Checking Testosterone After Hot Flashes

As we pass through menopause, we may understand what our grandmothers and mothers meant when they said "Oh, I'm too old for that sort of thing." Sex? Not interested. Exercise? We're just too tired. Living with zest and joy? We hadn't realized there were so many things in life to worry about.

These changes in sex drive, energy, and outlook may not be inevitable results of aging.-They could be a sign of testosterone deficiency.

"If women experience that type of decline and just don't feel interested especially when they've had a normal, healthy, active sex life-then that's a real clue that there's a hormonal factor involved," says women's health specialist Dr. Elizabeth Lee Vliet.

The overlooked hormone

Testosterone is the strongest of the male sex hormones, or androgens. In addition to estrogen and progesterone (the female hormones), our ovaries are the primary producers of testosterone during our reproductive years. Other androgens, as well as a small amount of testosterone, are produced by our adrenal glands and fat tissue, along with small amounts of estrogen.

At menopause, when our ovaries no longer release eggs, stop producing the potent forms of estrogen (estradiol and estrone) and stop producing progesterone, they also slightly decrease production of testosterone. The word slightly is important here because the lower amount of testosterone is less important than the fact that the ratio of testosterone to estrogen and progesterone changes.

Testosterone is particularly important because it activates the sexual circuits in the brain for both men and women, Dr. Vliet explains. It helps maintain normal energy levels, muscle tone, and a sense of well being. And it actually helps in the formation of new bone.

Preventing osteoporosis, a disease in which the bones lose mass at an excessive rate and break easily, is one of the primary reasons for adding testosterone to hormone replacement therapy after menopause, Dr. Vliet states.

Sex and the older woman

Sexuality in older women, while important to their quality of life, has been largely ignored by doctors in this country, Dr. Vhet says. Historically, she notes, the loss of a woman's sex drive has been attributed to psychological or relationship problems.

One woman in her sixties told her: "My doctor said that's just part of what happens when you get older, but I've just gotten married and I want to enjoy my sex life!" When Dr. Vliet measured that woman's testosterone level, it was less than 10 nanograms per deciliter of blood serum-normal levels in women range between 30 and 50 ng/dl when measured in blood and 20 - 50 picograms per milliliter when measured in saliva. (A nanogram is one billionth of a gram; a picogram is one trillionth of a gram).

"That doesn't sound like much of a difference," Dr. Vliet says, but "when you start dropping down below 20, it really is a significant decrease in the sexual arousal of the brain, physiologically." (For comparison, normal blood levels for men range from 500-1,000 ng/dl.)

In addition to measuring testosterone, Dr. Vliet also usually checks two other levels: FSH (follicle stimulating hormone) and estradiol (the main form of estrogen produced from the ovaries before menopause).

"That gives me a picture of where the woman is in her present balance and how that correlates with the symptoms she's experiencing, her cholesterol profile, and her bone density," she explains. "Then I can begin to design an individualized regimen."

Taking testosterone

If a woman has a testosterone deficiency, many physicians start by prescribing a testosterone cream applied vaginally twice weekly. Dr. Vliet usually starts her patients on 1.5-2 mg of testosterone per day, in capsules or a cream or lotion rubbed into the skin. Side effects of testosterone may include: anxiety or irritability, dark hairs on the chin or upper lip, excess body hair, oily skin and acne. If these side effects occur with testosterone therapy, your dosage may need to be adjusted.

Raising the issue

If you're noticing a decrease in your sex drive or energy level, talk to your doctor, she advises, but be aware that some physicians are not comfortable or knowledgeable in addressing the issue of testosterone deficiency and waning sex drive in women.