The Benefits of Testosterone in Female HRT
Those who have read my previous work will be aware that my work predominantly focuses on the male aspect of the topic. However, while The Men’s Health Clinic may appear targeted to solely men, there are also pressing issues we need to address in the world of Hormone Replacement Therapy (HRT) for women, too. Female HRT is more well known among the general population than TRT, but the in’s and outs of what constitutes a proper HRT protocol is still left to the gp. This article will explain a bit more about HRT for women and the benefits of including Testosterone in female HRT. This is an important read for any woman out there in need of HRT, so please do share it to those it may be of relevance to.
Female HRT is typically used to relieve symptoms of menopause, effectively replacing low-concentration hormones which typically occur with the approach of menopause. It’s history started in the 1960s and it gained significant popularity in the 1990s, declining in popularity after initial clinical trials suggesting more detrimental effects versus beneficial [1]. This led to early media reports creating panic among users and new guidance for prescribing doctors. In later years, the reanalysis of previous trials was performed; new studies demonstrated that HRT use in younger women or early postmenopausal women actually had beneficial effects on the cardiovascular system, reducing coronary disease, and all-cause mortality [1]. Don’t discredit it; it certainly has its place in medicine to ensure a healthy state and improved quality of life for women in need of it. The users of HRT will typically focus on pre-menopausal purposes, though other conditions can warrant its needs. That can include polycystic ovary syndrome, hypogonadism, metabolic syndrome and more.
Typically, HRT will include some kind of Oestrogen and often progesterone (combined-HRT). Oestrogen only is sometimes used if the womb has been removed during a hysterectomy [2]. While Oestrogen certainly is a primary sex-steroid hormone produced by the ovaries, it isn’t all a woman typically produces that is vital for good health.
A Look at the Hypothalamic Pituitary Ovarian Axis
Abbreviated as HPOA. The HPOA is the system responsible for a woman’s cycle. It’s also responsible for bone maintenance, muscle growth, strength development, cardiac health, libido, mental wellbeing, regulating metabolism, the reproductive cycle, secondary sex characteristic maintenance and much more. A diagram is shown below of the HPOA [3].
The HPOA controls the reproductive cycle. The average adult reproductive cycle lasts 28 days, ranging from 23 to 35 days, and has distinct phases [4], [5]:
- Menstruation, which is when the elimination of the thickened lining of the uterus occurs. Oestrogen and Progesterone are at their lowest. So is Testosterone.
- The follicular phase, which starts with the onset of menses, ending with the day of the Lutenising hormone (LH) surge. It is brought about by the release of FSH by the pituitary gland, which stimulates the ovary to produce 5-20 follicles that bead on the surface and house an immature egg (often, only one follicle will mature into an egg); the growth of the follicles stimulates the lining of the uterus to thicken. Oestradiol increases during this phase, as does Testosterone and progesterone.
- Ovulation, which causes the release of a mature egg from the surface of the ovary often around 2 weeks or so prior to menstruation starting and within the first 30-36 hours of the LH Surge. Oestrogen peaks just beforehand and then will drop shortly afterwards. The same is true of Testosterone.
- The Luteal phase starts on the day of the LH surge and ends with the onset of menses. The uterus gets thicker to prepare for possible pregnancy. Progesterone is produced, peaks, and then drops.
- The secretory phase occurs next where the uterine lining produces chemicals that will either help support the egg implanting to the uterus lining if fertilized, or prepare to break down the lining and shed if not.
Women involved in sports may attest that the early follicular phase (~10 days from the start of menstruation) can reduce exercise performance as hormones will have been low from the menstruation phase and are only starting to recover [6]. It’s important to note that Testosterone is predominantly produced within the zona fasciculata of the adrenal cortex (in the kidneys) and ovarian stromal and thecal cells which accounts to 50% of total Testosterone secretion in women; the remainder is produced in peripheral tissues like bone, breast, muscle, and fat [7].
Males have the HPTA, where T stands for Testes. The primary difference in terms of hormone output is concentration; respectively, women make significantly more Oestrogen than males and males more Testosterone than females. Yet both sexes need both hormones for good health. Drop Oestrogen in men too low and they’re in for some nasty side effects like bone mineral loss, anxiety, and worsened cardiac health.
The Importance of Testosterone in Women
While women make less Testosterone than men, Testosterone is an important component of female sexuality, where it enhances interest in initiating sexual activity and the response to sexual stimulation. That is, it’ll make your sex life a whole load better, ladies. Testosterone is also associated with much greater well-being and reduced anxiety and depression in women [8]. It also helps improve cardiovascular health in younger women (although, we aren’t so sure in older post-menopausal women) [9]. It is an essential hormone for women, much like Oestrogen is essential for men, but must be maintained at the correct concentration; lower for women, just like Oestrogen will be lower for men versus women.
