Cate Corridor’s intercourse drive tanked when she hit 40. After months of making an attempt—and failing—to spice up it, she learn a pamphlet in a health care provider’s workplace in regards to the results of low testosterone in ladies, together with low libido, lack of vitality, lack of energy and muscle tone, and cognitive difficulties, like hassle concentrating. “I simply had form of an ‘aha’ second,” says Corridor, a 41-year-old in Berkeley, Calif. “It clicked that that is perhaps what was happening, as a result of there was such a very good match between the issues I used to be experiencing and the signs of low testosterone.”
Corridor scheduled an appointment with a specialist, and in 2024 began testosterone substitute remedy (TRT)—receiving common small doses of the hormone that’s nearly synonymous with male well being. Inside a few week, she began noticing enhancements throughout most points of her life. “The cognitive results have been very dramatic,” she says; it shortly resolved her mind fog and reminiscence issues. “I really feel sharper now mentally than I did 10 years in the past.” She has much less nervousness and extra confidence, will get a minimum of eight hours of sleep an evening (in comparison with six pre-testosterone), and has welcomed again the vitality she must train commonly. She’s additionally misplaced 6% of her physique fats since beginning TRT—and her libido improved. “I actually assume it has been, by far, the most important quality-of-life enchancment I’ve ever made for myself,” she says.
Corridor’s story isn’t distinctive: Cisgender ladies throughout the web are touting the anecdotal advantages of testosterone remedy, and a few consultants say these tales match what they’re listening to of their workplaces. Many describe being requested about TRT a number of instances a day. “There’s been growing consideration to it,” says Dr. Kathleen Jordan, chief medical officer of Midi Well being, a digital care clinic centered on navigating perimenopause and menopause. “We name it the ‘ebook membership impact’—ladies who’ve super outcomes share it with their associates, after which we see associates of our sufferers coming in to inquire about comparable options.”
However can testosterone remedy for girls actually result in such profound well being enhancements? We requested consultants to clarify its potential advantages—and limitations.
What precisely is testosterone remedy?
Opposite to fashionable notion, testosterone isn’t merely a male hormone. Whereas ladies have smaller quantities than males, testosterone performs an essential position in regulating the menstrual cycle, sustaining bone density and muscle mass, and enhancing cognitive well being, temper, sexual operate, and vitality. “After 30, our testosterone ranges lower,” Jordan says. “And by the point we’re in midlife, within the premenopause and menopausal section, they’re all the way down to about 25% of what they have been after we have been youthful.”
Enter testosterone substitute remedy. Greater than 30 totally different testosterone merchandise are accredited for males by the U.S. Meals and Drug Administration (FDA), however the company has by no means accredited testosterone for girls. Nonetheless, docs can nonetheless prescribe it off-label to ladies they really feel would profit. Traditionally, testosterone was utilized in mixture with estrogen and progesterone, hormones that decline with age. However nowadays, it’s additionally prescribed as a standalone remedy, says Dr. Traci A. Kurtzer, a gynecologist on the Northwestern Drugs Middle for Sexual Drugs and Menopause, opening the door to individuals who can’t or don’t need to take different hormones for numerous causes.
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To find out if a girl is an efficient candidate for TRT, docs usually begin by checking hormone ranges to verify somebody “isn’t already coming in on the excessive facet of regular,” Kurtzer says. (Testosterone ranges underneath 20 ng/dL in ladies 50 and older are usually thought-about low.) It’s additionally essential to verify intercourse hormone binding globulin, or SHBG, as a result of if it’s excessive, “any exogenous testosterone we give somebody is simply going to be certain up,” she says. “It’s not going to be helpful to them, so it turns into form of wasted.” The precise dose that ladies take varies, however the objective is to realize the identical degree of testosterone they might have had of their premenopausal years.
There are a couple of types of testosterone, together with pellets injected underneath the pores and skin, drugs taken orally, and topical gels and lotions. Docs usually want a cream or gel that’s utilized to the pores and skin, often to the again of the thigh, calf, or buttocks. Girls have to take 1/tenth of the dose males take, which will be troublesome to estimate, so many get their prescriptions from compounding pharmacies specializing in customized dosing. The downsides of utilizing a compounding pharmacy are that their merchandise aren’t FDA-approved, and dosing will be inconsistent. In a single examine, some merchandise contained greater than 20% of the prescribed dose, whereas others had primarily no testosterone. “It could be very nice,” Kurtzer says, “if we did have an FDA-approved product for girls that was dosed appropriately.”
Potential advantages
The perfect evidence-based use case for TRT for girls is growing sexual operate in a protected, efficient manner. It’s “fairly clear” that low doses of testosterone can enhance libido for post-menopausal ladies experiencing hypoactive sexual need dysfunction (HSDD), which suggests lack of need with out another underlying trigger, Kurtzer says. “It’s not as a result of they hate their companion, or have ache, or as a result of they’re exhausted from working two jobs and might’t focus.” In accordance with one analysis overview, TRT improved the frequency of sexually satisfying occasions, arousal, and orgasm in surgically and naturally postmenopausal ladies.
