True or False? 

Men don't have Estrogen and Women don'e have Testosterone?  

FALSE!!!  

If you are a woman, you have three PRIMARY hormones that guide reproduction and gender defining characteristics.  They are, in order of MOST prevalent to least prevalent, PROGESTERONE, then TESTOSTERONE, then ESTROGEN!!

Does that surprise you to learn that you should have more Testosterone than Estrogen?  

Because it sure surprised me!  

Hi!  I'm Dr. Kelly, double board certified pelvic floor specialist, and owner of Pelvic Floored.  Our mission is to reduce geographic, financial and psychosocial barriers to accessing kick-butt pelvic health care and information.  

When it comes to hormone replacement therapy, YOU need to be an educated patient, because your doctor, EVEN your OB-Gyn, might NOT be educated as well as you think

A survey of 100 practicing physicians by Allen, et al, in 2023 found that while >90% of graduating physicians feel that menopause care is exquisitely important, Ob-Gyns commonly receive 2-3 hours of hormone specific training.   That's less training than a barista, friends!! 

And since a 2019 study found that <10% of new graduate OBGYN, Family Medicine and Internal Medicine docs are up to date on their Hormone Replacement Therapy (HRT) prescribing guidelines and evidence.  Link to Menopause Society Press Release HERE.  

In today's post, I educate you directly, so that you can overcome the plethora of misinformation out there, and be the best advocate to yourself, and to people you love!  So let's get to the top reasons why you, as a woman, might need testosterone HRT! 

Top Reasons that as a Woman, You Might benefit from Testosterone HRT

As a woman, you HAVE and NEED Testosterone.  A woman's circulating levels of Testosterone should be our second most prevalent hormone, after Progesterone and before Estrogen. 

During perimenopause, which tends to start around 35 years old, and is the 10 year period before menopause, our systemic levels of testosterone fluctuate WILDLY.  These fluctuations can result in bothersome symptoms, that can be helped by Testosterone HRT (and remember, FDA Testim is recommended instead of pellets or compounded Testosterone!!).   Here are the top reasons/symptoms that can indicate your levels are dropping, and you could benefit from HRT. 

1. You feel a reduced sex drive

TBH, I don't know of many people in their mid-30s and early-40s who are "pleased" with their sex drive.  But if your levels of circulating testosterone ARE dropping, that can be one factor in a lackluster sex drive.  Pelvic floor muscle health, overall stress management, and communication with partners are also extremely important, but prescription HRT of Testosterone can, and should, be considered in a perimenopausal female with reduced sex drive.  

As of the publication date of this blog, reduced libido is the ONLY approved diagnosis to allow for prescription Testosterone HRT.  But as you'll see in the next few bullet points, there are MANY other reasons and symptoms that can arise from having relatively low testosterone levels. 

2. Reduced overall energy

As with the reduced sex drive, there are MANY factors involved in reduced overall energy, but reduced testosterone can be a factor here.  You would want to check your basic red blood cell, and iron reserves first, to ensure that they are adequate, and be working on a nutritious dietary plan, and sleeping well (obviously), but if you are doing "all the things" and still feeling tired overall, a trial of Testosterone HRT Gel could be warranted.  

3. Reduced tolerance to cold

This is a funny one...but real!  As testosterone levels reduce, we not only feel "less vital" (which means less energetic), but we also tend to have a reduced tolerance to the cold.  This fascinating observation could be due to the hypothalamus (our temperature regulating system) being a bit more finicky as we go through perimenopause.  Adding in Testosterone HRT, as Testim Gel, has been shown to improve temperature tolerance.  

Those are the Top Reasons a Woman Would Want Testosterone HRT

If you want to learn more, I have this blog post about why Testim Gel might be a better option than Testosterone pellets for many women.  

I hope you found them helpful.  Were any expected?  What about did any surprise you?  Comment below, or follow me on socials for more free, fun education!  

XOXO
Dr. Kelly 💋

References:

Allen, J. T., Laks, S., Zahler-Miller, C., Rungruang, B. J., Braun, K., Goldstein, S. R., & Schnatz, P. F. (2023). Needs assessment of menopause education in United States obstetrics and gynecology residency training programs. Menopause, 30(10), 1002–1005. https://doi.org/10.1097/GME.0000000000002234. link here 

Davis S. Testosterone deficiency in women. J Reprod Med. 2001 Mar;46(3 Suppl):291-6. PMID: 11304877. link here

Gotmar A, Hammar M, Fredrikson M, Samsioe G, Nerbrand C, Lidfeldt J, Spetz AC. Symptoms in peri- and postmenopausal women in relation to testosterone concentrations: data from The Women's Health in the Lund Area (WHILA) study. Climacteric. 2008 Aug;11(4):304-14. doi: 10.1080/13697130802249769. PMID: 18645696. Link here