Journal / Testosterone for Women

Testosterone Replacement Therapy – TRT Benefits and Risks for Women

Medically reviewed by Dr. Green OB/GYN

Written by Winona Editorial Team

Last updated October 14, 2021

When one thinks about hormone replacement therapy for women, testosterone is not what immediately comes to mind. Estrogen and progesterone are usually considered the female sex hormones, and they are. It turns out testosterone also plays an important part in women’s health and wellbeing. TRT benefits for women are real.

In women, testosterone is mainly made in the ovaries. The levels peak in the 20’s and by the time women are in the 50’s the average testosterone levels have decreased by about 50%.1 When women have both ovaries removed surgically (oophorectomy), the levels drop precipitously. Testosterone has many important functions in female physiology and when the levels of testosterone drop those important functions can suffer. This article will serve to educate women on testosterone replacement therapy (TRT) benefits and risks.

Normal testosterone levels in women are responsible for many important physiologic properties. When testosterone levels drop the benefits of replacing the lost TRT are many. Testosterone levels in women help drive lIbido, sexual response, orgasm, and overall sexual satisfaction.2 Testosterone also helps improve lean muscle mass; these added muscles can increase metabolic rate and helps with weight loss.3 Replacing low testosterone to normal levels can also improve energy and decrease fatigue.4,5

Testosterone helps with brain function by improving concentration, clarity of thought, and overall cognition.6 Testosterone improves bone health and may be breast protective.1,3,6 Finally, testosterone replacement to your normal youthful levels has an anti-aging component for skin, hair, and nails and has been shown to improve the overall quality of life and a general feeling of wellbeing.5

Benefits of testosterone replacement therapy

  • Testosterone is important for sexual wellbeing
    While decreased sex drive or libido can happen due to lots of reasons, when you are a woman over the age of 40, it is the low testosterone levels that have been found to be a major risk factor for low libido.2 Studies have shown that by simply replacing testosterone to normal youthful levels you can reverse that lost libido and return your normal sexual desire.

    Beyond just desiring sex more, low testosterone levels can reduce the size and sensitivity of your clitoris which can make it more difficult to reach orgasm or even lead to loss of orgasm potential. Replacing testosterone to normal levels can reverse these changes and you can once again regain the ability to achieve orgasm.

    Women who replace testosterone levels report increased overall sexual satisfaction and increased quality of life. Sexual satisfaction spills over to satisfaction in other areas of life, the most obvious being an improvement in your relationships with intimate significant others, which can lead to improved mood, increase in positive self-image, decreased anxiety, and overall performance

  • Testosterone is important for lean muscle mass
    Testosterone is important for increasing lean muscle mass.3 Lean muscles are muscles that do not have a lot of fat around or within them. You want to maintain your lean muscle because it will reduce the risk of injury to your ligaments and tendons, and will improve your posture by creating and supporting stronger core and back muscles. While it may sound strange, lean muscle also protects your bones from becoming weaker in later life by increasing bone density and strength.

    If you are low on testosterone, you can exercise the same amount (or more) and will see less improvement in lean muscle mass than a woman with normal testosterone. When you improve your body’s response to exercise by increasing testosterone, you will likely notice the benefits in the mirror and the way your clothes fit. That positive feedback will likely encourage you to exercise more. It is motivational to actually see the changes and you will likely stick to an exercise routine when results are apparent more quickly. Testosterone can help you get there.

    Because testosterone is responsible for increased muscle mass, and leaner body mass you can better control your weight and increase your energy levels. Research studies show that testosterone treatment can decrease overall body fat and increase muscle tone and strength. 

    Muscle cells are always twitching or moving – even when you are asleep. Because they are always at work, muscles burn more calories than fat tissue even when you are resting. So, the more muscle you have, the higher your metabolic rate, which means that your body burns more calories while doing basically nothing. This means that women with more muscle will burn more energy at rest than women who weigh the same but have less of that weight from muscle. 

    The basal metabolic rate (BMR), or resting metabolic rate (RMR), is the minimum amount of energy required to keep your body alive when at rest. Another way to look at it is the number of calories you need to keep your heart beating, your lungs working, etc. Any other activities, like walking or running will require additional calories above the BMR.

    By increasing your muscle mass, you are increasing your BMR. Weight loss occurs when the amount of calories consumed is less than the number of calories burned. All else being equal, women with more muscle have a higher BMR, burn more calories at rest, and will lose weight more easily than women with less muscle. This is one of the reasons why it becomes so difficult to lose weight as we age. As testosterone drops with age, we require fewer calories. Returning testosterone to normal levels reverses this trend and we can burn more calories at rest.

    Increasing lean muscle mass also redistributes weight in a cosmetically pleasing fashion. We look better when we have more lean muscle mass. Women that experience a better response to exercise and have less fat and more muscle look better. Clothes fit better, posture improves and confidence improves.

  • Testosterone is Important for Maintaining Energy Levels
    Women with low testosterone are more prone to experience low energy and fatigue. Returning testosterone to normal levels will help to increase overall energy levels and can help you feel better.

    Think about how much energy we had when we were in our 20’s. One of the unfortunate parts of aging is the loss of energy and the body’s ability to refresh itself. One of the reasons we lose so much energy as we age is because of falling testosterone levels. Returning testosterone to normal levels will increase the body’s ability to refresh and increase overall energy levels.4

    Returning normal energy levels via testosterone replacement can have a profound impact on the quality of life. Decreasing fatigue can improve mood, boost confidence, and allow for activities that increase happiness.

