Testosterone replacement therapy (TRT) is no longer an unfamiliar term, especially among those who wish to retain the healthy hormones they used to have. The therapy involves administering testosterone into the body to reach the optimization of hormones and gain the health benefits that better hormones offer. Nevertheless, amid many untrue myths about the treatment, women may find it challenging to decide whether it’s good for them. This article separates science and stories about female testosterone therapy so you can be confident before you go on board.
Testosterone Therapy for Women: Debunking Facts & Myths
Fact: TRT Is Beneficial for Women
For too long, testosterone has been thought to be a male hormone. It’s not only because people tend to attribute a sex hormone to a particular gender but also because testosterone plays a vital role in men’s masculine characteristics. However, this conception is false.
Testosterone is a vital hormone in both sexes. Yet, in women, this so-called male hormone has a higher concentration than estrogen, as a healthy adult female may have up to 70 ng/dl (nanograms per deciliter) of testosterone while having only 40 ng/dl of estrogen.
So, can women take testosterone? The answer is yes. Testosterone is beneficial for both men and women on TRT. A survey in 2009 found that 4 million prescriptions were written for women to treat sexual dysfunction due to hormone deficiency. Many more were given for menopausal symptoms and other conditions caused by hormonal imbalance.
Fact: TRT Is More Effective if Initiated Early
Many women on TRT wait until their menopause symptoms, like low libido, mood swings, or weight gain, make them exhausted before seeking relief. The truth is the earlier you start the therapy, the better results you get.
According to the North American Menopause Society (NAMS), hormone therapy shows more efficacy and fewer safety risks if implemented between 50 to 59 years of age or within 10 years of menopause. However, side effects are more common in people over 60 and those more than 10 years from the onset of menopause.
This difference in the outcome of hormone therapy concerning the time of initiation is due to the existing hormone levels. After menopause, testosterone levels diminish quickly, making it even lower than half of the youthful levels. Still, the situation is worse 10 years after menopause. During this time, the amount of testosterone in women is almost zero, making hormone therapy instead do more harm than good to the female body.
Fact: TRT Causes Mild Acne
Suppose you’ve had a TRT session and started noticing some changes on your skin, such as acne. In that case, that might be the side effect of testosterone. Unfortunately, acne is among the most commonly reported side effects of testosterone.
According to research, elevated androgen levels among individuals receiving testosterone therapy are associated with a higher incidence of acne. Fortunately, although testosterone can increase the development of acne, severe cases are rare. Women on TRT can avoid acne by starting from a baseline dose and slowly increasing it over time.
That said, severe acne is a contraindication of TRT, which means women already suffering from acne should not request this treatment.
Fact: TRT Increases Facial Hair
Another side effect of female testosterone therapy is an increase in facial hair. This symptom is relatively common since it’s independent of the dose and duration of the treatment. Yet, according to research, testosterone, even in low dosage or for a short course, can cause hirsutism, a condition characterized by increased hair growth on the face and neck.
Nevertheless, this condition is reversible. Drugs like spironolactone may help. Although not approved for dermatologic conditions, it has been accepted as a treatment for acne and hirsutism. Another way is to undergo laser hair removal. This FDA-approved approach stops hair growth using a laser light beam to target the hair follicles.
Please remember that any unwanted side effect among women on TRT is reversible by lowering the dose. Yet, since the beneficial effects of this therapy depend on dosing, which means the benefits are only achieved at a specific amount, many women choose to treat the side effects simultaneously with the treatment rather than decrease the dose.
Myth: TRT Causes Hair Loss
Does TRT cause hair loss? Given that men have higher testosterone levels and are more susceptible to hair loss (67.1% in men and 23.9% in women), it’s reasonable to attribute this condition to the male hormone. However, scientists suggest that the shedding and thinning of hair only coincides with testosterone decline and doesn’t prove causation.
Instead, hair loss is a complicated and multifactorial disorder primarily determined by genetics. It is suggested that those predisposed to hair loss have up to 80% to develop the condition at some point in life. Moreover, the risk of hair loss is increased by some comorbidities, like obesity and diabetes, and the overproduction of dihydrotestosterone (DHT), a byproduct of testosterone.
An excessive amount of DHT can affect the hair follicles, interfering with the normal hair growth cycle and making it more difficult for hair to grow back. Meanwhile, obesity and diabetes increase 5-alpha reductase, an enzyme that converts testosterone to DHT.
Research has shown that hair loss only coexists with a drop in testosterone in about a third of women. In contrast, in two-thirds of women on TRT in the form of subcutaneous implants, hair regrows as a result of treatment. Those who don’t experience hair regrowth are more likely to have problems with their thyroids, iron deficiency, or elevated BMI.
Myth: TRT Causes Masculinization
While high testosterone is associated with masculinity, it doesn’t apply to women. Research shows that testosterone doesn’t cause masculinization unless the patient is given extremely high doses over an extended period. Moreover, women on TRT won’t develop any vocal or behavioral changes, such as voice deepening or aggression.
Instead, TRT can improve the psychological health of women who suffer from depression. For example, a study on 34 premenopausal women found that 10 mg of testosterone cream significantly improves depressed mood. In addition, women can request transdermal or subcutaneous testosterone, which provides predictable doses while maintaining effective absorbability, to ensure no safety concern regarding high dose incidence.
Myth: TRT Increases Heart or Liver Disease Risk
TRT and Heart Disease
Although there is a link between testosterone and heart disease, the connection is not yet fully understood. The truth is that the imbalance between testosterone and estrogen is associated with heart disease rather than testosterone only. Furthermore, an analysis of over 2,800 women shows that a disproportion between the hormones might increase cardiovascular disease risk, making it an accurate risk indicator for heart disease.
Because testosterone replacement therapy aims to optimize hormones, it maintains a balance between testosterone and estrogen, as seen in healthy women. For this reason, heart disease incidence among women on TRT is impossible.
TRT and Liver Disease
Oral testosterone can impair the liver due to its hepatic first-pass mechanism, meaning the hormone taken orally is processed in the liver before producing its effects. Any drug that needs to be processed in the liver may cause harm to the organ. A study found that testosterone was associated with abnormal liver functions and tumor development.
Nevertheless, oral testosterone is not given anymore in the context of other routes, including transdermal delivery, emerging and showing more safety for the liver. According to a study, transdermal testosterone avoids the hepatic first-pass effect and hepatotoxicity.
Myth: TRT Increases Breast Cancer Risk
Whether TRT can cause or increase the risk for breast cancer might be the top worry among ladies when it comes to replacing hormones. Because the aromatase enzyme in the breast can convert testosterone into estrogen, which in turn increases the growth of breast tissues, there is a hypothesis that testosterone may stimulate breast cancer.
Despite that, research has found no significant differences between women on TRT in the form of transdermal patches and those on placebo in mammographic breast density, an indicator for breast cancer. In addition, another analysis reported no significant association between breast cancer risk and androgen therapy.
Instead, research has confirmed that testosterone has a beneficial effect on preventing breast cancer by inhibiting the estradiol-induced proliferation of breast tissue. This inhibition can slow down the initiation or development of cancer cells. Therefore, testosterone doesn’t increase but lowers the risk of breast cancer in women.
Now you can be confident to start your first therapy as you know the real story of female testosterone replacement. It’s crucial to be selective about facts and myths, especially when false conclusions are becoming widespread. So get your first hormone therapy session and know you will only benefit from it.
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