Bioidentical testosterone therapy, at the right doses, is completely safe and allows for a correct hormonal restoration. Nevertheless, myths and rumours still circulate despite lacking any scientific evidence.

Some of the misconceptions that abound in the collective imagination are: that testosterone is a “male” hormone; that its only role in women is for sexual desire and libido; that replacement therapy makes women more masculine; that it gives you a deeper (more manly) voice; that it causes hair loss; that it can have adverse side-effects on your cardiovascular system; that it causes aggression; or that it can increase the risk of breast cancer.

Dr. Iván Moreno – Neolife Medical Team

Many of these myths that create such a bad reputation for hormones are in fact extrapolations of the adverse effects seen from taking very high doses of anabolics, which have nothing to do with bioidentical testosterone.

Testosterone therapy is being increasingly used to alleviate symptoms of hormonal deficiency in pre and postmenopausal women.

Although numerous scientific studies show the safety and success of this treatment, rumours and myths have been created, which by sheer force of repetition seem to hold more “influence” despite lacking any supporting medical evidence.

Many of these myths are extrapolations of the adverse effects seen from taking very high doses of anabolics (testosterone derivatives) for other purposes (such as bodybuilding, doping, etc.).

In this article, we refer solely to therapy with bioidentical testosterone (which is identical to a human testosterone molecule) and only at replacement doses which aim to replenish the physiological levels we already had in our youth; this is the standard that governs a correct hormone restoration, which we employ here at Neolife.

Myth 1: Testosterone is a “male” hormone.

While it is true that men have higher levels of testosterone, the most abundant sex hormone present in a women’s body is also testosterone. Oestrogen (typically referred to as the “female” hormone), although present throughout a women’s life, is found in concentrations 10 times lower than that of testosterone. Testosterone, in balance with lower doses of oestradiol, is equally important for both sexes.

Fact: testosterone is the most abundant and biologically active hormone in women.

Myth 2: The only role of testosterone in women is for sexual desire and libido.

Another misconception, given that testosterone receptors are found in practically all tissues of a women’s body. Testosterone and its precursors decrease with age, and pre and postmenopausal women may experience symptoms of androgen deficiency such as: mood disorders, lack of well-being, fatigue, loss of bone density and muscle mass, mental dullness, memory disorders, hot flushes, joint discomfort, and sexual dysfunction etc.

Fact: testosterone is essential to a woman’s physical and mental health.

Myth 3: Testosterone treatment makes women more masculine.

Restoring a woman’s ideal hormone levels (to that which we had between the ages of 18-25 years old) far from making you more masculine, can in fact make you more feminine. Treatment should not be confused with the high supra-pharmacological doses which are administered to patients requiring more drastic changes due to gender issues; in which case, symptoms are still reversible by merely reducing the dosage.

Fact: excluding supra-pharmacological doses, testosterone has no masculinizing effects on women.

Myth 4: Testosterone will make your voice deeper (more masculine).

Hoarseness of voice can affect us at different times due to inflammation or infection of the throat, but is always reversible. There is no procedure whereby testosterone could produce such a phenomenon; even in cases of high doses of other androgens, there is no clear evidence of producing a deeper voice or any irreversible changes to the vocal chords.

Fact: there is no evidence that testosterone changes your voice.

Myth 5: Testosterone causes hair loss.

Hair loss is a complex and multifactorial process which is also genetically determined. “Androgenic” alopecia refers to the similar type of pattern baldness commonly found in men, not referring to the cause, but rather to the defined pattern. In any case, it is dihydrotestosterone (DHT), and not testosterone, which is involved. Obesity and insulin resistance, as well as alcohol, a sedentary lifestyle and some medications, can increase the conversion of testosterone to DHT and oestradiol in the hair follicle.

Approximately one third of women experience brittle hair and hair loss with age, which often coincides with a decrease in testosterone levels. However, there are studies in which hair regrowth has been achieved due to subcutaneous testosterone implants in such women.

Fact: testosterone does not cause hair loss; in fact, in some cases it can improve hair regrowth.

Myth 6: Testosterone has adverse effects at a cardiovascular level.

