Ask Barbie: Should HRT for Menopause Include Testosterone?
Welcome to ‘Ask Barbie’ — an opportunity for you to get my answers to your most burning questions. Our question for today is, “Should hormone replacement therapy for menopause include testosterone?”
Now you know that I’m very complete in my answers to these questions. I always present the answer in a way that ensures you’ll know everything you need to consider. And when it comes to including testosterone in your hormone replacement therapy for menopause, there are several things to consider. So, let’s start at the beginning.
Three Sex Hormones With Three Different Roles
There are three sex hormones. Each hormone belongs to a different kind of human being. And each hormone has specific roles for that particular human being.
As an analogy for the three sex hormones, I always use the three bears in the fairy tale Goldilocks and The Three Bears. I do so because each of the three bears in Goldilocks and the Three Bears had his or her own bed, chair, and bowl of porridge. And the bed, chair, and bowl of porridge for each bear differed in accordance with that particular bear’s needs.
Well, the three sex hormones are no different. The three sex hormones are:
- Testosterone, which belongs to Papa Bear
- Estrogen, which belongs to Mama Bear
- Progesterone, which belongs to Baby Bear
Estrogen
Estrogen is the female sex hormone. It is what makes you a woman. It’s everything you associate with femininity and youth. By definition, menopause is when you lose your estrogen. So at menopause, you lose all the benefits of estrogen … including your youth.
Loss of estrogen at menopause entails rapid aging on the inside and on the outside. The outside aging consists of things you can see or feel. These include:
- Fatigue
- Loss of energy or motivation
- Loss of sex drive
- Hair loss
- Weight gain
- Hot flashes
- Night sweats
- Heart palpitations
- Insomnia
- Forgetfulness
- Anxiety
- Mood swings
- Irritability
- Depression
- Joint pain
- Dry skin
- Dry mouth
- Dry eyes
- Dry vagina
- Urinary tract infections
- Urinary incontinence
Testosterone
Testosterone is to men what estrogen is to women. Testosterone makes men masculine. So, testosterone causes:
- Excessively high sex drive
- Hair loss & balding
- Weight gain
- Whiskers
- Acne
- Deepening of your voice
- Anger
- Aggression
Men never lose all of their testosterone. It decreases slowly over time, but never disappears. That’s why they don’t have menopause. So, they retain their masculine characteristics that are due to testosterone.
Progesterone
Progesterone is the hormone in support of pregnancy.
“Pro” means in support of
“Gest” means gestation
“One” means hormone
The only reason Mama Bear produces progesterone is to support a baby during pregnancy. By definition, menopause entails loss of your progesterone along with loss of your estrogen. But the progesterone was never there for you. You produced it for the baby. So, progesterone serves a role for an entirely different family member, not you.
Well, when we get to our question about whether or not HRT should include testosterone, it’s a matter of deciphering whether or not your body needs Papa Bear’s male hormone in addition to Mama Bear’s female hormone.
Ovarian and Adrenal Test (graph)
Your ovaries produce testosterone throughout your reproductive life. But about two years after becoming post-menopausal, your ovaries stop producing testosterone. However, your adrenal glands continue to produce testosterone for the rest of your life.
So, while you do lose all your estrogen at menopause, you do not lose all your testosterone at menopause.
Symptoms
Three of the most common symptoms at the time of menopause are fatigue, loss of energy or motivation, and loss of sex drive. Notice that these are all symptoms of estrogen deficiency … and they are also symptoms of testosterone deficiency.
Well, when two hormones both cause the same symptoms, it comes down to which one you should replace in order to alleviate those symptoms.
Because you are Mama Bear, your estrogen was what contributed most to your energy, motivation, and sex drive. Testosterone is what does this for men.
So, if you want to alleviate your fatigue, loss of energy or motivation, and loss of sex drive, you have to get your estrogen right first. It’s the very foundation of all those qualities for you as a woman.
Levels Mean Nothing
Well, that brings us to testing levels of your sex hormones in a lab. And the bottom line is that it makes absolutely no sense whatsoever to check any of these sex hormone levels in a lab. There are several reasons for this:
- You didn’t go through your reproductive life checking either your estrogen levels or your testosterone levels. So, you have no idea what they used to be. If you have no idea what they used to be, you have no idea what they should be once you’re post-menopausal.
- For your disappearing estrogen and progesterone, there is no such thing as a normal level. So sex hormone lab assays for estrogen and progesterone mean nothing.
- Since you didn’t go through your reproductive life checking your testosterone, and since your adrenal glands still produce testosterone, you have no way of knowing what constitutes your normal testosterone level.
