Testosterone Deficiency in Men & Women

What is testosterone?
Testosterone is a sex hormone essential for male growth and development. This hormone is important for male:

• muscle size and strength
• bone growth and strength
• sperm production
• libido
• appearance of facial and pubic hair
• deepening of the voice
• development of the penis and testes

Women need testosterone too – just not in the same amounts as men! It is made in their adrenal glands and ovaries and has an important role in women’s health and brain function – maintaining ovarian function, bone strength, libido and mood.

Is ‘male menopause’ a thing?
While nowhere near as dramatic as the sudden drop in estrogen that happens as women approach menopause, men will get a gradual drop in their testosterone level as they age – about 1 to 2% per year after the age of 40 as their testes start to produce less of this hormone. Not all men will experience symptoms, which are slower to appear and more subtle than the symptoms women experience through perimenopause and menopause.

Other causes of low testosterone apart from the aging process can be significant stress, vigorous exercise, kidney disease, alcoholism, cirrhosis of the liver and sleep deprivation. The testes can be affected by direct injury, tumours, radiotherapy and chemotherapy.

In women who have had their ovaries removed, testosterone levels will be low, and also if they suffer from any disease of the adrenal glands, pituitary or hypothalamus.

How would I know if I have low testosterone?
You would need a blood test to check this as some of the signs and symptoms that come with a low testosterone level can also be caused by certain medications or by having a high body mass.

Common symptoms of low testosterone in men are:

• loss of body and facial hair
• loss of muscle mass
• hot flushes
• irritability, poor concentration, depression
• weight gain
• less energy
• increase in breast size
• low libido, impotence
• brittle bones, increased fracture risk
• infertility, small testicles, low sperm count.

For women:

• low testosterone levels result in low libido
• decreased bone strength and muscle mass
• poor concentration
• depression

Is there a male version of HRT to treat low testosterone?
Yes, there is fully subsidised treatment called Testosterone Replacement Therapy (TRT) in New Zealand for low testosterone (hypogonadism). Oral, injectable and transdermal forms of testosterone are available. However, to be offered this treatment, low testosterone levels need to be clinically established as consistently low, and the signs and symptoms shown to have a significant impact on the quality of life, as well as any possible reversible causes to have been identified and worked on first.

What about for women?
Testosterone is now widely used in other countries to treat peri- and menopausal women alongside the other well-known hormones of estrogen and progesterone. As yet there is no fully funded or approved testosterone treatment for New Zealand women. The approved, funded forms of testosterone are all produced in the male physiological range, in doses appropriate for men only. In New Zealand, prescribers can only prescribe testosterone to women as an “off-label” and unapproved medicine, and there can be significant cost to this.

What are the benefits of TRT?
TRT can improve mood, well-being, cognitive function (memory and executive function), energy levels, libido and sexual function for both men and women. It also increases muscle and bone mass. For women it can improve the tissues and organs of the pelvis. It can be used to help the vulvo-vaginal and urinary tract symptoms in menopause (testosterone is an important hormone for vulva skin health, thickness and elasticity and to prevent vaginal dryness).

Talk to your healthcare professional about testosterone as an option to consider for:

Men – TRT may be suitable for you if you have symptoms that are impacting your quality of life, your blood tests show consistently low levels of testosterone, and your doctor decides it is an appropriate treatment based on your lifestyle factors and health history.

Women – Testosterone may be an option worth considering as an addition to a well-established hormone replacement therapy regime for post-menopausal women experiencing sexual dysfunction.