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What Every Woman (And Her Doctor) Should Know

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Testosterone. All women are supposed to have some. A deficiency can cause many problems, among them, lack of or low sexual desire, lack of sexual fantasies, lack of sensitivity to sexual stimulation in the clitoris and nipples, anorgasmia (lack of orgasms), flabbiness and muscular weakness, poor muscle tone, poor energy and stamina, lack of coordination and balance, lack of sense of security, indecisiveness, poor body image, dry skin, and hair loss in some women, including pubic hair loss. Yet many doctors will tell women their testosterone levels are normal when they have no testosterone at all.

There are many potential reasons for testosterone deficiency. Menopause or a hysterectomy can cause it, but it can also be caused by the birth of a child, or for no obvious reason at all.

If you decide you need to have your testosterone levels checked, be sure to ask for the numbers, as doctors do not agree on how much testosterone a woman needs. Doctors Jennifer and Laura Berman, founders of the Network for Excellence in Women's Sexual Health and authors of the book For Women Only, believe that a testosterone level under twenty is too low, whereas other doctors suggest that anything below 24 is too low. I know of a woman whose testosterone level was 0.0, and her doctor told her it was normal. But you cannot assume that if your levels are above 20 you have enough. Even if your levels fall within the normal range, you may not have sufficient testosterone. Every woman is different. You may have fewer receptors than most women, or you may just need more testosterone for some other reason.

According to a paper presented at the Woman's Sexual Health State-of-the-Art Series, February 2-3, 2002 at Shutters on the Beach, Santa Monica CA, testosterone deficiency is diagnosed as a level less than 16 nanomgrams per deciliter. For healthy, menstruating women, the median level is 31 nanograms per deciliter, and any level less than 31 is considered a deficiency in women with signs of deficiency. However, According to Dr. Susan Rako, Testosterone levels cycle daily. They are highest in the morning, when you awaken, and diminish by as much as one third or one half throughout the day. Testosterone levels also rise and fall with experiences of success and failure in social encounters. Sexual activity can stimulate a rise in testosterone, more so in women than in men. Testosterone is lowest in the early follicular phase of the menstrual cycle, so if you have it tested and it is just above 31, you may want to go back at a different menstrual phase and time of day, and try again. Generally speaking, if you have symptoms of low testosterone, you have low testosterone.

According to Dr. Uzzi Reiss, a normal total testosterone level can be anywhere from 20 to 100. It is typically between 30 and 80, but a woman with little muscle and body hair might have a normal level of 20-40, and a more muscular and hairy woman may have a level in the 75-100 range. The general rule is, if you have the symptoms, it's low, but if it's above 31 and you have symptoms of deficiency, be extra careful while monitoring yourself for side-effects.

When you have your testosterone levels checked, be sure to have both the free and total levels checked. It's extremely important, because you may have enough total testosterone, but if you have too little free testosterone, you will still have a deficiency. Free testosterone is not bound by Sex Hormone Binding Globulin (SHBG's). Your free testosterone count should be above 1.9, although you may be told 0.05 is within in normal range. Again, research into women's sexual issues is relatively new, and doctors have not yet completed the research. Note: just because your testosterone is within the normal range when you have it tested doesn't mean it usually is. Testosterone levels fluctuate throughout the day, so a woman with a normal amount of testosterone at lunch time might have too little in the evening.

If you have your levels checked, and you have a deficiency, you will need to inform your doctor about compounding pharmacies. The testosterone your doctor is likely to prescribe you is not what you need.

Your physician will most likely want to give you testosterone shots or put you on the drug Estratest, which comes in pill form. You should note that Estratest is NOT natural testosterone, it is a synthetic form called methyltestosterone. Estratest is the only testosterone approved for women, but it frequently does not help, and will probably do harm. Estratest is a much higher dose than a woman's body needs, and will almost certainly give you side-effects. Even Estratest H.S. (half-strength) is much too strong. Many women have had the unwanted side-effects of increased facial hair, an increase in the size of the clitoris, and permanently deepened voice. Other side-effects which may indicate you are taking too much testosterone may include acne, oily skin, subtle increases in aggression, and moderate weight loss. These changes will be very small and you will have to watch carefully for them. Should you have any of these mild side-effects, you should decrease your dosage of testosterone. There is no benefit from taking too much testosterone. This is true in men as well as women.

The PDR (physicians desk reference) lists this drug as well as the testosterone shots for men. The shots are much too strong for women, and most women taking these shots will have unwanted side effects.

