Testosterone replacement has quite rightly become very popular with both men and women.
At IHA we very much support this, however as a clinic we have learnt over the years that there are a few issues that we need to be aware of.
It is worth sharing them here:
- Testosterone is not just a male hormone – it is present in both men and women and has multiple tasks to improve both sexes health. The difference is that we give men one strength of testosterone to men, and about a ten times lighter strength to women.
- Although testosterone is only generally recommended in women to improve their libido, at our clinic we recognize that both men and women have testosterone receptors in their brains, muscles, fat and bones and we certainly find that testosterone replacement improves much more than just libido in both men and women.[1] The data to support this is still evolving but we sincerely trust that this will soon become an even playing field for both sexes.
- We do not offer men what is commonly known as TRT – testosterone replacement therapy. TRT generally gives a relatively high dose of testosterone to push the testosterone blood levels up to the top end of normal. The problem is that many people who have been put on this regimen come to see us with side-effects (hair loss, prostate enlargement, mental irritability, blood thickening) that then need correcting. instead, we prefer micro-TRT, where we give much smaller doses of testosterone to keep the blood testosterone levels at a more natural physiological level. The result is that there is a good testosterone effect, plus there are rarely any side effects. In addition, because we are keeping the testosterone levels at a middle-of-the-road level, instead of shutting down your own testosterone production, we often find that the baseline testosterone level improves naturally over time, moving back up to normal levels.
To that end there are some points that you should know when you are going for your blood test.
Testosterone is only in the blood for about 30 minutes after which it needs to be removed through the liver. Because of this, testosterone replacement is attached to different bases to slow down its entry into the body. A testosterone cream that you rub onto the inside of your arms or legs will generally take 12 hours to pass through the skin, into the body and out via the liver. Therefore, if you put the cream on this morning and go for a blood test tomorrow morning (24 hours later) then you would expect that most of the cream has already left the body by the time of the test and we would be measuring what we call a “trough” blood level – just the testosterone that you are still making in your own body. We want to see that with micro-TRT, this trough level gradually increases over time, with the goal being that you eventually do not need to supplement with the cream.
If you were to put the testosterone cream on the evening before a morning blood test, then because we are within our12-hour window, we would expect most of that testosterone from the cream to still be in the body at the time of the test. We would then be measuring a “peak” blood level – the testosterone that you are making plus the testosterone that you have added as a cream. We want this level to be within the top natural or physiological blood level. If it is higher, then you are at risk of side effects, and we should drop your dosage. If it is lower than expected, and you are still having deficiency symptoms, then we would want to supplement you with a stronger dose.
There is one mistake that we see a lot and is worth mentioning: on the morning of the blood test, most people know not to eat food or swallow any medication but is not so well known is that it is critical not to smear your hormone creams on before going for the test. If you have inadvertently rubbed testosterone cream onto your inner arm and the phlebotomist then sticks a needle through the cream, the blood result will show a scarily high and completely incorrect testosterone level (which we then need to repeat).
Overall though, done correctly, micro-TRT is incredibly useful for both men and women and can easily be monitored and tracked so that we achieve optimal results in a very safe manner.
[1] Davis SR, et al. Global consensus position statement on the use of testosterone therapy in women. JCEM. 2019: 104: 4660-4666.