All these things add up to the fact that there is no way for you to know what constitutes a high, normal, or low testosterone level for you, personally.
Body Talk
Determining whether or not your body has enough estrogen is easy. Your body tells you in three different ways.
If you have enough estrogen, you will have:
- No symptoms of estrogen deficiency,
- Stable cholesterol lipid labs from year to year,
- and no bone loss.
If you do not have enough estrogen, you will have:
- Symptoms of estrogen deficiency,
- Worsening cholesterol lipid labs from year to year,
- and bone loss.
Priorities
So, when it comes to answering the question, Should HRT for menopause include testosterone? … it’s all about priorities. It’s a matter of first things first. Because you are Mama Bear, you have to get your estrogen right first … before you focus on any other hormone. If you don’t get your estrogen right, nothing will be right.
As a female, 99% of your energy, motivation, and sex drive were dependent entirely upon estrogen. So, you need to alleviate them by replacing estrogen. And if you don’t take enough estrogen, you will not alleviate these symptoms.
You cannot use testosterone replacement to fix estrogen deficiency.
Face it: Testosterone cannot do estrogen’s job. This is consistent with the fact that insulin cannot do thyroid hormone’s job.
Do you think that any man would worry about replacing his estrogen if he lost all his testosterone? Of course not! No man would give a single thought to taking estrogen replacement along with or instead of testosterone replacement.
And that’s because men thrive on testosterone, not estrogen. Likewise, you thrive on estrogen, not testosterone.
So why is it that women think about replacing testosterone when they lose their estrogen? Why is the “Ask Barbie” question for today such a common one?
Well, the answer is simple … although completely illogical. It’s fear!
Somehow, women and society have come up with the crazy notion that estrogen is dangerous. But how can estrogen be dangerous when your own body produced it for almost 40 years? If it’s so dangerous, why didn’t it harm you during those 40 years?
Well fear is the most powerful emotion on earth. It is so powerful that it erases all common sense. And because of their fear of estrogen, people try to substitute the fearful hormone replacement with something that is less fearful. Of course, that makes about as much sense as Mama Bear trying to wear Papa Bear’s clothes. You will not succeed.
There’s nothing like the real thing, Mama Bear.
So when it comes to setting your priorities in order to achieve your goals, you have to start with estrogen. Starting with anything other than estrogen will never get you to the point of success. If you have your uterus, you need to take progesterone along with estrogen.
But, under no circumstance should you start with testosterone. Under no circumstance should you start with testosterone in addition to estrogen.
In scientific research, we call this “isolation.” It means that you can only study one thing at a time. Since you are Mama Bear, and your sex hormone is estrogen, you need to start with estrogen. If you start with both estrogen and testosterone, you will completely sabotage your experiment from the start.
So, if you discover that you do have enough estrogen, then you might consider adding testosterone … but only if you already have enough estrogen.
Sex Drive
Most women who consider taking testosterone do so in order to boost their sex drive.
If you consider using any kind of testosterone to boost your sex drive, first decide whether your lack of sex drive is “above your waist” or “below your waist.”
Lack of sex drive above your waist consists of having no interest in sex. It’s no sex on the brain. If that’s the case, the testosterone replacement therapy needs to be something that will circulate throughout your body. Why? Because it has to act on your brain in order to change your level of interest in sex. But, when testosterone circulates throughout your body, it increases the yucky, undesirable, masculinizing side effects that women hate. These include:
Excessively high sex drive
Hair loss & balding
Weight gain
Whiskers
Acne
Deepening of your voice
Anger
Aggression
There is no way to get the benefits of testosterone for your sex drive above your waist without also enduring these masculinizing side effects. And these side effects are typically irreversible.
Just think about men. They have:
Excessively high sex drive
Hair loss & balding
Weight gain
Whiskers
Acne
Deepening of their voice
Anger
Aggression
They have these characteristics all because of testosterone. Do these characteristics subside? No! Men who go bald stay bald. Men who grow whiskers continue to grow whiskers. Men who are aggressive remain aggressive. And the same will be true for you if you take any kind of testosterone that travels throughout your body.
Notice that some of the symptoms of estrogen deficiency are also symptoms of testosterone excess. These include:
Weight gain
Hair loss
Contrary to lack of sex drive above your waist, lack of sex drive below your waist consists of being interested in sex … but being unable to respond to sexual stimulation in order to have an orgasm. If this is the situation, you can use a local testosterone product in your vagina or on your clitoris. It may provide the benefit of increased stimulation, without the severe masculinizing side effects.
