrary, social media influencers are more and more selling testosterone remedy as an elixir for girls experiencing troubling signs of menopause.

In a collection of documentaries and social media posts about menopause in 2021 and 2022, British TV presenter Davina McCall promoted the usage of testosterone remedy along with normal menopausal hormone remedy. The “Davina impact” has helped gasoline a ten-fold enhance in prescribing of testosterone for girls in the UK since 2015.

Knowledge is not accessible for Australia, however in my medical observe, ladies are more and more asking to have their testosterone stage checked, and searching for testosterone to deal with fatigue and mind fog.

However whereas testosterone continues to be an vital hormone earlier than and after menopause, this does not imply ladies ought to be having a blood check to get their testosterone ranges checked—or taking testosterone remedy.

What does testosterone do?

Testosterone is a vital hormone in ladies’s our bodies, affecting the blood vessels, pores and skin, muscle and bone, breast tissue and the mind. In each men and women, testosterone can act by itself or be transformed into estrogen.

Earlier than menopause, testosterone is made within the ovaries, the place it helps growing eggs develop and aids in estrogen manufacturing.

The ovaries launch each testosterone and estrogen into the bloodstream, and the degrees of the 2 hormones within the blood peak round ovulation.

A few of the testosterone measured in blood can also be produced exterior the ovaries, equivalent to in fats, the place it’s produced from “pre-hormones” secreted by the adrenal glands. This supply of manufacturing of testosterone takes over after menopause.

Do we have now extra testosterone earlier than menopause?

The declare is commonly made that pre-menopausal ladies have extra testosterone of their bloodstream than estrogen, to justify the necessity for testosterone substitute after menopause.

However, when intercourse hormones have been measured with precision, research have proven this isn’t true. Our analysis discovered estrogen ranges are greater than testosterone ranges in any respect levels of the menstrual cycle.

Blood testosterone ranges fall by about 25% between the ages of 18 and 40 years in wholesome ladies. The autumn in testosterone coincides with the decline in eggs within the ovaries however whether or not it is a marker of the decline, a consequence, or a reason behind the decline will not be identified.

From round 40, the speed of decline slows and blood testosterone ranges do not change when menopause happens naturally. Research haven’t proven testosterone ranges change meaningfully through the menopause transition.

Can blood checks detect ‘low testosterone’?

Some influencers declare to have a situation known as “testosterone deficiency syndrome” or low ranges of testosterone detected in blood checks.

However there is no such thing as a “regular” blood stage beneath which a lady may be recognized as having “testosterone deficiency”. So there is no such factor as having a testosterone deficiency or testosterone deficiency syndrome.

That is additionally partially, as a result of ladies have very low testosterone concentrations in contrast with males, and most business strategies used to measure testosterone can’t separate regular from low ranges in ladies with any certainty.

Pre-menopausal ladies may additionally be instructed they’ve “low” testosterone if blood is drawn early within the menstrual cycle when it’s regular for testosterone to be low. (Nonetheless, it will solely be clinically essential to do such a blood check to search for excessive testosterone, in somebody with with extreme hair development or extreme pimples, for instance, not for low testosterone.)

In post-menopausal ladies, a lot of the motion of testosterone happens within the tissues the place it’s made, after which testosterone is both transformed to estrogen or damaged down earlier than it leaks again into the circulation. So blood testosterone concentrations will not be a real reflection of tissue concentrations.

Additional complicating the image is the large variability within the results of testosterone. At a given blood stage of testosterone, some ladies may need oily pores and skin, pimples, elevated physique hair development or balding, whereas others may have no such results.

So, on the lookout for a “low” blood testosterone in ladies will not be useful.

Can testosterone enhance sexual need? What about different circumstances?

There’s sound proof that testosterone remedy could enhance sexual need in post-menopausal ladies who’ve developed low sexual need that bothers them.

This was confirmed by a scientific overview of medical trials evaluating testosterone with a placebo or an alternate. These trials, all of which concerned a remedy time of at the very least 12 weeks, confirmed testosterone remedy, total, improved need, arousal, orgasm and sexual satisfaction in post-menopausal ladies with low need that induced them misery.

Remedy is simply indicated for girls who need an enchancment in sexual need (after excluding different elements equivalent to melancholy or treatment negative effects) and its success can solely be decided by every lady’s private self-reported response.

However there may be not sufficient proof to indicate testosterone is useful for some other symptom or medical situation. The general accessible information has proven no impact of testosterone on temper or cognition.

As such, testosterone remedy shouldn’t be used to deal with signs equivalent to fatigue, low temper, muscle weak spot and poor reminiscence, or to stop bone loss, dementia or breast most cancers.

Nonetheless analysis continues to analyze these potential makes use of, together with from my analysis workforce, which is investigating whether or not testosterone remedy can defend towards bone density loss and muscle loss after menopause.

You’ll be able to be taught extra about collaborating in certainly one of our research right here.

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