Unlike synthetic anabolics, there is no evidence that testosterone has any adverse effect at a cardiovascular level. In fact, its replacement has a beneficial effect on the metabolism of glucose and lipids, as well as on the maintenance of “lean mass” in both men and women’s bodies.

The most complete meta-analysis ³ carried out on this topic shows that there is no greater cardiovascular risk with testosterone replacement therapy; in fact, a lower occurrence of cardiovascular disease has been demonstrated in some groups (those presenting a higher cardiometabolic risk).

Fact: there is substantial evidence supporting the cardiovascular safety of testosterone, which even indicates a likely protective effect.

Myth 7: Testosterone damages the liver and can cause “clotting” (venous thromboembolic disease).

This is an “imported” rumour from the world of anabolic (synthetic androgens) over-use, which when taken orally in high doses, can in effect, cause liver damage. The truth is that parenteral testosterone (gels, skin patches or subcutaneous implants) avoids that first step through the liver and thus has no adverse effects (i.e. there is no increase in transaminase enzymes nor any alteration to the factors that affect blood clotting). There is therefore no relationship between testosterone administered in this way and the occurrence of blood clots (thrombosis, embolism), unlike synthetic steroids, or oestrogens taken without progesterone and progestins.

Fact: non-oral testosterone does not damage the liver or increase blood clotting.

Myth 8: Testosterone causes aggression.

Although the use of anabolics at high doses can cause aggression and attacks of “rage” (hence the rumour), this does not happen with testosterone. Even with supra-pharmacological doses of intramuscular testosterone, there has been no clear onset of aggression.

As has been previously mentioned, in cases of obesity, alcohol consumption, or a marked sedentary lifestyle, the conversion rate of testosterone to oestradiol can be seen to increase. The effects of excess oestrogen (oestradiol and its derivatives) however, have been associated with irritability and aggression in other species. In fact, in women presenting symptoms of androgen deficiency, treatment with testosterone has been shown to improve anxiety and irritability in more than 90% of cases².

Fact: testosterone therapy is not linked to aggression; even in women suffering from testosterone deficiency, therapy improves anxiety and irritability.

Myth 9: Testosterone may increase the risk of breast cancer.

Since 1937, it has been known that the development of breast cancer is usually dependent on oestrogen. Testosterone, however, could play a possible role in slowing down the growth of breast tissue, and may even be a treatment for breast cancer.

In recent studies, in which testosterone was administered together with an aromatase inhibitor (preventing any conversion into oestrogen), they found the tumour to reduce or even disappear⁵.

Fact: testosterone does not increase chances of breast cancer; in fact, it could help to prevent it.

Myth 10: the safety of testosterone use in women has not been tested.

Data of treatment at very high doses in transgender patients has existed for more than 40 years, and has shown this treatment to be safe. Any side-effects have been the consequence of oral intake (which is no longer used) or due to the conversion to oestradiol (which is rarely a problem at the doses used for bioidentical hormone replacement).

Fact: the safety of non-oral testosterone use has been well established in women for cases of very long-term treatments.

BIBLIOGRAPHY

(1) Glaser, R., & Dimitrakakis, C. (2013). Testosterone therapy in women: myths and misconceptions. Maturitas, 74(3), 230–234.

(2) Glaser R, York AE, Dimitrakakis C. Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale (MRS). Maturitas 2011; 68: 355–61.

(3) Corona G, Rastrelli G, Maggi M. Diagnosis and treatment of late onset hypogonadism: systematic review and meta- analysis of TRT outcomes. Best Pract Res Clin Endocrinol Metab 2013; 27: 557-579.

(4) Hackett, G., Kirby, M., Edwards, D., Jones, T. H., Wylie, K., Ossei-Gerning, N., et al. (2017). British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice. The Journal of Sexual Medicine, 14(12), 1504–1523.

(5) Glaser, R., & Dimitrakakis, C. 2015. Testosterone and breast cancer prevention. Maturitas, 82(3), 291–295.

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A recent study demonstrates the unreliability of using conventional measures to assess the presence of obesity in menopausal women.

