Some women in midlife experience a decline in libido and other symptoms linked to hormonal changes. Actress Kate Winslet recently discussed using testosterone therapy in her late 40s to address reduced libido, highlighting the importance of checking thyroid and testosterone levels. Her message resonates with many women experiencing similar issues, and it aligns with current evidence-based approaches to hormone health.
This blog post will explain when testosterone therapy may be appropriate for women, how it works, and why it’s important to monitor it closely. We’ll break down key topics like free vs total testosterone, thyroid health, lab testing, and treatment options.
Table of Contents
- Why this is in the news
- Do women make testosterone, and what does it do?
- When testosterone helps women
- When it likely does not help
- Free vs total testosterone explained
- The thyroid–libido link
- Our lab testing and workup at 1st Optimal
- Treatment options, dosing, and monitoring
- Risks and side effects
- How GLP-1s, peptides, gut health, and training fit in
- A 6-week case example
- FAQs
- Next steps
- References
Why This Is in the News
Actress Kate Winslet publicly discussed using testosterone therapy in her late 40s to address low libido, while also advising women to check their thyroid and testosterone levels. This message resonates with many women, as libido can decrease during perimenopause and menopause. There are evidence-based ways to address these symptoms, which we’ll explore in this post.
Her openness about using testosterone therapy for sexual health, along with her advocacy for checking thyroid health, brings attention to the challenges women face during perimenopause and menopause. Both testosterone and thyroid hormone imbalances are significant contributors to symptoms like fatigue, low libido, and reduced mood. Addressing these imbalances is crucial for optimal health, especially in women over 35.
Do Women Make Testosterone, and What Does It Do?
Yes, women do produce testosterone, though in much smaller amounts than men. Women produce testosterone in the ovaries, adrenal glands, and peripheral tissues. It plays an important role in maintaining:
- Sexual desire
- Arousal
- Orgasm
- Bone and muscle health
- Red blood cell production
Testosterone levels decline with age, and low testosterone can contribute to reduced libido and other symptoms. It’s important to note that levels do not “hit zero” but decline gradually. The goal of testosterone therapy is to restore physiologic levels when needed.
Why Testosterone Matters in Women
Testosterone is involved in more than just sexual health. It also plays a role in overall energy, muscle mass, and cognitive function. When levels fall below normal, women may experience symptoms like fatigue, decreased muscle mass, and mood changes. Additionally, testosterone contributes to the maintenance of bone density, which can help protect against osteoporosis as women age.
When Testosterone Helps Women
The most significant evidence supports the use of testosterone for postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD). Studies show that transdermal testosterone can increase sexual desire and satisfaction in women with this condition.
Testosterone Therapy and Libido
Testosterone therapy is particularly beneficial for postmenopausal women who have experienced a significant drop in libido, often due to hormonal imbalances. Research and systematic reviews show that testosterone therapy is effective in improving sexual desire and distress, especially when dosed properly. However, it’s important to note that the benefits are modest and should be monitored carefully.
Key Benefits of Testosterone Therapy for Libido:
- Increased sexual desire and frequency of satisfying sexual events.
- Enhanced genital arousal and sensitivity.
- Improved mood and reduced anxiety related to sexual activity.
Who Should Consider Testosterone Therapy?
- Women in menopause or post-menopause: If you are in perimenopause or menopause and have experienced a noticeable decline in sexual desire, testosterone therapy may be an appropriate option.
- Women diagnosed with HSDD: If you have been formally diagnosed with Hypoactive Sexual Desire Disorder (HSDD), testosterone may help restore your sexual drive.
- Women with low testosterone levels: If lab tests show that your testosterone levels are lower than the optimal range for women, testosterone therapy may be worth considering.
When It Likely Does Not Help
Testosterone therapy is not recommended for improving mood, energy, memory, body composition, or general well-being in women. No FDA-approved female testosterone product exists, and expert groups advise against pellets or compounded testosterone for systemic use, as they can lead to inconsistent dosing and side effects.
Testosterone should be used specifically for diagnosed HSDD, with the goal of restoring sexual desire and relieving distress. It is important to avoid using testosterone as a “cure-all” for weight loss, energy, or mood, as these are multifactorial issues that require a comprehensive approach.
Testosterone Therapy and Weight Management
Although many women look to testosterone therapy for its potential benefits in fat loss or muscle gain, the evidence for these uses is lacking. Testosterone therapy should not be used as a weight-loss treatment. Instead, consider pairing testosterone therapy with a balanced diet and regular exercise, which are proven to help with weight management.
Free vs Total Testosterone Explained
Total testosterone (TT) measures all testosterone in the bloodstream, while free testosterone (FT) refers to the unbound fraction of testosterone. Since much of the testosterone is bound to proteins like sex hormone binding globulin (SHBG), measuring FT gives a better understanding of available testosterone in the body. When SHBG is high or low, TT may appear normal while FT could still be off.
