Do women have a testosterone problem?
The influencers On social networks they think so. And with the rise of remote medicine and testosterone replacement clinics opening across the country, access to the medication has never been easier.
In the United States, testosterone prescriptions increased nearly 50% between 2013 and 2023, according to recent data from health technology company IQVIA. Doctors affirm that interest in the hormone is not only being driven by men, but also by women, specifically those of between 40 and 50 years.
“It seems almost like an epidemic,” Dr. Rebecca Dunsmoor-Su, medical director of Gennev, a national telemedicine company for menopausal patients, said of middle-aged women seeking testosterone. “They tell them this is the miracle pill they were looking for.”
The number of women turning to this hormone could be even higher than believed, Dunsmoor-Su said, noting that testosterone is often prescribed in gel, granules or pills through medical centers and telemedicine.
Testosterone is the main male sex hormone and performs various functions in the human body. In men, it increases muscle mass, sexual desire and voice gravity. In women, who also have it at much lower levels, it intervenes in libido, muscle health and energy levels.
Normally, testosterone levels in men are about 15 times higher than those found in women.
In both men and women, it is normal for testosterone levels to decrease with age, starting at age 30 for men and around age 40 for women. This reduction does not necessarily mean that it has to be replaced, neither for health nor longevity reasons.
Levels of what is considered normal can vary depending on the laboratory, and just because they are low does not mean that a person should start taking testosterone. Doctors rely on a combination of symptoms and blood tests to decide who to treat.
If a patient has symptoms of low testosterone, such as depression, lethargy and lack of sexual desire, specialists usually measure the levels with a blood test before deciding on treatment, which may include a gel rubbed on the shoulder, pills or a granule that is implanted in the buttocks.
Why are women using testosterone?
In recent years, Dr. Amy Voedisch, an obstetrician-gynecologist at Stanford Medicine in Palo Alto, California, has seen a dramatic increase in the number of middle-aged women seeking testosterone therapy.
Perimenopause symptoms begin when they turn 40, triggered by hormonal fluctuations and accompanied by irregular periods, brain fog, insomnia and hair loss. The changes begin a few years before menopause, when menstruation disappears permanently.
Some women may notice a decreased sexual desire, as levels of estrogen and testosterone, which are involved in libido, fall as they age.
“Every time I talk about hormone therapy for menopause, I get asked: but what about testosterone?” Topical testosterone products appeared on the market in the early 2000s.
Voedisch, who has been practicing her profession for decades, pointed out that the phenomenon among women began to emerge in the last two years; before, interest in this therapy rarely arose in consultations. Now, virtually every new menopause patient asks him.
A patient told her: “I was listening to a podcast, and they told me I needed this,” the doctor said. “Or I follow a person on Instagram who told me I should do it.”
On the Reddit forum r/menopause, dozens of posts tout the benefits of the hormone for improving women’s energy and sexual appetite. Few of these claims are supported by evidence, Dunsmoor-Su noted.
“It will give you energy, it will make you lose weight, it will make you excited, just like you’ve been promised,” he said, describing common promises about the treatment. “It solves everything, and they attribute all their problems to low testosterone.”
Dr. Traci Kurtzer, a menopause specialist at Northwestern Medicine’s Center for Sexual Medicine and Menopause in Chicago, agrees that the boom has occurred in recent years. His patients ask about therapy for multiple problems: from improving mood, energy and sex drive, to brain fog and muscle mass.
She tells them that testosterone therapy is recommended for low sexual desire, although future research could find other benefits.
“If that’s the case, that would be wonderful, but right now we don’t have the data to back it up,” Kurtzer said.
Does testosterone help women?
The Food and Drug Administration (FDA) has not approved testosterone treatment for women.
But doctors can prescribe it for low sexual desire after ruling out other causes, including medical and psychological ones, according to Dr. Jan Shifren, director of the Center for Midlife Women’s Health at Massachusetts General Hospital in Boston.
Shifren, who has participated in clinical trials of testosterone treatment for women, said the benefits for patients with low libido are not very notable.
“Women who were randomly assigned testosterone have one additional satisfying sexual encounter in four weeks, compared to those who received placebo,” he said.
In addition to reduced hormone levels, other causes of low libido include relationship problems, anxiety or depression, and metabolic diseases such as hypertension or diabetes. Another reason is the discomfort derived from vaginal dryness resulting from menopause, and stress.
Shifren urged women to treat all other possible causes before starting testosterone. “It’s not that I don’t prescribe it, but it’s after addressing a lot of other concerns,” he said.
For Marcella Hill, 44, symptoms of depression, body aches and low sexual desire were affecting her relationship with her husband.
“I was really suffering,” explained Hill, who lives in Vineyard, Utah. His doctor told him it was normal. “It was crazy. “I couldn’t live like this,” he said.
At first he was prescribed a testosterone gel, but he did not notice any improvement and had difficulty using it. Frustrated that her doctor did not offer more help, on the recommendation of a friend she went to a local clinic and began therapy with testosterone pellets, a more potent version of the hormone.
After two years of treatment, the results have changed his life, he said.
“I opened TikTok just to tell this story, and the next day my phone blew up with 9 million views,” he said. “Women all over the world were saying, ‘Wait, I have all these symptoms.’”
Hill is not paid to promote testosterone, although she has collaborated with a telemedicine company on ads urging women to get regular checkups.
She undergoes frequent checkups and her testosterone levels are closer to those considered low for a man, he explained. He is not worried about them, but it has a side effect: he grows a lot of hair on his face.
Is testosterone safe for women?
According to experts, when prescribed by a doctor and carefully monitored, it is a relatively safe treatment for women. Side effects are rare.
When men resort to it, it is usually administered in gel form, with a dose of 50-100 milligrams per day. Women, on the other hand, are recommended to take only 5 milligrams a day, 10% of a man’s dose.
Higher doses for them can lead to side effects such as acne, excessive body hair, and even body odor. Some are permanent.
Voedisch remembers a patient who left therapy after her voice changed. “He told me, ‘It really affected me one time when I was on the phone and someone called me ‘sir,’” she said.
“It may not be reversed even by stopping taking it, which is really unfortunate,” Voedisch warned of the side effects of an inadequate dose.
The doctor understands patients who feel ignored by doctors and frustrated by the lack of therapeutic options available for perimenopause and menopause symptoms.
“We have ignored women’s health for too long in this country,” Voedisch said. “This has come from a place of frustration and a desire to feel better.”
