Testosterone and Women

I was asked the question this week about thinning hair and hair loss in women which is a good question. As I was formulating an answer, my thoughts turned to testosterone, an anabolic steroid, and one of the sex-hormones in women along with estrogen and progesterone.

Rochelle, I'm sure many of your listeners have been in a room of networking women. Typically, there's a fabulous about of healthy energy present and I've often suggested, with a big smile of course, there is more testosterone in that space than is found in a men's locker room at a football game!

While this statement isn't factually true in terms of the total testosterone level - in fact, the adult male actually produces 20-30 times more compared to the amount for the adult women - women do produce this hormone, primarily from the ovaries and to a lesser extent the adrenal glands.

Testosterone is considered an "anabolic steroid" which means it promotes protein synthesis, or tissue growth, and it plays key roles in the health and well-being of women. Benefits include maintenance of strength and muscle mass, maintenance of bone density, mental and physical energy and enhancement of libido and clitoral engorgement.

Too little testosterone as a result of the aging ovaries and women may experience the opposite effects like mental and physical fatigue, loss of muscle strength, osteoporosis, and decreased libido. Notice these are many of the same symptoms women express when going through menopause.

However, the adrenal glands can continue producing this hormone past menopause and too much testosterone in relationship to the amount of estrogen present can also cause problems.

In women, excess testosterone may result in the appearance of masculine traits, such as a deepening voice, acne, male pattern balding, or hirsutism - which means excessive hairiness. This is the reason why women tend to develop increased facial and body hair after menopause.

Thus, like most things in the body, there is a delicate balance between too much and too little. Talking about one's concerns with their healthcare provider, along with appropriately directed testing, can help pinpoint a solution.

Getting back to the original question, hair loss in women, or "alopecia" as it's called, is a big concern. While it rarely indicates serious disease, it does take an emotional toll on the woman. The evaluation process requires a good work up, including blood tests and a detailed history, in order to obtain answers. Solutions are available although I have to say, they are still somewhat disappointing.

I've provided a link to a very good medical article on this topic of alopecia which can be found on the Chat With Women website at the end of this TIP.

How do you treat a woman with testosterone excess?
Assuming there is not a serious reason for the excess, such as a hormone producing tumor, options are fairly limited. One of the mainstays is a potassium sparing diuretic or water pill called "spironolactone," a weak diuretic with anti-androgenic properties.

Until recently, many women took estrogen replacement in their postmenopausal years, and this was the best thing for preventing the presence of facial hair. Now that HRT is not in favor, the options revolve more around aesthetic and topical skin care products.

We hear about bio-identical hormones. What are your thoughts on this?
Many women ask about using "bio-identical hormones" as a substitute for the pharmaceutical estrogens on the market. These hormones, which are said to have the identical chemical structure as those the body produces, are none-the-less estrogen, and if one accepts the conclusion that estrogens can increase the risk of breast cancer, these hormones, just like their cousins, have to be considered suspect. The jury is not out on this yet but erring on the side of caution is good.

Then what about the treatment for a woman who is low in testosterone?
It's important to remember, not every woman who is lacking energy, libido, and strength has low levels of testosterone. Additionally, not every woman who is low in testosterone needs replacement. Having said that, testosterone replacement for women can be a blessing and a challenge. First of all, the testosterone products for men are of a different strength and type than what we use in women. And, there is only one FDA approved product manufactured for this condition in women. It's called Estrotest and the problem with this product is that it combines testosterone with estrogen, so its usage has fallen off. Additionally, one study suggested that testosterone, when combined with estrogen, led to an increase in breast cancer. (Most analysts believe this is based on the fact that testosterone, which in part converts to estradiol in the body, again leads to increased levels of circulating estrogen. )

Therefore, most providers who supplement women with testosterone, rely on compounding pharmacies, which are pharmacies who will make the product in their shop. While this is how I prescribe testosterone for women, there are three major disadvantages to this approach: 1) there is not a substantial body of conclusive science showing evidence for this form of therapy; 2) insurance companies often won't cover the cost, since they don't recognize this as FDA approved, and 3) it is not the most convenient since it requires a special pharmacy.

Benefits can be great, but remember balance. Again, talk to your healthcare provider about your concerns until you are satisfied with the answers!
Here's to your good health!!
Dr. Larry Greenblatt
www.cmadoc.com

Link to American Academy of Family Practice article on hair loss in women: http://www.aafp.org/afp/20030301/1007.html