  • Testosterone is Important for Brain Health
    Normal testosterone levels in women are key to brain health. Clarity of thought, improved concentration, and overall cognition come with normal testosterone levels. When testosterone levels lower due to decreased production in the ovaries, brain fog can be the result. Returning testosterone to normal levels can treat the brain fog and can help return brain function to optimal youthful levels.5

    Low testosterone levels in women are also associated with significant mood changes including anxiety, depression, and irritability. Replacing testosterone and returning levels to youthful numbers can reverse these symptoms and return women to a state of good mental health.

  • Testosterone Improves bone health
    Loss of bone mineral density (osteopenia and osteoporosis) is associated with increased bone-breaking and fracture risk and is an important health concern for women as they age. Osteoporosis can lead to life-threatening bone fractures, especially in the hip. Osteoporosis is also responsible for loss of integrity of the spine leading to the loss of height, fractures of the vertebrae, back pain, abnormal curvature of the spine, and even nerve damage.1,5

    Low testosterone levels in women have been found to be an important risk factor for bone mineral density loss in women. Replacing testosterone to normal levels in women can be an important part of maintaining bone mineral density.

  • Testosterone is Breast Protective
    Replacing testosterone, back to normal levels, has a beneficial effect on breast tissue. Testosterone actually decreases the stimulation of breast tissue which can help protect the breast from cancers. You can further enhance the protection testosterone provides by giving an additional aromatase inhibitor, such as Anastrozole.  These protective effects on the breast are even more pronounced than with testosterone alone. 

  • Testosterone Improves Overall Quality of Life and Feelings of Wellbeing
    Women with low testosterone feel better when their testosterone is replaced to normal youthful levels. Overall sexual health improves, lean muscle mass improves, weight loss becomes easier, and energy levels improve. All these positive changes lead to increased feelings of well-being and improved quality of life. Women tend to feel more confident and relationships improve.4

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Risks of testosterone replacement therapy

TRT is extremely safe when levels are returned to normal youthful levels. Side effects are rare and when they do occur, they are mild. The worrisome side effects sometimes associated with testosterone replacement therapy such as voice deepening, clitoromegaly, and male pattern baldness are only seen in very large doses; levels much higher than normally found in women and would never be prescribed by your Winona physicians. High doses of testosterone are typically used by female bodybuilders. Because of the side effects of testosterone when used as a performance-enhancing drug, there are many myths associated with thyroid replacement therapy (TRT) which are not true in the mild doses used to return testosterone to normal female levels.

Myths associated with testosterone replacement in women

  • Testosterone is the male hormone and not needed in women.
    This is not true. Testosterone is essential for women’s health and wellbeing and has many important functions in women’s bodies. It is made in the ovaries in women and present in larger concentrations than estrogen. 

  • Testosterone replacement will make me look like a man.
    This is false. Replacing testosterone to normal levels has very few, negative side effects. Some women may experience mild acne or hair growth but most have no detrimental side effects at all. It is only when testosterone is given in very high doses are there risks of more serious side effects such as voice deepening, male pattern hair growth, and clitoromegaly.

  • Testosterone replacement will give me huge muscles, I don’t want to look like an athlete from East Germany in the 1970’s
    Another falsehood. Women who take huge doses of testosterone and train to increase muscle mass can transform their bodies into the stereotypical 1970’s athletes. This will not occur in normal replacement doses used for women wanting to regain the advantages of normal testosterone levels.

  • Testosterone replacement will change my personality and make me aggressive
    Also not true. Replacing testosterone to normal levels will not change a woman’s personality. It can help improve mood by helping women feel better and improve quality of life. But returning testosterone to normal levels will not change a woman’s personality.

  • Testosterone replacement is dangerous for my liver
    Again, another false myth. Testosterone is indeed metabolized by the liver. Women who have a pre-existing liver disease such as hepatitis should not take hormone replacement. It is also true that in massive doses, testosterone can stress the liver. The important fact is that in healthy women, replacing testosterone with normal levels will not hurt the liver.

Summary

The benefits of testosterone replacement in women are many and the risks are minimal when used in physiologic doses. TRT can be an important part of hormone replacement therapy in women.

Winona offers testosterone replacement therapy for symptoms of low testosterone in women. We use DHEA, sometimes in combination with anastrozole, to gently and safely return testosterone to normal levels. DHEA is a testosterone precursor. The body naturally breaks down DHEA into a combination of estrogen and testosterone. This is a natural way to replace falling testosterone to normal levels without risking going too far and ending up with dangerously high testosterone levels. Anastrozole is a medication that can block the conversion of DHEA to estrogen. By adding anastrozole, more of the DHEA ends up as testosterone. This can give a slightly higher testosterone boost for women that need a bit more testosterone.

When considering hormone replacement in women, TRT benefits should not be discounted. Ask your Winona physician about how adding testosterone to hormone replacement therapy can be a safe and important part of helping women feel young.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”

References:

  1. Glaser, Rebecca, and Dimitrakakis, Constantine, “Testosterone Therapy in Women: Myths and Misconceptions.” Maturitas, Vol 74, issue 3, 2013, 230-234

  2. Testosterone Insufficiency and Treatment in Women: International Expert Consensus Resolutions

  3. MF. Sowers, et. al., “Testosterone Concentrations in Women Aged 25 – 50 Years: Associations with Lifestyle, Body Composition, and Ovarian Status,” American journal of Epidemiology, Vol 153, Issue 3, 2001, 256-264

  4. S Bolour and G Braunstein, “Testosterone Therapy in Women: a Review,” International Journal of Impotence Research, 17, 2005, 399-408

  5. https://www.biotemedical.com/research/testosterone-insufficiency-and-treatment-in-women-international-expert-consensus-resolutions/

  6. Davison, S.L., et. al, “Androgen Levels in Adult Females: Changes with Age, Menopause, and Oophorectomy.” The Journal of Clinical Endocrinology & Metabolism, Vol 90, Issue 7, 2005, 3847-3853