There is no conclusive evidence that testosterone therapy causes hoarseness or irreversible vocal cord changes in women. In fact it’s been shown that a lack of testosterone can cause hoarseness. Hoarseness is typically due to inflammation and testosterone acts as an anti-inflammatory. Voice change due to testosterone would be an uncommon side effect.
DHT dihydrotestosterone is often the main culprit in hair loss. But, let’s take a step back. Before DHT becomes DHT there is an increase in 5-alpha reductase, which converts testosterone to DHT in the hair follicle. Simply replacing testosterone to normal levels does not speed up this conversion. Here are things that do speed it up: obesity and insulin resistance. Now here is the catch: if you have a genetic sensitivity to DHT testosterone can cause hair loss. Often times early into testosterone therapy (2-3 months) some women experience shedding in particular around the temples. However, in our experience the hair grows back. In fact, women will often regrow hair while taking testosterone. That includes hair everywhere not just the scalp- eyebrows and body hair.
Many women experience hair growth and without shedding. It’s a fine line between too little testosterone and too much. Each women’s level is individual. Things we do to help prevent hair loss- go slow and titrate up testosterone dose and repeat labs to check levels at the 6-8 week mark. We also offer oral minoxidil and other hair loss treatments.
High doses of oral synthetic testosterone can damage the liver. Oral formulations of testosterone are typically modified to survive the first pass through the liver, which can create additional strain on it. This modification can lead to an increased risk of hepatotoxicity, which is why oral testosterone is seldom prescribed. We use bioidentical testosterone transdermal cream so this is not an issue for our patients.
The relationship between testosterone levels and aggression is complex. Elevated testosterone levels can increase the likelihood of assertive, competitive, and aggressive behaviors in some people, but these outcomes are influenced by a variety of factors, including individual biology, personality, and environmental circumstances. It’s important to note that many people undergo testosterone therapy without experiencing significant changes in their behavior.
If you start to notice increased aggression we simply dial back your dose.
Breast cancer is an estrogen sensitive cancer. Testosterone is an androgen, and androgens have been shown to inhibit the growth of certain types of breast cancer cells. This has led to investigations into the potential protective effects of androgens like testosterone against breast cancer.
There is currently no conclusive evidence linking testosterone therapy to an increased risk of breast cancer in postmenopausal women.
If you currently have breast cancer it’s not recommended as testosterone can be converted into estrogen.
This study suggested a protective role of testosterone, against the development of breast cancer in women presenting with symptoms of hormone deficiency (BioMed Central).
No. Men’s testosterone medications are 10-20X more potent than what women require. There are FDA approved testosterone medications for men and some clinicians will prescribe these for you. Here is why we don’t. You can’t control the dose. When you can’t control the dose you can over or under dose. Too much will cause the masculinizing effects we don’t want. Too little will do nothing. It’s not worth the risk.
Yes. You still have uterine tissue so you need progesterone to protect it.
No. Your IUD will provide protection. If you have a copper IUD you need to take oral progesterone.
You may have an issue with your detox pathways which could cause the conversion of progesterone into cortisol. We can create a compounded vaginal progesterone and you can try that. In the mean time things like candida overgrowth or mold toxicity should be addressed. For that we refer you to a functional medicine specialist.
You don’t have to stop. A common side effect of progesterone is sleepiness. This is why we recommend it be taken at night before bed. Switch to night time instead of stopping.
You can take it continuously if your using it to help you sleep. If you are taking it to help regulate menses you can cycle it. If you no longer have periods or have very infrequent periods you’ll get better symptom control taking it every day.
We don’t offer compounded progesterone creams because the molecule is too large to get absorbed systemically well enough to increase blood levels and provide uterine protection. We only use micronized oral progesterone.
Not necessarily. Oral estrogen can increase sex hormone binding globulin which acts like a sponge and sucks up your free testosterone. It binds it making it not available. We’ll first switch you over to transdermal patches for a month or so and see if libido returns.
Bi-est cream has too much estriol 80% and hardly any estradiol 20% which is the estrogen we want. It’s also much more expensive than commercially available formulas. The decision to switch would made if your symptoms are not managed well or if the alternatives are more economical for you.
Yes. Vaginal estrogen only works locally on the vagina, bladder and external genitalia. It is not systemic and does not raise blood levels of estrogen. It won’t relieve the signs of low estrogen like hot flashes, mood, insomnia. It only improves things related to the vagina and bladder like dryness, loss of clitoral sensation, urine leakage, frequent UTIs. The estrogen patch or pill are systemic medications to help with the other symptoms of menopause.
The birth control is a form of HRT. If you want to know if your in menopause you can stop taking the birth control and see what symptoms appear. Once you reach age 55 you can swap the birth control for HRT because at this point 98% of women are in menopause. You just have not “felt” it yet because the birth control pills prevents symptoms.
You have to weigh the risk vs benefit. The risk is a blood clot. But what is your individual risk of a blood clot? If you have a history of clots that is a higher risk. Other risks like smoking, obesity, high cholesterol, hypertension that’s not well controlled, being immobile, chronic inflammatory diseases like arthritis or chron’s disease to name a few. To have a really good indication of your risk for about $50-$99 get a coronary calcium artery score and a carotid artery intima thickness score. These are two separate tests. One is a non-invasive CT scan of the heart, the other is an ultrasound of the arteries in your neck. Insurance does not pay for these tests. All major hospitals offer it and most radiology centers for about $99. Some don’t require a prescription. This test tells you your risk of heart attack and stroke. If these tests show normal levels your risk taking HRT is significantly lower.
You have ovaries (making hormones) so you progress through peri and menopause just like anyone else. Since you don’t have periods we’ll go off your symptoms, age to determine the type of HRT to start you on. You can start when you begin experiencing symptoms.
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