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 concerning the results of low testosterone in ladies, together with low libido, lack of vitality, lack of power and muscle tone, and cognitive difficulties, like bother concentrating. “I simply had kind of an ‘aha’ second,” says Corridor, a 41-year-old in Berkeley, Calif. “It clicked that that is perhaps what was occurring, as a result of there was such a superb 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 alternative 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 had been very dramatic,” she says; it rapidly 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 at the very least 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 places of work. 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 targeted on navigating perimenopause and menopause. “We name it the ‘guide membership impact’—ladies who’ve large outcomes share it with their buddies, after which we see buddies of our sufferers coming in to inquire about related options.”
However can testosterone remedy for ladies 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 widespread notion, testosterone isn’t merely a male hormone. Whereas ladies have smaller quantities than males, testosterone performs an vital position in regulating the menstrual cycle, sustaining bone density and muscle mass, and enhancing cognitive well being, temper, sexual perform, 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 right down to about 25% of what they had been once we had been youthful.”
Enter testosterone alternative remedy. Greater than 30 completely different testosterone merchandise are accepted for males by the U.S. Meals and Drug Administration (FDA), however the company has by no means accepted testosterone for ladies. Nevertheless, medical doctors 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 lately, it’s additionally prescribed as a standalone therapy, says Dr. Traci A. Kurtzer, a gynecologist on the Northwestern Drugs Heart 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 effective candidate for TRT, medical doctors usually begin by checking hormone ranges to ensure somebody “isn’t already coming in on the excessive facet of regular,” Kurtzer says. (Testosterone ranges beneath 20 ng/dL in ladies 50 and older are usually thought-about low.) It’s additionally vital to examine 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 just a few types of testosterone, together with pellets injected beneath the pores and skin, tablets taken orally, and topical gels and lotions. Docs usually want a cream or gel that’s utilized to the pores and skin, normally to the again of the thigh, calf, or buttocks. Ladies 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 ladies that was dosed appropriately.”
Potential advantages
The perfect evidence-based use case for TRT for ladies is growing sexual perform in a protected, efficient manner. It’s “fairly clear” that low doses of testosterone can enhance libido for post-menopausal ladies experiencing hypoactive sexual want dysfunction (HSDD), which implies lack of want with out another underlying trigger, Kurtzer says. “It’s not as a result of they hate their associate, or have ache, or as a result of they’re exhausted from working two jobs and might’t focus.” In accordance with one analysis evaluate, 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 all the time valued an lively way of life, however discovered that when she reached perimenopause, issues began altering. “I imply, drastically,” she says. “I had no want to rise 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 the very best model of herself once more. “Inside per week, I believed, ‘I really feel so significantly 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 would like 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 is not 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?” Possibly. “The issue is,” she says, “we simply haven’t got ample information.”
The research that do exist have yielded unsure outcomes past enhancing sexual perform; plus, little is understood concerning the long-term results of testosterone in ladies. “We’ve got 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 lady’s general coronary heart illness threat? Are we growing breast most cancers threat? We’ve got no long-term information on that.”
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Extra information exist for males. Massive 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 alter. One other examine discovered that TRT doesn’t improve the danger of prostate most cancers, even after greater than 15 years of therapy. But it’s onerous to attract conclusions about ladies based mostly on these findings, consultants say, since dosage isn’t the identical (although it’s normally decrease) and ladies’s our bodies work otherwise.
Nonetheless, Kurtzer—who has been prescribing testosterone to ladies for years—hopes analysis will someday affirm that TRT is as useful as a few of her sufferers declare. “I’d love for it to be true that it helps with all these issues, as a result of we do not have a number 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 had 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 will use it long run, I am all for it.’ However at this level, we simply do not know the detrimental piece of it.”
Uncomfortable side effects of testosterone remedy
When April Sandefer first tried TRT 10 years in the past, it went effectively. “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 start out again up once more, and inside just a few months, she observed her hair was turning into skinny and her face was breaking out. She additionally grew to become aggressive at work, she says—an out-of-character improvement. “I mentioned 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 therapy. “It’s disappointing that as we become old, we simply have to simply accept [annoying symptoms], as a result of they do not appear to have a number of issues created for ladies,” she says. She doesn’t plan to strive testosterone once more: “It’s not value it to me.”
Certainly, analysis suggests that within the brief time period, TRT may result in hair development on the face, chest, and again, in addition to zits and behavioral and character modifications. That may be very true for these receiving pellets, which generally comprise 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 issues, 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 unintended effects. That is why consultants together with Kurtzer usually suggest in opposition to utilizing pellets.
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Nonetheless, consultants say that one frequent fear about TRT in ladies—creating 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 unintended effects like gentle masculinization do happen.
“The way in which we method it’s we hearken to ladies, work out what their signs are and what well being profit they’re in search of, and what is going on to assist them really feel effectively and important—quite than simply saying it’s a blanket anti-aging therapy that each one ladies ought to have,” Jordan says. “When it’s performed with that kind of steerage and counseling, it may be very protected and efficient.”