In the study, published in the prestigious journal Menopause and carried out on more than 1300 menopausal women, two techniques for the diagnosis of obesity were compared: use of BMI assessment and DXA. The results showed a clear bias towards not diagnosing women who were actually obese as obese when using conventional methods.

Dr. Iván Moreno – Neolife Medical Team

The “Gold-standard” (reference standard) is the dual energy X-ray absorptiometry (DXA): non-invasive test, with a similar diagnostic accuracy as magnetic resonance imaging.

A recent American study (1) demonstrates the unreliability of using conventional measures to assess the presence of obesity in menopausal women. In the study, published in the prestigious journal Menopause, two techniques for the diagnosis of obesity were compared, which highlighted that perhaps we are not using the best diagnostic tool at present.

This research, conducted by the public health universities of Buffalo and Boston (USA), compared the use of the Body Mass Index (BMI) with the use of dual energy X-ray absorptiometry (DXA) in order to assess which was more effective at determining the presence or absence of obesity in menopausal women.

The BMI (weight divided by the size in centimetres squared) has been traditionally used as a measure to classify the presence of excess weight above 25kg / cm2 and obesity when it was higher than 30kg / cm2. This is a simple tool to use in clinical practice (only weight and height are required), but it does not accurately reflect any differences in body composition between different people or in the same person throughout the year.

The dual energy X-ray absorptiometry (DXA): non-invasive test has a similar diagnostic accuracy as magnetic resonance imaging which is considered today the “Gold-standard” (reference standard) for obesity diagnosis. This test allows medical professionals to directly measure (and not by approximations with formulas) how much fat, how much muscle and how much bone the patient has in kilograms. This also allows us to assess where said categories are located and how much of that fat is the dreaded “visceral fat”, which is clearly associated with the presentation of insulin resistance, diabetes and cardiovascular disease.

Although BMI is recognized as being the less accurate test, in the specific case of menopausal women it could be even more inaccurate due to the changes that occur in their body composition, such as the loss of bone mineral density, muscle loss, intra-abdominal fat deposits and loss of height that accompany the hormonal decline if the imbalance is not corrected.

In an effort to clarify this point, more than 1300 menopausal women were studied and given both a BMI assessment and subjected to DXA. The results showed a clear bias towards not diagnosing women who were actually obese as obese when using conventional methods.

When we analysed what constitutes a point on the BMI scale taking into account the sensitivity required for the detection of obesity in menopausal women, we determined that this was 24.9kg / cm2 (a figure much lower than what we had been using previously).

These results show the flaw in the calculation of BMI as it uses weight and height as a tool for the early detection of obesity. The patient may suffer subsequent damage in cases where they require stricter protocols to avoid numerous diseases that lead to obesity in the future.

At Neolife we always assess a patient where obesity is part of the presentation by undertaking a body composition examination, either using advanced octopolar impedanciometry or with the bone density scan previously discussed (DXA), which is the best test currently available today. This allows us to accurately diagnosis the condition of our patients, which is the first step in creating a personalized work plan and working towards a full body and metabolic optimization.

Similarly, it is important to prevent all harmful changes that the menopausal hormone deficiency conditions may cause by using bioidentical hormone replacement therapy. By implementing suitable training and nutrition plans alongside advanced nutraceutical supplementation and returning the patient to a more functional hormonal balance, we can mature healthily and delay aging.

BIBLIOGRAPHY

(1)Banack, H. R., Wactawski-Wende, J., Hovey, K. M., & Stokes, A. (2017). Is BMI a valid measure of obesity in postmenopausal women? Menopause (New York, N.Y.).

(2) Vasan, S. K., Osmond, C., Canoy, D., Christodoulides, C., Neville, M. J., Di Gravio, C., et al. (2017). Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk. International Journal of Obesity (2005).

(3) Al-Safi ZA, Polotsky AJ. Obesity and menopause. Best Pract Res Clin Obstet Gynaecol 2015.

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In the US they have been using growth hormone as part of Hormone Replacement Therapy for decades as their low plasma levels are associated with greater morbidity and mortality.

