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Testosterone Treatment for Women
The majority of female patients with testosterone deficiency exhibit reduced sexual drive and/or unexplained lethargy and fatigue. They may also experience altered mood.

Management requires a multidisciplinary, integrated approach. This should be co-ordinated by a suitably trained medical practitioner.

See the table  in our post about Symptoms of Testosterone Deficiency.

A medical practitioner’s assessment of a patient must include:

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Medical History Including Sexual History - It is very important for your doctor to be skilled in discussing, understanding and managing problems associated with sexual matters. In terms of obtaining your sexual history, it is vital your doctor knows his or her limits. If your doctor has little or no training in sexual counselling a referral to a trained sex counsellor is recommended.

A doctor should:

Examination - It is important a general good female health check be undertaken by your doctor.

Routine screening should include: a mammogram, a Pap smear, testing of cardiovascular parameters, a fasting blood glucose test, a serum thyroid stimulating hormone (TSH) level test, a full blood examination and iron studies.

Further investigations of specific medical disorders such as abnormal bleeding, breast lump(s), incontinence and osteoporosis are essential before any consideration of testosterone treatment.

A psychological evaluation of mood, well-being and sexual function may need to be conducted.

Hormone Blood Testing - The measurement of testosterone levels in the blood provides a snapshot of the testosterone status of a person at that time.

Testosterone secretion follows a diurnal rhythm in females. This means it rises and falls over a 24 hour period. Testosterone production occurs during the night and early morning with levels highest on waking. Serum testosterone levels slowly decrease during the day and are lowest in the late afternoon and early evening.

Therefore, blood samples should preferably be taken in the morning, when hormone levels are at their highest. Individual variations in serum testosterone levels can occur due to time of day, medication usage, stress, illness, high alcohol intake or after recent surgery.

testosterone levels in women

The ovaries and adrenal glands do not store testosterone. Once produced, testosterone is secreted into the blood stream where it is rapidly adhered to by the protein sex hormone- binding globulin (SHBG).

Up to 99% of testosterone produced in the body is bound to SHBG. Once testosterone is bound to SHBG (bound testosterone), it is inactive.

Testosterone to which SHBG does not attach is biologically available testosterone. This is free to act on cells throughout the body (free testosterone or free T). Free testosterone is the vital component to measure when having a blood test.

Because SHBG has such a significant effect on testosterone, it is essential SHBG levels be considered when doing blood tests. High SHBG will result in free testosterone being low, hence the cause of lowered energy and libido.

Some doctors will measure only testosterone levels (called total testosterone) and not take into account the SHBG levels. While not technically wrong, total testosterone measurement alone is not the most accurate representation of how much testosterone is free to act in the body. As a consequence, the total testosterone reference ranges commonly adopted by pathology laboratories for determination of ‘normal’ and ‘low’ testosterone are potentially misleading. This is because the results do not take into account the effects of SHBG.

In order to establish an accurate diagnosis for a patient, it is essential the testosterone component of most relevance be measured the free testosterone. Free testosterone is best measured directly via a method called equilibrium dialysis. However, not many pathology laboratories have this specialised equipment. A more common and equally accurate method is via a mathematical calculation that takes into account SHBG levels. This is called the ‘calculated free testosterone’ (cFT). This is the gold standard measurement when assessing testosterone status in women.

A good alternative to ‘free testosterone’ measurement is the ‘free androgen index’ or FAI. This is calculated by dividing the total testosterone level in the blood by the SHBG level, multiplied by 100. Pathology labs will automatically do this calculation and the result will be the FAI reading. Generally a FAI of less than two indicates there is very little free testosterone and is a likely cause of symptoms.

Understand more on testosterone in women:

Testing for low testosterone

Testosterone in women explained

Signs and Symptoms of Testosterone Insufficiency

Testosterone cream for Women Quick Q & A

The information in this article has been taken with permission from the official Lawley booklet on Understanding Testosterone for Women.

 

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