But regardless of whether you lack sex drive above your waist or below your waist, you have to get your estrogen right first, and take testosterone only if you need it. And, of course, you don’t know if you need testosterone unless and until you get your estrogen right.
The goals of HRT for menopause fall into two categories:
To alleviate the symptoms caused by estrogen deficiency
To prevent the diseases caused by estrogen deficiency (heart attack, osteoporosis, and Alzheimer’s).
Testosterone is to men what estrogen is to women. Therefore, while estrogen replacement can prevent the three diseases of estrogen deficiency for a woman, testosterone cannot.
So, no matter what you do, it’s going to be a package deal. And the key is timing. Only consider testosterone replacement once you have achieved all your goals for estrogen replacement.
Testosterone Products
Testosterone includes all products by the names of:
Testosterone
Androsterone
Androstenedione
DHEA (the acronym for dehydro-epi-androsterone)
DHEA-S (the acronym for dehydro-epi-androsterone sulfate)
All of these function as testosterone in your body. And they all produce the same masculinizing side effects.
There are many different delivery systems for testosterone. And currently, there’s a whole lot of testosterone-pushing going on.
You will encounter people pushing pharmaceutical testosterone. The problem with pharmaceutical testosterone is that there is only one pharmaceutical testosterone product made specifically for women. That one product is made and marketed only in Australia. All other pharmaceutical testosterone products are made only for men. As such, they are ten times stronger than what any woman would want or need. If you use any of them, be sure you take only one tenth of the designated dosage.
Each pharmaceutical company markets their testosterone product as one that will magically improve your sex drive and energy level. And it will. But it will also include the masculinizing undesirable side effects of testosterone.
You will also encounter people pushing compounded testosterone products, both systemic and local. These come in the forms of testosterone pellets and testosterone creams.
All testosterone-pushers will inevitably require you to have blood draws for testosterone levels on a regular three or four month basis. But such labs are meaningless. These compounded testosterone-pushers are merely marketers … making loads of money off of you.
Testosterone Pellets
Testosterone pellets are the latest fad. They entail implanting the pellets under your skin, where they remain for four to six months. Marketers promote them as “bioidentical” testosterone along with estrogen. But they contain a whole lot of testosterone and only a tiny bit of estrogen.
Most testosterone pellet pushers are alternative providers who fall into the categories of functional medicine or integrative medicine. The hormones in pellets are compounded, which means they are not tested or regulated. And they are completely incapable of preventing any of the diseases of estrogen deficiency.
Testosterone pellet pushers will force you to do sex hormone laboratory testing every three months. This makes no sense because there is no such thing as a normal level of these hormones for purposes of menopause. So, save your time, blood, and money! Do not get any kind of sex hormone testing for any of the sex hormones.
The good thing about pellets is that they are long term, lasting four to six months. That’s good if you love them.
The bad thing about pellets is that they are long term, lasting four to six months. That’s bad if you hate them.
The testosterone is the component that most women hate because it causes:
Excessively high sex drive
Hair loss & balding
Weight gain
Whiskers
Acne
Deepening of their voice
Anger
Aggression
And remember: Pellets are completely incapable of preventing any of the diseases that are due to estrogen deficiency.
If your only goals are to increase your energy and sex drive, then pellets will accomplish your goal. However, they will bring along with them permanent masculinizing side effects. If you have any other goals for menopause management, your pellets will fall short.
So, beware of testosterone pushers of all kinds.
If you end up deciding that you need testosterone, be sure that you make the distinction between testosterone above your waist versus below your waist. Get only the testosterone necessary for your needs.
Answer
So there you have it. Should HRT for menopause include testosterone? Well, that depends on you, your goals, and your willingness to accept the permanent masculinizing side effects that come with testosterone.
For the vast majority of women, simply replacing their estrogen restores their energy, motivation, and sex drive, which makes testosterone replacement unnecessary. So, if you get your estrogen right, you’ll get everything right.
So, it really isn’t a question of “should” HRT for menopause include testosterone. It’s really a question of:
When should HRT for menopause include testosterone?
If HRT for menopause should include testosterone?
Where HRT for menopause should include testosterone:
Above your waist
or
Below your waist?
And the answer is as follows.
- HRT for menopause should include testosterone:
- Only when you’ve already gotten your estrogen right,
and - Only if you decipher that you still need testosterone for purposes of improving your sex drive,
- and
Only where you need it for purposes of improving your sex drive.
So that should help you decide whether or not your HRT for menopause should include testosterone.
