Testosterone for Men & Women – What you need to know to make informed decisions

I have been a Family Doctor since 1984, and for the past 13 years I have dedicated my time to the practice of non-surgical aesthetics and weight loss.

Eleven years ago I started treating men and women over the age of 35 with testosterone. During that time the use of testosterone in the USA has taken off. I want to share with you my opinions regarding Testosterone Replacement Therapy, in the hope that you will make educated, safe and informed decisions regarding your use of testosterone.

What is a safe blood level for total testosterone in women? The upper range of normal, as reported by the laboratory, for women over the age of 40 is usually around 40-50. When physicians are trained, as I was over eleven years ago, we are educated that the safe goal for blood levels of total testosterone in women is in the range of 80-120. The national company that trained me did not put that number in writing, even though we received a binder full of other information about bio-identical hormones and pellet therapy in particular. I accepted the range of 80-120 to be a safe and desirable range for women. And my anecdotal experience since then is that they were correct. This was the range that helped women feel relief of “low T” symptoms such as night sweating, poor quality sleep, daytime fatigue, mental fog, moodiness and reduced libido. In this range most women do not report problems with acne or new growth of unwanted facial hair. My impression is that the lower a women’s total testosterone at baseline, the more likely she is to respond. For example, women who have a pre-treatment total testosterone level of under 15 seem to do the best. Women with a baseline of 50 or higher are less likely to respond. Overall, I would estimate that 60% of women respond, and feel better with testosterone.

My concern is raised when I see women treated at other offices who bring in lab reports showing that their pellet therapy is providing them with blood levels of total testosterone in the range of 250-350. This is far higher than any normal young woman would ever have experienced. Levels of 250-350 are not “replacement therapy”, “hormone balancing” or “hormone wellness”. Levels above 250 are completely unnatural. I call this jacking hormones. Yes, some women may like the increased energy, muscle building and heightened libido from these high levels, but this is clearly not safe. We have no idea regarding the risk these women may be exposed to from this overdosing of testosterone. Certainly a higher risk of stroke and heart disease is entirely possible. I caution you from allowing this to happen to you.

If men stop testosterone therapy will their fertility rebound? When a man is given testosterone – either by injections, pellets or topical gels, we know that their “sperm count” or fertility will be reduced. Younger men are often told that they can take testosterone when they are young, and when they want to father children to stop treatment, and fertility will be restored. That statement concerns me. What if you stop testosterone, and find that you are infertile? My office policy for men is strict. If, as a man you believe that you want to keep the option open to father more children, then testosterone should clearly not be given until you are absolutely sure that you are done having children. Having a family is not a choice that should be taken away from a young man.

Should all men take an estrogen blocker? When men are given testosterone, the body converts some of it to estradiol. Yes, it is normal for men to produce estradiol, but too much can cause problems such as breast tissue growth, nipple sensitivity and unwanted mood changes. Men receiving testosterone, who experience this problem, can be treated with estrogen blockers, often taken by mouth once or twice per week. I find that I have had to treat less than 5% of men with estrogen blockers. Other male health providers will promote the use of estrogen blockers in most, if not all of their patients. If estrogen blockers can help, then the reasoning is “Why Not?” My argument is to only use estrogen blockers when they are necessary. Men on testosterone, who have elevated estradiol, and are symptomatic from it, may be receiving unhealthy doses of testosterone in the first place. It is certainly acceptable to raise the blood total testosterone in a male to the upper range of normal, which runs between 1,000-1,200. Some men are attaining levels as high as 1,600, which is clearly not safe or acceptable. Men who are being jacked up on testosterone are much more likely to need an estrogen blocker. High estradiol levels in men usually means that they need to back down on the dose of testosterone that they are receiving. The truth about estrogen blockers is that they are not FDA approved to be used in this way. They do have side effects. Why would you want to taken a second prescribed drug unless it is absolutely needed?

Can women receive testosterone by injection? Men have been receiving testosterone by injection for decades. Just recently, I have found a safe and effective way to dose injectable testosterone in women. I will share with you my dosing, and injection technique, in the hope that some patients and providers will now also be able offer this option to women. Dosing for women is by weight, as follows:

Up to 175 pounds: 10mg im every two weeks

over 200 pounds: 20mg im every two weeks

The challenge is then how to accurately draw up these small doses for administration. Testosterone Cypionate is manufactured in vials contained 200mg per 1mL. In a man, this is easy, since the starting dose of 200mg is easily measured as 1mL from a 3mL syinge. The solution is women is to use a 1cc TB syringe, with detailed markings allowing us to measure 0.1mL (20mg), 0.05mL (10mg) and 0.075mL (15mg). Even with the TB syringe, this takes care and having a good eye. The injector should first connect a 21 G 1″ needle to the TB syringe. Draw the correct dose into the syringe from the vial of testosterone cypionate. Remove the needle from the vial. Pull back on the plunger to draw the full dose out of the needle hub before removing the 21 G needle. Then attach a 22 G x 1.5″ needle to be used for im administration into the gluteal muscle.