Although the Growth Hormone is often referred to in a frivolous way due to its association with Hollywood celebrities, the truth is that it has numerous beneficial effects on patient health: from reducing body fat, improving cardiovascular risk biomarkers and hydrocarbon metabolism, improving muscle strength, preventing sarcopenia or loss of muscle mass to improving the quality of sleep and quality of life.

Neolife medical management

The Growth Hormone (HGH, Human Growth Hormone) is currently fashionable amongst Hollywood celebrities, as well as amongst the wealthy elite in the US. Next, we will answer some of the most frequently asked questions about hormone therapy using HGH.

According to an article published in Vanity Fair, HGH makes you feel ten years younger and gives you more energy and charisma than you had before. You feel great with less grey hair and better looking skin. Is this true?

The article in Vanity Fair, like most articles in the general press that attempt to discuss such subjects, makes repeated references to the frivolous aspect of such treatment and talks of Hollywood actors and other exclusive elite and the restrictions regarding use but does not accurately explain that a person will not feel 10 years younger, or feel more charismatic or even stop having grey hair simply from use of the hormone.

However, it is true that some of the symptoms cited above are linked to the growth hormone, and many have been described as improvements in the well-being and quality of life questionnaires contained in the scientific literature. But it is important for this reason that we accurately describe the positive effects in scientific literature and not simply to the personal experiences of a select number of actors.

So, if it is not an elixir for rejuvenation then what use is the growth hormone?

In the US, there are already many people who use the growth hormone, but not as a means to rejuvenate themselves, but to maintain physiological functions associated with this hormone that would otherwise disappear in later life without the hormone.

It is important to remember that HGH declines sharply between the age of 20 – 30 and then declines at a slower pace of 2% per year thereafter. This means that between the ages of 30 and 50 an individual may suffer a declined of up to 40%.

How can you tell if you have a hormone deficiency?

By undertaking a stimulation test to determine the secretion levels. An insufficient level may suggest, along with a certain symptomatology (tiredness, weight gain, sleep disturbance, inability to exercise etc.), an adult growth hormone deficiency.

On the other hand, to determine the plasma level it is necessary to use IGF-1 as it is used to mediate levels of growth hormone in the body. The value of IGF-1 in the body typically peaks during puberty and adolescence and declines sharply during the subsequent 10 years. From an Age Management Medicine perspective the goal is to ensure that this biomarker is maintained above 200 ng/mL at any time of life.

What are the consequences of taking HGH?

The consequences of use, if correctly prescribed, are positive.

A prospective study regarding its use over a 10 year period and published in the J Clin Endocrinol Metab in 2007, listed the following effects: reduction in body fat, improvement in biomarkers related to cardiovascular risk and hydrocarbon metabolism, improvement in muscle strength, prevention of sarcopenia (or loss of muscle mass), improvement to sleep quality and quality of life. There are many other studies that have related low levels of this hormone with a greater morbidity-mortality rate.

Conversely, as with any other medical treatment, if it is not properly prescribed it can have adverse effects on an individual’s health. The replacement of hormones must be adjusted and monitored for each patient in small doses of between 0.2 and 0.6 mg/day to avoid the most common side effects such as edema, arthralgia, myalgia or hyperisulinism. For those concerned about cancer, growth hormone is not carcinogenic. The Vence article published in the New England Journal of Medicine in 1999 concerning treatment using HGH in children and adults documented that their cancer incidence was lower than that of subjects who had not received treatment with HGH.

One of the benefits of HGH is that it helps those who want to lose weight. What is the reason for this?

Growth hormone stimulates the carbohydrate metabolism and improves sensitivity in the insulin receptors. The hormone also increases lean mass and as a result raises basal metabolism. All of these combine to decrease fat mass.

Those who defend their use argue that if it has not been shown to be harmful to children then the same can be implied for treatment on adults…

It is an argument that is not without some support from a physiological perspective. If you treat children who are under-height (short stature) for years in order to achieve an increase in their final size which amounts to a couple of centimeters and you accept the very high costs associated with the treatment without adversely affecting the child’s psychology then one would argue why not treat an adult with the same hormone who presents with less than 50% of the levels he once had in his youth? The answer could be because treatment in adults often causes side effects that are not present in children. But this is not accurate. It is moreover a matter of administrative approval: can you imagine if everyone asked for their daily dose of growth hormone from the age of 50?