These shots and pills are very bad for you. Estratest is approved for women, but taking testosterone in pill form is very hard on the liver. If you take Estratest long-term, you WILL GET LIVER DAMAGE, and probably a deepened voice and more body hair, too. It is only approved for menopausal women and is for the treatment of hot flashes that do not respond to other treatment, and is only approved for short-term use. Don't be a guinea pig. Don't let your doctor give these drugs to you. Another drug approved for women is Premarin with testosterone. This is also way too strong. And, the testosterone in these drugs is not really what you need. For one thing, it is combined with estrogen. The estrogen can negate the free testosterone by causing your body to produce more SHBG's. Your body also likely does not need the estrogen. The testosterone in these products is synthetic. Methyltestosterone is a synthetic version of testosterone found in pills such as Estratest, and in testosterone shots. This substance is synthetic, and use of these products is not reflected on blood tests for testosterone levels. Therefore, women who have taken testosterone in these forms are not raising their levels by these means, and can only be harmed by them. This substance causes excess testosterone, while a test reveals that they still have inadequate levels!

You need to contact a compounding pharmacy for the testosterone gel, cream, sublingual drops or tablets, or pills you will take. (I wouldn't take pills if I were you, but in very low doses your liver should be safe.) The pharmacy can work with your doctor over the phone to create the product you need.

Testosterone is a controlled substance and is available by prescription only. You will have to get the prescription filled every month, and your physician will have to renew the prescription every six months.

The testosterone you will get from a compounding pharmacy is natural, not synthetic like Estratest and testosterone shots. The testosterone in these products is not the same as that contained in yam creams in a health food store; this testosterone, available only from compounding pharmacies, exactly matches the testosterone already in your body (unless you are not producing any).

There are many compounding pharmacies, two of which are
Women's International

College Pharmacy

To search for a compounding pharmacy in your area, click here.

You may wonder why you have to use a compounding pharmacy, and why the big pharmaceutical companies do not or cannot produce these products. The answer is that these creams, gels, et cetera cannot be patented, because they are natural hormones. So a drug company could spend all that money on research and then another company could go right out and profit off of it. Drug companies are for-profit organizations, so they won't spend the money for the double-blind drug studies. However, because of a loophole in current legislation, compounding pharmacies can compound natural hormones with a base and sell it if it is prescribed by a doctor (in the case of testosterone), or over-the-counter (in the case of non-controlled substances, such as DHEA).

Many physicians are reluctant to prescribe testosterone to women of childbearing age, because there are serious birth defects associated with taking testosterone, most of which lead to ambiguous sexual organs in the child. If your doctor objects on these grounds, or if you plan to have a child in the near future, there is a special kind of testosterone for premenopausal women. Sublingual testosterone is placed under the tongue a few hours before sex. It temporarily increases testosterone levels. There is a much lower risk of unwanted side-effects such as increased facial hair, deepened voice, and aggression, associated with taking sublingual testosterone. However, it does have two disadvantages:
You have to plan ahead several hours before you have sex.
You will not have the benefits of increased testosterone
except a few hours after using the product.

A recent Dutch study confirms the benefits of sublingual testosterone. Peri-menopausal and post-menopausal women can take sublingual testosterone as well, if it seems the best course of action for them.

All these products are available only from compounding pharmacies because it is not legal to patent natural human hormones. Therefore, drug companies cannot profit from manufacturing it.

One more note about having your testosterone levels tested. There is a little bit of mis-information floating around that women on hormonal birth control methods (birth control pills, Norplant, Depo Provera, or IUD's that dispense hormones) cannot have their testosterone levels accurately tested, because the hormonal birth control throws the results off. While it is true that BCPs can cause a loss of sexual desire, as can testosterone, they DO NOT throw off the test results for testosterone. They do throw off the results for some other hormones, for example, estrogen, but you can have your testosterone levels tested while using hormonal methods of birth control. The Doctors Berman state on their Testosterone FAQ page that you can't test Testosterone levels while on hormonal birth control, however, they have not responded to my e-mail regarding why they state this. I believe at this time that they probably say so that they can rule out the possibility that the cause of the symptoms in the method of birth control. They also use a different method to test testosterone levels than any other lab, so for their tests you may need to be taken off of hormonal birth control.

There is a good testosterone FAQ page at NEWSHE.