For accurate testing, it’s best to measure TT using LC-MS/MS (liquid chromatography-mass spectrometry), SHBG, and calculate FT using a validated equation.
Why Free Testosterone Matters
Free testosterone is the active form of the hormone that is available for use by your body. Low levels of FT, even when TT appears normal, may explain symptoms like low libido or fatigue. At 1st Optimal, we measure both TT and FT to ensure you are in the optimal range.
The Thyroid–Libido Link
Thyroid dysfunction can negatively affect libido. Women with thyroid conditions often experience sexual dysfunction, so testing thyroid levels is an essential part of diagnosing low libido. Ensuring thyroid function is within the optimal range is critical for addressing hormonal imbalances.
Thyroid and Hormonal Imbalances
- Hypothyroidism: This condition can cause fatigue, low libido, and dry skin, all of which affect your overall quality of life. Women with hypothyroidism may notice a significant decrease in their sex drive and energy.
- Hyperthyroidism: An overactive thyroid can also impact your sexual health, causing symptoms like irritability, anxiety, and muscle weakness, which can reduce libido.
Checking thyroid function is an essential step in any comprehensive workup for low libido and other hormone-related symptoms.
Our Lab Testing and Workup at 1st Optimal
At 1st Optimal, we take a root-cause, evidence-based approach when evaluating low libido. We start with a thorough history and lab workup, which includes:
- Hormones: Testosterone (TT and FT), SHBG, estradiol, progesterone, DHEA-S, and FSH/LH.
- Thyroid: TSH, free T4, and thyroid antibodies.
- Metabolic markers: fasting glucose, A1c, lipids, liver panel, CBC, ferritin, and vitamin D.
- Other factors: pelvic floor pain, vaginal dryness, relationship issues, medications, and mental health screens.
Additionally, if symptoms suggest issues with gut health or cortisol levels, we may recommend targeted testing.
Treatment Options, Dosing, and Monitoring
Testosterone therapy is typically administered in transdermal form (via patches, gels, or creams). This method helps to avoid peaks and valleys that occur with oral forms of testosterone. While there is no FDA-approved testosterone product for women, evidence supports the use of low-dose transdermal testosterone for postmenopausal women with HSDD.
The common starting dose is approximately one-tenth of the male dose, and we monitor blood levels of testosterone and SHBG closely. We recommend checking levels 6–8 weeks after starting treatment and then every 6–12 months.
Risks and Side Effects
Testosterone therapy for women can cause side effects like acne, facial hair growth, and voice deepening, though serious adverse events are uncommon. Long-term safety data are limited, and the use of pellets or compounded products is not recommended due to inconsistent dosing. We carefully monitor for potential side effects and adjust the dose as needed.
Some red flags to look out for include voice deepening, clitoral enlargement, and persistent acne. If any of these occur, therapy may need to be adjusted.
How GLP-1s, Peptides, Gut Health, and Training Fit In
While testosterone therapy can help with libido, it’s not a cure-all. At 1st Optimal, we take a holistic approach by also considering other factors that affect overall health, such as GLP-1 therapies, peptides, gut health, and exercise. Each of these plays a role in optimizing metabolism, mood, and overall well-being, which can indirectly support sexual health.
A 6-Week Case Example
Meet Sarah, a 52-year-old woman with a history of HSDD. After a thorough workup, we identified low testosterone levels and elevated SHBG. We prescribed a low-dose testosterone gel and monitored her response over six weeks. By the end of the treatment period, Sarah reported a significant improvement in sexual desire and satisfaction, with no adverse side effects.
FAQs
- What are the main benefits of testosterone therapy for women?
Testosterone therapy can improve sexual desire, arousal, and overall sexual satisfaction in women with low libido caused by hormonal imbalances. - How is testosterone therapy administered?
Testosterone therapy is typically given through transdermal patches, gels, or creams. These methods ensure steady hormone levels. - Are there any risks associated with testosterone therapy for women?
Potential risks include acne, facial hair growth, and voice deepening. Monitoring and adjusting doses can help manage these side effects. - Can testosterone help with other symptoms like mood and weight gain?
While testosterone therapy is effective for improving libido, it does not address mood or weight issues. We recommend a comprehensive approach to address these concerns. - How long should I use testosterone therapy?
Treatment duration depends on the individual’s response and symptoms. We typically reassess every 6–12 months.
Next Steps
If you’re struggling with low libido or other symptoms related to hormonal imbalances, the team at 1st Optimal is here to help. Schedule a free consult or book a hormone lab test today to start your journey to optimal health.
References:
- PubMed study on testosterone therapy in postmenopausal women
- JAMA article on testosterone and sexual health
- NEJM article on hormone therapy
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