The reason that the growth hormone is not prescribed to adults is because ageing is not viewed in the same way as growing, but is it not the case that ageing is a disease?

Indeed it is. The debate about whether or not ageing is a disease is thriving and growing as the molecular causes of ageing become known. At present the advances in science are far ahead of our ability as humans to “digest” such information and assimilate the information into our lives. There have always been voices which rise up against the great discoveries in science: penicillin, blood transfusions, oral contraceptives, organ transplants etc. and now we are in the next phase where we are making advances in the prevention of diseases related to ageing. Until now such diseases were cured when they appeared, in the near future they can be prevented in advance. This does not mean that they will not appear in the future but that they will appear much later. For example, it is known that instances of cancer will increase due to the ageing population, but more and more of said cases will be cured by medicine.

As Dr. María Blasco (director of the CNIO) has explained by treating ageing we are treating all diseases related to ageing at the same time.

Treatment with HGH is very expensive (around $15,000 per year), which is why it is often associated with wealthy people. What is the reason for the cost?

The high price is due to the manufacturing process – it is manufactured using genetic engineering and requires a large investment in research and development to produce the end-product. Furthermore, the prohibitive cost is fueled by the limited number of approved therapeutic treatments available, which means that there is little competition on the market, about 4 or 5 pharmaceutical companies in total manufacture the hormone.

Unfortunately the high price has been taken advantage of by opportunists who promise creams or pills online that supposedly boost natural production of the hormone.

Whilst this is possible, there is no scientific evidence in support of such products. However, it is possible to modulate this hormone with exercise and diet in a natural way simply by changing your lifestyle.

 Can this type of hormone therapy be carried out in Spain?

In Spain it is not yet possible to acquire growth hormone, except in limited circumstances approved by the Ministry of Health. At present this applies to cases involving children of short stature (growth defects) and severe adult growth deficiencies.

Does this prohibition make it illegal to buy growth hormone in Spain?

You may have noticed that the hormone appears frequently in the news due to some clandestine operation but this tends to be related to the use of growth hormones in gymnasiums and as part of wider doping operations in competitive sports. These stories are unrelated to the use of HGH in Hormone Replacement Therapy as a means to maintain physiological functions.

La entrada Growth hormone: Myths and realities se publicó primero en Neolife.

Bioidentical hormone replacement therapy using testosterone has been shown to improve premenopausal and postmenopausal symptoms in women.

According to the study, the implant of subcutaneous testosterone pellets which contain a personalized dose can significantly improve all the symptoms related to androgen deficiency, such as insomnia, depression, anxiety, fatigue, headaches, hot flushes, decreased libido, joint and bone pain, memory loss and vaginal dryness.

Neolife medical management

Bioidentical hormone replacement therapy using testosterone in women, the great unknown

There are hundreds of scientific articles that further support the effectiveness of Bioidentical Hormone Replacement Therapy (BHRT) as a means to help prevent diseases and maintain a high quality of life as we age. That being said, the use of BHRT is still not widespread amongst the population and health professionals, for a number of different reasons, not all of which are strictly scientific. However, there is a growing demand for hormone replacement therapy using bioidentical hormones and an ever increasing number of doctors who are interested and trained in their proper prescription. In general terms, bioidentical hormone replacement therapy in women focuses on the use of estradiol and progesterone (female hormones), and testosterone is used in male cases. However, testosterone is also a very important hormone in women with numerous beneficial effects.

Dr. Rebecca Glaser is a surgeon who specializes in breast cancer yet at the same time she is one of those doctors who remain passionate about the need to prevent disease, improve the quality of life of their patients and avoid surgery to the greatest extent possible. To further this goal, she has developed research, together with Dr. Constantine Dimitrakakis, which focuses on treatment with subcutaneous pellets (granules) of bioidentical testosterone in healthy premenopausal and postmenopausal women and women with breast cancer.

