April 2, 2015 Testosterone Replacement in Women I recently gave a female patient of mine a prescription for testosterone skin gel, which she didn’t fill and use because her husband wasn’t comfortable with her using testosterone. I’m not sure why, but apparently he read some negative stuff on the internet about it. She was complaining of low libido and fatigue and her testosterone level was in the low end of normal. The goal of the testosterone gel was to bring her level into the upper normal range. I know that many people are surprised to know that testosterone is important for women, too. God put it there for a reason, and women often feel better when their testosterone levels are supported with some replacement, just like people feel better when their thyroid hormones are supported with replacement. Interestingly, birth control pills cause testosterone levels to fall because they do two things: they lower FSH and LH which are stimulators of testosterone production and they increase a protein called Sex Hormone Binding Globulin (SHBG) which binds up testosterone so there is less FREE testosterone in the blood to what testosterone does. So, I guess you could say that BCP’s work to prevent pregnancy in more than one way, if you know what I mean (lower libido, get it?) One principle that I have learned is that it’s not so much that aging causes hormone levels to decline, but that declining hormone levels cause more rapid aging. Some have said that you are as young as your hormones. And testosterone is a normal and important hormone for women as well as men. So if you want to slow down aging, it makes sense to support your hormone levels, including testosterone. Testosterone, by the way, also keeps your brain, bones, and muscles stronger for longer. Elizabeth Vliet, MD, wrote a nice little book called “The Savvy Women’s Guide to Testosterone Therapy” (Amazon 5 star rating 22 reviews) in which she clearly shows the why and how of testosterone replacement for women. If you want more info on testosterone replacement therapy in women, check it out. The possible downsides of raising testosterone to high levels are increased facial hair, increased acne, slight deepening of the voice, and nipple tenderness. All of these are reversible upon stoppage or dose reduction. Interestingly, when I asked my testosterone pellet implant patients who got more facial hair if they wanted me to lower their dose, they typically said “no”, which I interpret to mean that they really liked the improved sex life and overall improvement in their quality of life. A little excess facial hair is usually easily managed and well worth the benefits of testosterone replacement. And don’t worry, you won’t get big like Arnold. Dr. William Epperly, Fellow American Academy of Family Practice Fellow American Academy of Otolaryngic Allergy Member of Christian Medical and Dental Society.