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Of the many health trends on social media, the demand for testosterone as a performance enhancing drug in women is one of the strangest. It’s a “powerhouse hormone,” claims one influencer, who recommends it for “energy, mood, muscle tone, libido, and overall vitality.” Some women also have injections of slow-dissolving testosterone pellets into the buttocks.
Although generally considered a “male” hormone, testosterone is also essential for women – it contributes to libido, sexual arousal, and orgasm by increasing dopamine levels in the central nervous system. Since the 1940s, doctors had been prescribing hormones to their female patients to address problems such as low libido. But this ended when fears over hormone-replacement therapy (HRT) emerged at the turn of the millennium. Although concern focused on estrogen and progesterone, testosterone has joined the mix. Doctors are concerned about the lack of evidence-based research supporting its use.
Although concerns about HRT use have subsided, women have begun to reconsider testosterone, says Dr. Caroline Messer of Fifth Avenue Endocrinology, a clinic in New York. Since 2019, hormones have been introduced for low libido, now called hypoactive sexual desire disorder (HSDD). In the US, between 2013 and 2023, prescriptions are expected to increase by nearly 50%; In Britain these increased tenfold between 2015 and 2022.
Testosterone peaks in a woman’s 20s; By menopause, blood levels drop to about a quarter of the peak. The goal of therapy for HSDD is to bring women back to approximately pre-menopausal levels using products applied to the skin. Dr. Messer avoids injectable pellets – she says women can get too much testosterone that way. Too much hormone comes with side effects that include acne, excess hair on the body, mood swings or permanent deepening of a woman’s voice.
Testosterone may also be useful during menopause for reasons other than sexual dysfunction. Women in menopause often complain of “brain fog” – which includes symptoms such as fatigue, difficulty concentrating, poor memory, decreased verbal fluency and decreased ability to multitask. Anon McKenzie, consultant psychiatrist specializing in women’s hormonal mental health at The Soke, a London clinic, says that menopausal women who have been prescribed testosterone for low libido report improved mood and say they remember things better and have less fatigue in making decisions. Some studies also suggest improvements in mood and cognition in women treated with testosterone after menopause.
However, well-designed trials are still needed to establish long-term efficacy and safety for these types of uses. This leaves them in a medical gray area. For young women who have no medical need for testosterone, its use to improve mood or performance is terra incognita. The use of high doses for muscle building or performance, the way male bodybuilders might use hormones, is considered unsafe by experts.
For women with medical need, appropriate testosterone supplements can be invaluable. But Dr. Messer says, for everyone else, it’s just another “hormone du jour” offered unnecessarily by influencers on social media.
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