Testosterone may prove to be an effective treatment in female sexual arousal disorders, and is available as a dermal patch. There is no FDA approved androgen preparation for the treatment of androgen insufficiency; however, it has been used off-label to treat low libido and sexual dysfunction in older women. Testosterone may be a treatment for postmenopausal women as long as they are effectively estrogenized.
Testosterone improves not just your sex drive, but it also enhances exercise drive, energy for work, mental sharpness, muscle repair, and revs your metabolism to help with weight control. Although improving testosterone levels has not yet been shown to increase lifespan, having a healthy testosterone level improves quality of life for both men and women.
Let’s do a quick review of what I shared in the introduction to this series. August of last year was a tough month for me, primarily because of a huge and grueling project we were in the midst of here on the site. I was stressed out and my sleeping, healthy eating habits, and workout regimen all suffered. At the end of the month I got my testosterone levels tested and found that my total T was 383 ng/dL and my free T was 7.2 pg/mL – close to the average for an 85-100-year-old man.
These researchers took saliva samples from recreational women athletes before and after playing 10 minutes of flag football. The data showed that this short, intense burst of competitive sport triggered the immediate release of testosterone. Interestingly, the subjects' mental state also contributed to the data. Self-rated performance scores were directly related to testosterone levels.
As with a number of treatments or medicines that have been around for a long, long time, it hasn’t been scrutinized like a new drug would be. And although they’ve been discussed, there aren’t any large-scale, randomized controlled clinical trials of testosterone-replacement therapy under way. [See “A male equivalent to the Women’s Health Initiative?” below.]
Testosterone may strengthen your heart. Research on testosterone’s relation to heart health is split. Some scientists have found that men with higher testosterone levels have an increased risk of heart disease, while recent studies have shown that men with below-normal T levels are more at risk for heart problems. The research is still on-going, but many doctors find the evidence compelling that optimal testosterone levels can help prevent cardiovascular disease.
There is a dirty little secret about testosterone cream that almost no one knows, and I’m going to share it here. Please don’t abuse it. If you take a vanishingly small dose of testosterone cream and apply it to your labia and the vulva (or your partner’s), you will witness a form of vasodilation rarely seen no matter how good you are in bed. It has a profound local effect and will produce a night you won’t forget for years.
Sleep apnea is another frequently listed contraindication to testosterone treatment. There have been a few reports of the development, or worsening, of sleep apnea during testosterone therapy (Matsumoto et al 1985) but sleep apnea is actually associated with lower serum testosterone levels (Luboshitzky et al 2002). The reduction in fat mass during treatment with testosterone could potentially be beneficial for sleep apnea, so many specialists will still consider patients for treatment with appropriate monitoring. It is wise to take a clinical history for sleep apnea during testosterone treatment in all men and perform sleep studies in those who develop symptoms.
At the present time, it is suggested that androgen replacement should take the form of natural testosterone. Some of the effects of testosterone are mediated after conversion to estrogen or dihydrotestosterone by the enzymes aromatase and 5a-reductase enzymes respectively. Other effects occur independently of the traditional action of testosterone via the classical androgen receptor- for example, its action as a vasodilator via a cell membrane action as described previously. It is therefore important that the androgen used to treat hypogonadism is amenable to the action of these metabolizing enzymes and can also mediate the non-androgen receptor actions of testosterone. Use of natural testosterone ensures this and reduces the chance of non-testosterone mediated adverse effects. There are now a number of testosterone preparations which can meet these recommendations and the main factor in deciding between them is patient choice.
But can testosterone replacement therapy help with heart disease? Study results are mixed. Small studies in the early 2000s found that men with heart disease who underwent testosterone therapy saw only slight improvements. Some were able to increase their walking distance by 33 percent. Another study found that hormone therapy only widened healthy arteries but had no effect on angina pain.