Not surprisingly since men and women are the same except for hormone-balance related reproductive function, the two sexes become more alike after middle age as the sex hormones wane, moving towards what William Masters quoted as the Third Sex. For some – but certainly not the majority- this is a state of pleasing asexual tranquility- and usually physical including musculoskeletal – circulatory as well as immune and mental involution.

In mature adults, sexuality is obviously driven largely- perhaps 80%- by the head rather than the pelvis (where some may be reputed  to have their brains!). But it has always been obvious that sexual desire and responsiveness often go together with positive mood, drive and energy, that  obvious hypogonadism accompanies low sexual and general drive and vigour.

Like men, women who were robust, vigorous and sexual young are more likely to remain so into old age- but sterilization has been linked to decline in both sexes due to fall in balanced sex hormones.  Reproduction aside, there is much evidence that for all-system health both sexes need our youthful balance of testosterone >estrogen lifelong- at peak their relative bloodlevels of these two prime hormones are perhaps 300:1 in lusty young men, 4:1 in sexy maidens; with the sexy healthiest  lean  bucks having testosterone resistance and thus testosterone levels (25-40nmol/L) about 10-20 times that of the wenches (1 – 3nmol/L) .

 But the past 50 years both sexes in many regions have much lower androgen to estrogen balance due to decline in physical activity, to pervasive estrogenics (stress –cortisol), and the thousands of endocrine disruptors in our food chain and polluted atmosphere) let alone medication, cell phones and environmental radiation- which has led to ~50% falls in testosterone levels, sperm counts and fertility in men. 

But (youthful obesity and the hyperandrogenic polycystic ovary syndrome aside), women from puberty are far more likely to  have lower testosterone balance due to the contraceptive hormones  and sterilization in youth, then hysterectomy, radiochemotherapy for breast or pelvic cancers which afflict then at least a decade earlier than men; and finally the conventional massive overdose (for symptom relief) with oral sex hormones – estrogens and synthetic progestin for hormone replacement  – which obviously all reverse the usual youthful androgenic>estrogenic balance in young women.

So it is no wonder that major clinics that have used appropriate hormone replacement therapy for over 60 years  -testosterone and estrogen (and progesterone -which is not the same as any synthetic progestin)  -have seen nothing but wellbeing in women, some of whom continue to return for over 40 years for their replacement.

As was shown with appropriate estrogen-progestin therapy in the first decade after menopause  in the Womens’ Health Initiative and the Oulu studies recently – one-third and greater reduction in all common major degenerative diseases and deaths- all major clinics around the world that have used appropriate testosterone replacement (not anabolic steroids, and not orally)  for men and women have seen similar reductions;  with better wellbeing. But although appropriate HRT may seem appropriate from the patient’s clinical data and hormone profile, it may not suit or benefit all. The best bakers sometimes have cakes that flop..

To add to the major studies already reviewed in this column, a new one compares 2100 UK women given testosterone  (mostly by implant) with 6300 matched controls. “There were no statistically significant differences  in rates of cerebrovascular disease, ischemic heart disease, breast cancer, deep venous thrombosis/pulmonary embolism, diabetes mellitus or acute hepatitis.”

Obviously cosmetic androgenic changes are easily and soon seen and avoided by appropriate dose adjustment – as in all of life, it is stupid to expect the same cookbook dose to suit  all. For testosterone especially in women, this makes it wiser for her to at least initially try conservative administered  dose 0.3mg/day upwards by cream daily,  or tiny subcutaneous depot self-injection ie 5mg every week or two – with appropriate estrogen-progesterone- increasing the dose every few dose, to find what suits her; before deciding if she wants implants 2 or 3 times a year, or 3 monthly ultra-long acting self-injection of say 50 to 100mg.

As in men, individuals differ in their rates of conversion of testosterone to estrogen, and thus their temporary  risk of excess androgen (facial, aggression) or estrogen (breast/pelvic discomfort)  effects till the right dose level is found – balanced as appropriate with estrogen and progesterone..

Ref Maturitas. 2008 Dec 22. [Epub ahead of print  Study of adverse outcomes in women using testosterone therapy.van Staa TP, Sprafka JM




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