Testosterone for Women: The Evidence and Benefits No One Talks About
A 45 year old female presents to you complaining of fatigue, loss of energy, weight gain, muscle pain, and weakness in exercising.
She read about the benefit of hormones in treating her condition, but her PMD is against the use of hormones. Although she is open to taking hormones, her PMD scared her into thinking that testosterone is somehow harmful. You assure her that testosterone is not harmful and that many of her symptoms will improve on testosterone supplementation – which you, as the prescriber, have learned how to prescribe, monitor, and dose by attending the Hormone Optimization Workshop Series.
Based on recent published studies demonstrating that testosterone is safe and efficacious, you prescribe testosterone for off-label use in order to improve symptoms in this patient. The patient reports significant improvement in symptoms after one month of therapy. However, she again stops the HRT program as her PMD again scares her into thinking that testosterone is harmful and not indicated in her situation. You advise the patient that testosterone is not harmful, and she has the choice of feeling better or not. You suggest that the patient not discuss the use of hormones with her PMD as they will probably be down on the use of hormones to improve QOL and wellness.
The patient is again puzzled by the lack of understanding by her PMD. You alleviate her fears by providing several medical studies (that will be provided in this new webinar series!) demonstrating the safety and efficacy of testosterone use in women for a multitude of reasons. Finally, you suggest that the patient no longer discusses the use of HRT with her PMD with the understanding that medical science and literature trumps a physician’s lack of understanding of medical studies.
Interested in taking a deeper dive into the evidence and benefits for Testosterone for Women?
A New Webinar Series on Testosterone
The webinar series for testosterone in men, which is now available as a series of courses, What You Need to Master Before Prescribing Testosterone, lasted 12 months (8 separate webinars). The series in men took so long due to the sheer numbers of important and profound studies / papers / opinions that have been published. Although the number of studies / papers / publications for testosterone in women pale in comparison to that in men, none-the-less testosterone is just as important of a hormone in women as it is in men.
However, a recent consensus paper (written all by men) concluded that testosterone use in women should only be for improving the hypoactive sexual desire disorder and for no other reason. Thirty years of studies demonstrating tremendous benefits on health and wellness were ignored by these authors. Why? I don’t know, however, in these circumstances there is usually some economic or political agenda. Perhaps the denigration of compounded testosterone as well as all other compounded hormones may have been the driving force for this quite negative consensus paper written by members of ACOG and NAMS.
Nevertheless, the authors ignored the plethora of data published on the benefit of testosterone in women. As a result, this webinar series is an attempt to rebut that consensus paper and to include all the studies and data demonstrating the benefits of testosterone in women that were ignored by the authors of the recent consensus paper.
Understanding the Bias
One has to understand and appreciate the bias in the recent testosterone consensus guideline by “experts.” In my own opinion, these experts are not experts in prescribing testosterone as I have done over the last 25 years. But to be fair, I’m extremely biased also but I support my bias with 25 years’ experience in prescribing testosterone as well as over 20 years of studies and literature that guide my therapy. The recent (what I will term negative) consensus opinion paper wreaks of pharmaceutical company clout by the insistence that there is no good evidence that testosterone provides any benefit other than for HSSD. Nothing could be further from the truth. The authors successfully published their opinion consensus guideline due their status and connections. Nevertheless, their opinion does not mean that we can’t use or prescribe testosterone to women. And our own personal experience and opinions will remain muffled and unpublished, unfortunately.
Even though the above referenced consensus paper got published, it is unfortunate that a rebuttal in the same journal did not get published. We will review why this was the case, and we’ll also review the rebuttal opinion paper that was published in an androgen journal and eloquently written by a female as opposed to an all-male consensus group. This positive rebuttal was written and published in a separate medical journal “Androgens: Clinical Research and Therapeutics 2021;2(1);82-84.” However, this positive rebuttal paper received little press in contrast to the negative paper that received negative press. Nonetheless, the author in the Androgen Research Journal criticizes the consensus paper as it ignores the plethora of papers and studies published on the important health benefits of testosterone in women. The author, Dr. DeRosa, points out the consensus authors’ bias in their connection to the pharmaceutical industry and all the authors were men. Dr. DeRosa alludes to the lack of any FDA approved testosterone for women and cites the bias that will prevent any FDA approved testosterone product coming to fruition (politics and economics at their finest).
At this point in time, the only available testosterone products for women are produced by compounding pharmacies and the compounding industry. Unfortunately, the compounding industry is heavily criticized and denigrated by the FDA and pharmaceutical industry. It is highly problematic when the experts that wrote their negative consensus paper on testosterone in women have significant financial conflicts of interest. Moreso, all the scientific literature demonstrating safety and efficacy of testosterone in women is simply ignored as if it doesn’t exist. And the many studies and literature that support testosterone administration in women is completely suppressed by their insistence that data and studies don’t exist.
“Nowhere in medicine is the pharmaceutical bias and medical society contamination so prevalent as in the hormonal needs of women for both estradiol and testosterone.”
– Angela Marie DeRosa
BHRT Experts Weigh In
Fortunately, there has been a separate consensus statement written by BHRT experts that do have experience and knowledge in the use of testosterone in women. And there are over 100 references/articles supporting the safe and efficacious use of testosterone in women. Testosterone insufficiency in women negatively affects sexuality, general health, and quality of life. Supplementation has a positive influence on sexuality, bone health, cognition, lipids and cardiovascular disease, body fat and esthetics, energy, metabolism, and fatigue. Why, and how, all the foregoing information is ignored and allowed to be suppressed is unconscionable.