The book, "Natural Hormone Balance for Women" by Uzzi Reiss, an OB/GYN, is highly recommended by both the_siren and myself, as is Susan Rako's book, "The Hormone of Desire." Rako's book, however, is somewhat old, and is geared only toward menopausal women, stating that the risk of birth defects means that pre-menopausal women shouldn't take testosterone. With proper precautions, pre-menopausal women CAN indeed take testosterone.

I wanted to add a little more information about the responsiveness of doctors. You may encounter a physician who is more than willing to treat your Testosterone deficiency. If so, you are one of the lucky ones, because many, if not most, doctors, even gynecologists, do not believe that women should take supplemental testosterone, even if they have a deficiency. This is because of the traditional belief that testosterone is only a "male hormone." If your doctor refuses to treat you, you should know that Testosterone testing is a medically valid test, and that, in not providing this test when requested by the patient, the doctor is violating an oath. You may have to advocate for yourself, just to get the test, and you may have to push your doctor very hard just to accept that you have a deficiency, no matter how low your testosterone is. Once you establish deficiency, your doctor may try to give you Estratest, Testosterone shots, or other synthetic, high-dose forms. Don't let them do it to you. You need the correct amount of natural testosterone, you must demand it!

There really seem to be four types of doctors in dealing with these issues. The ones you have to fight with to get the test, fight with the get a diagnosis as testosterone deficient, and fight with the get the treatment you need are only one type. Another is the pushover doctor, who will take your word for it that you have low testosterone without bothering to test you, and who will just look in the PDR and ask if you'd rather have the shots or the pills. You don't want this kind of doctor. An online friend of mine has a permanently enlarged clitoris, lack of clitoral sensation, and a permanently deepened voice because of a doctor like this. He gave her a methyltestosterone shot, with a dosage meant for a man, followed by Estratest. She was indeed deficient in testosterone, but the synthetic estrogen in the Estratest counteracted the methyltestosterone with SHBG's, and so she got no results. The doctor told her to double the dose, and this gross overdose has caused her permanent damage. She is now on natural Testosterone, and all her symptoms are gone, but she still has the permanent side-effects. Don't let this happen to you. Don't get an overdose of testosterone, either natural or synthetic.

I also want to mention why it is bad to take Testosterone without getting tested first. There is more than one cause of low desire. A woman I know thought she needed Testosterone, and was prescribed it without a test, when in fact she naturally had plenty of Testosterone. As a result, she became hyper-sexual. She felt like a nymphomaniac. Fortunately, she had no permanent side-effects from this overdose. This is another problem with the pushover doctor.

The next type of doctor is the one who knows little or nothing about FSD, but is willing to work with you and learn. This is the kind that will gladly order you the appropriate test and do what he or she can to find information, and who is willing to look beyond the PDR and prescribe natural testosterone.

The last type is the knowledgeable doctor or the specialist. A knowledgeable doctor may have had special training, or may read the literature widely and attend conferences to pick up new skills, or may have been educated by another patient. Remember that it is important that you help your doctor by pointing out articles and books, and with good information. This information is not taught at most medical schools, and the doctor has to learn it somewhere. Once your doctor is knowledgeable on the subject, he or she can go on to help other women with sexual problems. You may be fortunate enough to find a doctor who specializes in this field, who may even be conducting some of the current research. In any case, be aware of the facts. Arm yourself with knowledge. Read many books and articles. Do not trust everything you read online, or even everything you read on this page. I have read several books and have spent a lot of time researching this, but I can't guarantee that all my sources were perfect. Some of this data may be outdated. Things may change. I update this page whenever I can, but it isn't intended as a replacement for your own research. This page is intended to point you in the right direction, to steer you clear of Testosterone overdose, and to direct you to the right type of treatment. It is to warn you of potential pitfalls, and to refer you to more concrete (print) information. My purpose in creating this page is to help other women. I hope that it accomplishes this end.

Visitors Since July 5, 2001.

Click here to read other women's testosterone testimonies.

Please submit comments, testimonies, and questions here!

All information on this page was collected from the the aforementioned texts, and online resources, primarily the Women's Sexual Health forum on the Network for Excellenct in Women's Sexual Health--NEWSHE-- web site. Special thanks to the_siren, who provided constructive criticism on this site and shared much of the information on this page with myself and other NEWSHE users.

The creator of this web site is not responsible for what you do with this information and it does not replace a doctor's visit. Feel free to print this and take it to your doctor.