Testosterone levels in women decrease from about the age of 25, so by the time a woman has reached the age of 40 the plasma levels are approximately half of those that she once had in her 20s. Such decrease in hormone levels can be attributed to numerous symptoms and signs of the ageing process such as decreased vitality, mood disorders (irritability, sadness, anxiety etc.), permanent tiredness, decreased libido, hot flushes, decalcification of bones, loss of muscle mass and strength, increase in fat weight, memory loss and disturbances to the sleep-wake cycle. Notwithstanding the above it is arguably true that many of these symptoms also occur years before the menopause and may be due to decreased levels of testosterone in the body (and not the decline in estradiol which is often associated with the menopause).

Testosterone treatment in women has been shown to significantly improve menopausal symptoms, including: hot flashes, sleep disturbances, depression, fatigue etc.

The subcutaneous testosterone implant produces general improvements, both psychological, physical and urogenital in premenopausal and postmenopausal women. The study published by Dr. Glaser in the Maturitas journal ⁽¹⁾ analyzed the effect of testosterone on the following aspects:

1. Hot flushes and sweats.
2. Cardiac discomfort, such as palpitations, strong heartbeat, tightness in the chest.
3. Disturbances to the sleep-wake cycle.
4. Sad or depressed state, changes in mood.
5. Irritability.
6. Anxiety.
7. Physical and mental fatigue (loss of memory and inability to concentrate).
8. Sexual problems, decreased libido, performance and sexual satisfaction.
9. Bladder problems, such as incontinence or increased frequency of urination.
10. Vaginal dryness and dyspareunia (pain).
11. Joint and muscle discomfort.

All of these questions can be found in the scientifically validated questionnaire, the MRS (Menopause Rating Scale) and the participant responses were quantified from 0 to 4 in accordance with the following criteria:

1. nothing
2. mild
3. moderate
4. severe
5. very severe

This questionnaire was provided to 300 premenopausal women (one third of the total group) and postmenopausal women before and 12 weeks after the implantation of a subcutaneous testosterone pellet which includes a personalized dose for each woman. All of the participants had some form of prior symptom often related to anandrogen deficiency (or testosterone) such as insomnia, depression, anxiety, fatigue, headaches, hot flushes, decreased libido, joint and bone pain, memory loss and vaginal dryness. Premenopausal women were shown to present to the doctor with more problems focusing on the psychological aspect (questions 4, 5, 6 and 7) whereas postmenopausal women intend to discuss their physical symptoms (questions 1, 8, 9 and 10).

At 12 weeks all values provided in relation to the 11 questions had shown signs of very significant changes in both premenopausal and postmenopausal women. For example, the average value provided in response to the third question (alterations to the wake-sleep cycle) reduced from a mean of 2.43 (between moderate and severe); treatment fell to 0.69 (between nothing and mild) but at the 12 week post-implant monitoring; question 7 (physical and mental fatigue) went from 2.58 (moderate-severe) to 0.89 (nothing-mild), and so on with all the others. We recommend that you record the mean of the sum of the 11 responses prior to treatment of all the women who contributed a value of 21 – what happened to being a 6.8 at the 12 week check up,

An extremely important aspect of this study is that the symptom(s) should be treated and not solely the plasma value in testosterone. The value of plasma testosterone does not correlate with the incidence and severity of the other symptoms.

This study includes a larger number of patients and a follow-up time which is due to provide results in the future as time passes. At the time this study was published no adverse effects had been documented across any of the 1,200 women treated with more than 7,000 testosterone pellets over the 5 year period.

Neolife, specializes in Anti-ageing Medicine, and is a pioneering clinic in Spain renowned for the implantation of testosterone pellets in women for the treatment of symptoms related to androgen deficiencies and our attempts to improve the quality of life of our patients.

BIBLIOGRAPHY

 (1) Glasser, R., York, AE, Dimitrakakis, C. “Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale (MRS)”. Maturitas, 2011 Apr; 68 (4): 355-61

La entrada The benefits of testosterone treatment in women se publicó primero en Neolife.