But the image will get murkier past that. Anecdotally, many ladies expertise a bunch of advantages. Toi-Yan Littlejohn, 57, a retired firefighter in California, tried testosterone pellets and sublingual testosterone earlier than switching to a supplier at Midi Well being who prescribed testosterone cream. Littlejohn had at all times valued an energetic way of life, however discovered that when she reached perimenopause, issues began altering. “I imply, drastically,” she says. “I had no need to stand up, no libido, nothing.” It took a while for her and her physician to determine the proper testosterone dosage, however as soon as they did, she felt like one of the best model of herself once more. “Inside every week, I believed, ‘I really feel so a lot better. I really feel extra clear.’ I used to be figuring out and my depth was again, my libido was again,” she says. ‘I believed, ‘That is implausible. Who wouldn’t do that? I want to inform extra folks.’”
So is TRT actually all that? There’s merely not sufficient information to again up the hype. “We actually cannot say that it isn’t probably useful,” Kurtzer says. “May it assist with physique composition and changing that muscle? May it assist with bodily functioning, vitality, and even cognitive well being and temper?” Perhaps. “The issue is,” she says, “we simply do not have ample information.”
The research that do exist have yielded unsure outcomes past enhancing sexual operate; plus, little is thought in regards to the long-term results of testosterone in ladies. “We have now no long-term research—even utilizing it for HSDD, the research actually are round two years,” she says. “With the concept it is a long-term resolution, what is the tradeoff? Are you now impacting that girl’s total coronary heart illness threat? Are we growing breast most cancers threat? We have now no long-term information on that.”
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Extra information exist for males. Giant analyses have discovered no proof that testosterone will increase cardiovascular issues within the short- to medium-term, for instance, and an individual’s threat of dying early doesn’t seem to vary. One other examine discovered that TRT doesn’t enhance the danger of prostate most cancers, even after greater than 15 years of remedy. But it’s exhausting to attract conclusions about ladies based mostly on these findings, consultants say, since dosage isn’t the identical (although it’s often decrease) and ladies’s our bodies work in another way.
Nonetheless, Kurtzer—who has been prescribing testosterone to ladies for years—hopes analysis will sooner or later affirm that TRT is as helpful as a few of her sufferers declare. “I might love for it to be true that it helps with all these issues, as a result of we do not have a whole lot of different options, and it’s irritating for folks,” she says. “I used to liken it to a drug—and I meant that facetiously—however individuals who have been on it felt so elated and good. It’s a strong form of feeling. That is why I am like, ‘Wow, if it is true and it is protected, and we are able to use it long run, I am all for it.’ However at this level, we simply do not know the detrimental piece of it.”
Unwanted side effects of testosterone remedy
When April Sandefer first tried TRT 10 years in the past, it went properly. “I felt nice,” she says. However she stopped taking it when the compounding pharmacy she used went out of enterprise. A pair years in the past, she determined to begin again up once more, and inside a couple of months, she observed her hair was changing into skinny and her face was breaking out. She additionally grew to become aggressive at work, she says—an out-of-character improvement. “I stated some actually inappropriate issues,” remembers Sandefer, 64, who lives in Oklahoma Metropolis. “My boss pulled me apart and was like, ‘April, you possibly can’t discuss like that to me.’” She ended up stopping remedy. “It’s disappointing that as we become old, we simply have to just accept [annoying symptoms], as a result of they do not appear to have a whole lot of issues created for girls,” she says. She doesn’t plan to attempt testosterone once more: “It’s not value it to me.”
Certainly, analysis suggests that within the brief time period, TRT might result in hair progress on the face, chest, and again, in addition to zits and behavioral and character adjustments. That may be very true for these receiving pellets, which usually include larger doses than different types of testosterone. “As soon as they’re in your physique, you possibly can’t alter or alter the dose or how lengthy you are uncovered to it,” Kurtzer says. “These have usually been the individuals who come to us with problems, as a result of it’s far more than their our bodies can accommodate.” It takes about three to 4 months for testosterone pellets to metabolize out of your system, she provides, which is a very long time to take care of disagreeable unwanted side effects. That is why consultants together with Kurtzer usually advocate in opposition to utilizing pellets.
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Nonetheless, consultants say that one frequent fear about TRT in ladies—growing male traits—is overblown. “Concern about masculinization is disproportionate to what actually occurs,” Jordan says. She hasn’t seen sufferers develop male sample baldness, develop a beard, or begin talking in a deeper voice, for instance. Common blood testing is useful, she provides, and permits clinicians to make dosage changes if unwanted side effects like delicate masculinization do happen.
“The way in which we strategy it’s we take heed to ladies, determine what their signs are and what well being profit they’re searching for, and what is going on to assist them really feel properly and important—reasonably than simply saying it’s a blanket anti-aging remedy that each one ladies ought to have,” Jordan says. “When it’s executed with that form of steerage and counseling, it may be very protected and efficient.”