The medical literature demonstrating the safety and benefits of testosterone will be reviewed in this new webinar series along with the long list of scientific publications supporting tremendous improvement in women’s health and QOL. The compounding industry provides for the availability of testosterone that can be prescribed by clinicians, and Worldlink Medical provides the appropriate education and training on the correct use and administration of testosterone for both men and women. The contention that testosterone “could” be harmful is not born out in any study in the past 50 years.
Is Prescribing Testosterone Harmful?
The best way to fully address health problems is to treat their root causes. This may be surprising to some but one way to do this is through hormone replacement therapy. Simply stated, hormone replacement therapy replaces hormones that decline as we age. In essence, it treats the root cause of many age-related ailments.
Before we jump into all the studies demonstrating/proving the benefits of testosterone in women, we should first review the studies demonstrating that testosterone is potentially harmful and should not be utilized. (I hope that you understand that this is stated sarcastically yet the “expert consensus guidelines” will make claim to these opinions and that is all they are-just opinions). The above expert opinion guideline alludes to the fact that testosterone is harmful. Nothing could be further from the truth and we, therefore, need to review how and why this supposed harm of testosterone came about.
So, there are multiple observation studies demonstrating that “high” levels of testosterone in pre-menopausal women are “associated” with an increase in breast cancer, heart disease, and diabetes. Furthermore, the same is demonstrated in post-menopausal women that high levels of testosterone are associated with an increase in breast cancer and heart disease. Conclusion: we should not prescribe testosterone to women based on the overwhelming data demonstrating that high levels of testosterone are harmful and that we should, accordingly, keep testosterone levels low in women and certainly not prescribe it.
Over the last 20 years, I have encountered many PMDs that openly express their disdain to any patient taking testosterone by their inappropriate comments such as “you’re going to grow a penis or a beard.” My patients also laugh it off but are puzzled by their doctor’s dislike/hate for testosterone and their opinion that testosterone is somehow harmful. Lastly, we will review the studies demonstrating that low testosterone levels in females is detrimental to their health and that replacing testosterone to optimal levels is both safe and efficacious.
Association Does Not Prove Causation
The recent consensus paper reflects this opinion. I also refer to the foregoing paragraph where the authors suggest and mislead us to believe that testosterone is “associated with” harm. You have heard before, and you will hear it again, association does not prove causation.
Observation does not prove a mechanistic cause. Only RCTs will prove causation, or lack thereof. Once we review all the data demonstrating that high levels of testosterone are associated with harm, I simply do not understand why authors continue to write this (rubbish) and why journal editors continue to publish it. It is just overwhelming to me that so many authors, as well as so many academicians, continue to get it wrong. And by being allowed to publish this nonsense, our peers and patients will end up being confused also. So, we will start this series with a review of literature demonstrating that extrapolating the harm of association studies to intervention studies is simply wrong and inappropriate.
In the most recent published study showing that high testosterone levels (within normalcy) are associated with harm, the authors at least recognized this flaw in their study design whereby they did profess that their observational results may not prove that testosterone is mechanistic or causative of any harm. Again, just because we observe something in a “baseline study” does not mean that what we observed (high testosterone levels) was actually the cause for harm observed in the study as it may be something else instead (insulin resistance) that was responsible for the harm and not the testosterone. The higher quintile of testosterone associated with harm was not directly related to the testosterone as testosterone was only an innocent bystander and not causative of the harm seen in the study. These are extremely important concepts to understand before moving forward. The authors of such baseline studies falsely mislead us into believing/assuming that testosterone administration, or having high levels of testosterone, are harmful. Nothing could be further from the truth as we will see.
There is no study that demonstrates prescribing testosterone to women is harmful, aside from the few androgenic side effects that are easily corrected by dose adjustment. The same can be stated for the use of estradiol and progesterone as no study has proven or demonstrated any harm, only benefit. There is no study demonstrating that removing ovaries, with the concomitant loss of E2, P4, and testosterone is beneficial either; only harmful.
Treating Elevated Testosterone
After reviewing the most recent literature demonstrating that high levels of testosterone in the upper quintile of normal are associated with more harm than testosterone levels in the lower quintile of normal, we will review where this “high” level of testosterone comes from and what can/should be done for it. Assuming that every study shows harm of elevated testosterone, and lack of harm when testosterone levels are in the lowest quintile, then we are led to believe that testosterone administration to women is harmful. What treatments are available to lower levels of testosterone into the purported safe lower levels and are there outcome studies that show benefit to this? Under what circumstances should we lower testosterone level into that safe lower quintile and why?
Similar to E2 in women, high levels of E2 in women are associated with an increased risk of breast cancer, CAD, and CVD. However, raising E2 by prescribing it protects against breast cancer, CAD, & CVD, just the opposite of what we observed in baseline studies. The same applies to testosterone in women. Taking testosterone, or raising testosterone levels, protects against CAD, CVD, and breast cancer.
There are multiple reasons for prescribing testosterone to both pre-menopausal women as well as in post-menopausal women. The outcomes demonstrated in intervention studies are the opposite of what we observed in baseline observation studies. Again, the difference is that in baseline studies, testosterone was not administered, and the levels observed were baseline levels and not from any treatment by testosterone.
On the other hand, in the RCTs (randomized interventional trials where testosterone was administered), the results were the opposite than what was observed in baseline observation studies. Reviewing outcome studies (RCTs) demonstrates improved health and wellness when testosterone is administered.
This is why we doctors prescribe testosterone, and which is why patients seek out treatment to feel and function better as well as have improved health and wellness. We will review all the outcome studies proving safety and efficacy of testosterone replacement in contrast to baseline observational studies in which testosterone is associated with harm but does not cause it.