Testosterone and DHEA – let’s talk about Androgens
In previous blogs, I’ve written lots about estrogen and progesterone, but let us not forget about the powerfully potent androgens, namely DHEA and Testosterone.
DHEA: Think of DHEA as an energy and hormonal savings account, made and stored in your adrenal glands. You can draw on this hormone anytime during your life (especially in times of stress), but during menopause it is especially important that you have some reserved, because DHEA turns into estradiol and testosterone (is called a pro-hormone). This will turn into our main source of post menopausal estrogen and testosterone. Thank you adrenal glands, always looking out for us.
A women with healthy adrenal function, and an ample store of DHEA may be able to transition into menopause with less symptoms, because of this brilliant conversion.
Conversely, there are a number of situations that decrease your adrenal DHEA reserves, like….LIFE.
Chronic stress and illness, or just living on this planet right now. Or maybe if you just have that personality type a hyper-responsible and over-performing. Sound familiar?
Lower DHEA reserves may lead to a more difficult menopausal transition.
Enter DHEA supplementation!
After DHEA gets tuned into one/both of these hormones, the estrogen and/or testosterone is biologically active in the tissues, and they also get broken down right there inside the cell, so you really won’t get a rise in estrogen or testosterone on serum testing, even if you supplement with DHEA. This makes DHEA good option for a woman who are not a candidates for estrogen therapy.
In addition to it’s pro-hormone benefits, DHEA is also beneficial because:
It’s anti-glucocorticoid (which helps with chronic inflammation)
Immune supportive: DHEA concentrations were found to be significantly decreased in various cancers, inflammatory diseases, certain autoimmune diseases, and cardiovascular disorders.
Anti-plaque forming
Enhances insulin sensitivity and reduces Type 2 diabetes
Reduces of subcutaneous fat.
Maintains tissue strength and repair
Neuro-protective
It’s been shown that women with higher levels of DHEAS post-menopausally have better bone density and less osteoporosis. That’s because androgens help with endochondrial bone development (estrogen decreases bone loss, but it can’t stimulate new bone development like the androgens can).
DHEA and Testosterone also helps with sarcopenia (low muscle mass) which is sort of the new obesity epidemic, especially with all of the GLP 1 agonists (I do really like GLP-1 agonist, but they do contribute to muscle loss).
Androgens, interestingly, can also be anti-estrogenic (even though they are a pro-hormone), and in some studies have shown that testosterone therapy decreased breast cell hyperplasia and decreased growth of breast cancer.
Testosterone isn’t just great for libido and hypoactive sexual disorder. That’s just one of the many benefits. Sometimes adding testosterone to your HRT prescription can decrease the need for more and more estrogen, as it can also help with the vasomotor symptoms of menopause!
If you are struggling with low low libido, that could be estrogen or testosterone (or both) deficiency.
Pain during intercourse? Also could be estrogen and/or testosterone deficiency
Increased belly fat? Or low mood or energy? (Same)
Have your testosterone tested by LCMS, saliva or urine (with all of your other hormones, including DHEA-S), and know that if your testosterone is in the lower quartile of the reference range, you may want to consider testosterone therapy. Have a conversation with a practitioner who can appropriately guide and monitor you during therapy.
Each decade of life has a reference range for testosterone, but why does Quest have a normal reference range of 2-45? And after the age of 18, that’s where the reference range ends?
| Quest ≥18 Years | 250-1100 male | 2-45 female |
Check out the discrepancy here:
The reference ranges below come from a study of premenopausal women with no complaints of sexual dysfunction. This study intended to define normal female androgen values, in women aged:
20–29 years had testosterone values ranging from 45.5 to 57.5 ng/dl
30–39 years had testosterone values ranging from 27.6 to 39.8 ng/dl
40–49 years had testosterone values ranging from 27.0 to 38.6 ng/dl,
Parish, et al J Womens Health (Larchmt). 2021 Apr 19;30(4):474–491
These reference ranges are most likely not on your doc’s desk (unless they are well trained in women’s health). But now you know!
To recap, the general benefits from androgens (DHEA and Testosterone)
1) Stimulates endochondral bone development.
2) Has a positive effect on general well-being, energy, mood, and quality of life. This is a big one, and noticed almost across the board by my patients.
3) Improvements in irritability, nervousness, memory and insomnia have been reported after adding androgens to HRT, or even when used alone.
4) Libido and sexual satisfaction improves. Studies have shown a great improvement in vaginal atrophy and dyspareunia as well as desire.
5) The addition of androgens has been found to be effective in relieving hot flashes in women who did not get complete relief from traditional HRT.
6) Androgens may improve endothelium vasodilation in postmenopausal women (cardioprotective)
8) anti-inflammatory
9) reduces insulin resistance
10) neuro-protective effects
For women, there is no manufactured Pharma option for testosterone, so it does need to be compounded, and prescribed and monitored responsibly.