You’ll note I say ‘correct concentration’, because you can have too little and too much. Too much and we could increase the risk of thrombotic events [7]. Too little and we increase the risk of anxiety, depression, reduced muscle strength, libido, increased risk of metabolic syndrome and type-2 diabetes mellitus, and worsened cognition.
HRT often fails to provide Testosterone to women because there just weren’t enough studies around its safety. A significant concern in the HRT world for women is the risk of cardiac events and there is a long held belief that Testosterone increases said risk. Sure it does, in high doses. Or when Sex-hormone binding globulin (SHBG) is too low. It’s very important for the level of Total and free Testosterone and SHBG to be examined. A previous article I wrote on SHBG details why. While it may seem targeted to men, the same physiological principle of high versus low SHBG still applies.
Put simply, Testosterone is vital for your well-being as a woman. Not just Oestrogen and Progesterone. DHEA is also important, another steroid hormone which has a whole host of important effects in the body.
The overall goal of any HRT should be balance, a yin and yang of hormones. That is, having the correct balance of hormone concentrations for all sex-steroid hormones for you – whatever optimal for you is. You work this out with your Doctor based on blood tests, body composition, health assessments, and symptom reports. If you need Testosterone because your levels are too low and you’re symptomatic, then you should be prescribed it, but within reason. Your Doctor must work with you to ensure you have adequate free Testosterone levels, appropriate SHBG levels, enough DHEA, in addition to Oestrogen and Progesterone. This ensures you feel your absolute best and are in the best health condition possible. HRT shouldn’t take any other shortcut.
Conclusions
The Men’s Health Clinic initially focused on just men’s health. But, it’s now focusing on women too as they have been inundated with requests from current TRT patients to apply the same methodology in women. No other clinic in the UK currently microdoses to our knowledge, nor takes such a holistic approach towards your health to ensure that you get the best bang for your buck and above all, the best health outcomes. Testosterone is essential for women, just like Oestrogen is for men. It’s essential to ensure correct hormonal balance and resultantly a better quality of life and health status. It’s just all about ensuring you have enough for you, based on your body, your age, your response, and your genetics. The Men’s Health Clinic ensures that the protocol is personalised for you. Hence the inclusion of Testosterone in TMHC’s HRT protocol for women. Remember ladies, you need a little bit of Testosterone for the three H’s: happy, healthy, and horny. Don’t skip Testosterone, work with your Doctor to include it.
Further information on our Female HRT programme can be found here.
References
[1] A. Cagnacci and M. Venier, “The Controversial History of Hormone Replacement Therapy,” Medicina (Mex.), vol. 55, no. 9, p. 602, Sep. 2019, doi: 10.3390/medicina55090602.
[2] “Hormone replacement therapy (HRT) – Types,” nhs.uk, Oct. 23, 2017. https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/types/ (accessed Feb. 20, 2022).
[3] “Hypothalamic-Pituitary-Ovarian Axis,” BrainKart. http://www.brainkart.com/article/Hypothalamic-Pituitary-Ovarian-Axis_25823/ (accessed Feb. 20, 2022).
[4] “Menstrual cycle – Better Health Channel.” https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menstrual-cycle (accessed Feb. 20, 2022).
[5] “The menstrual cycle, explained.” https://helloclue.com/articles/cycle-a-z/the-menstrual-cycle-more-than-just-the-period (accessed Feb. 20, 2022).
[6] K. L. McNulty et al., “The Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis,” Sports Med. Auckl. NZ, vol. 50, no. 10, pp. 1813–1827, Oct. 2020, doi: 10.1007/s40279-020-01319-3.
[7] V. Tyagi, M. Scordo, R. S. Yoon, F. A. Liporace, and L. W. Greene, “Revisiting the role of testosterone: Are we missing something?,” Rev. Urol., vol. 19, no. 1, pp. 16–24, 2017, doi: 10.3909/riu0716.
[8] S. Davis, “Testosterone deficiency in women,” J. Reprod. Med., vol. 46, no. 3 Suppl, pp. 291–296, Mar. 2001.
[9] S. R. Davis and S. Wahlin-Jacobsen, “Testosterone in women–the clinical significance,” Lancet Diabetes Endocrinol., vol. 3, no. 12, pp. 980–992, Dec. 2015, doi: 10.1016/S2213-8587(15)00284-3.
