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Are your menopause symptoms caused by low testosterone?

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I’ve written previous posts on menopause, but this is a topic I do want to address as little has been written about it.

Back in 2013, I was struggling post menopause. I’d officially hit menopause (over a year since menstruation). I was studying post grad, advanced topics in micronutrients.

Here is what I noticed:

Memory problems: I’d keep forgetting where I put my car keys or my glasses. (That is definitely not me). I struggled to hold a lot of concepts and facts in my mind while writing an assignment. I couldn’t remember things I’d just studied. It was though my brain had sprung leaks and information that should be staying in just fell out. My brain felt fuzzy, unusual for me. (Image source)

State of mind, mood: I felt somewhat pathetic, my motivation decreased, I just lacked oomph.

Libido: Decreased

Strength: I was going to the gym and lifting weights but my strength seemed to be decreasing. I expected it to at least stay the same.

Weight gain: More specifically an increase in fat around my trunk, waist size was up 3- 4 cm and difficult to shift.

I happened across this Huff Post article, and immediately felt I’d found someone who was experiencing what I was – and they used supplemental testosterone which sorted it out. Is Low Testosterone Adding to Your Menopause Miseries?

I did a bit more research – this time on PubMed. In this study, the authors state “Testosterone plasma levels correlate to depression in a parabolic curve: at about 0.4-0.6 ng/ml plasma free T a minimum of depression is detected. Lower levels are related to depression, osteoporosis, declining libido, dyspareunia and an increase in total body fat mass.”

In another paper those women who had  surgical menopause “are among the populations most likely to experience T deficiency, a syndrome characterized by blunted or diminished motivation; persistent fatigue; decreased sense of personal well-being; sufficient plasma estrogen levels; and low circulating bioavailable T (either a low total T/sex hormone binding globulin (SHBG) ratio or free T in the lower one-third of the female reproductive range); and low libido. Exogenous estrogen, particularly when administered orally, increases SHBG, which, in turn, reduces free T and estradiol (E2).” (This suggests that supplementing with estrogen may make the free testosterone lower.)

When I had my levels tested – here is what they came back as:

11 Nov 2013, Testosterone
Testosterone:    < 0.4 nmol/L ( ideal: 0.5 – 2.6 ) LL
In other words too low to be measured.

I got a prescription for testosterone cream and started using it. That helped so much – I felt normal again in 3 weeks.

I continued using it for a year or so, and after that I tapered off, it seemed I just didn’t need it anymore, and I felt like my levels were too high. Sure enough they tested above ideal. My levels had come up. Recently they measured at 0.8 nmol/L (with no supplementation). Without testing I knew they were okay – my strength is increasing, my memory and everything else feels pretty much normal.

Memory loss in peri and early menopause is typical for many women, however this is temporary and memory improves again. Working memory in particular is affected, and this explains why things did not stay in my brain. Sadly my study at the time was affected, and I got my lowest mark ever for a post grad paper. I’m happy to report the memory loss was temporary Menopausal women ‘suffer from temporary loss of memory’, study finds. Once my working memory came back and I adjusted some of my study habits to accomodate the change in how my brain worked, I finished post grad with grades I was happy with.

It appears that the testosterone drop is temporary for some women. This graph is interesting – it shows DHEA levels dip and then increase again – DHEA converts to testosterone (reference The relationship of circulating dehydroepiandrosterone, testosterone, and estradiol to stages of the menopausal transition and ethnicity.) 

According to this article in the post menopause time testosterone can actually increase (no references given for this statement though). “Menopause (between ages 50 and 60). By the time women are experiencing the full-blown effects of menopause, hormones such as estrogen and testosterone have been significantly depleted. As the body produces less estrogen, testosterone production can sometimes increase.”

However in this study hair loss is associated with increased androgen to estrogen ratio.

Testosterone is not the only hormone that affects muscle strength; progesterone, but not estrodiol supplementation post menopause also increases muscle mass. ( Testosterone and Progesterone, But Not Estradiol, Stimulate Muscle Protein Synthesis in Postmenopausal Women)

Skeletal muscle protein fractional synthesis rate (FSR) in postmenopausal women during basal, postabsorptive conditions before and after no intervention (control) or treatment with T, estradiol, or progesterone (top) and the treatment-induced changes in FSR in each group (bottom). Data are mean ± SEM. *, Value significantly different from corresponding value before treatment (P < .05); †, value significantly different from corresponding value in the control group (P < .05).

I’ve not tried progesterone supplementation, and my progesterone does measure low, so as yet this is untested for me. If I were to try it, I would use bio-identical hormones.

So if you are suffering through uncomfortable menopause symptoms, and you have symptoms associated with low testosterone, get tested for all 3 hormones; testosterone, progesterone and estrogen, and supplement if your health professional recommends that. Use bio-identical hormones if you do. Let me know how you respond.

And thank you all for your feedback in previous menopause posts, it is useful to hear of other recommendations and N=1 experiments.

Julianne

2 COMMENTS

  1. It is interesting to see that, in many women, DHEAS levels temporarily rise at the beginning of menopause and then return, when menopause is established, to their early-perimenopausal levels.

    A 2012 study’s abstract says,
    “It is now recognized that mean circulating dehydroepiandrosterone sulfate (DHEAS) concentrations in most midlife women exhibit a positive inflection starting in early perimenopause, continuing through early postmenopause and returning to early perimenopausal levels by late postmenopause.
    This rise in mean DHEAS is accompanied by concomitant rises in testosterone (T), dehydroepiandrosteone (DHEA), and androstenedione (Adione) and an equal rise in androstenediol (Adiol). These observations suggest that there is a specific relationship between the circulating levels of steroids emanating from the adrenal glands, declining ovarian function, and the stages of the menopausal transition.”
    https://www.ncbi.nlm.nih.gov/pubmed/22415570

    An article from the following year states,
    “Observations over the past decade using longitudinal data reveal a gender-specific shift in adrenal steroid production. This shift is represented by an increase in the circulating concentrations of delta 5 steroids in 85% of all women and is initiated only after the menopausal transition has begun.
    While the associated rise in the major adrenal androgen, dehydroepiandrosterone sulfate (DHEAS), is modest, the parallel rises in dehydroepiandrosteone (DHEA) and androstenediol (Adiol) are much more robust.
    These increases in circulating steroid concentrations are qualitatively similar on average between ethnicities but quantitatively different between individual women. Both circulating testosterone (T) and androstenedione (Adione) also rise concomitantly but modestly by comparison.
    This phenomenon presents a new and provocative aspect to the endocrine foundations of the menopausal transition and may provide important clues to understanding the fundamentals of mid-aged women’s healthy aging, particularly an explanation for the wide diversity in phenotypes observed during the MT as well as their different responses to hormone replacement therapies.”
    https://www.ncbi.nlm.nih.gov/pubmed/22415570

    It is interesting how much it varies according to ethnicity (see the second chart here):
    https://www.ncbi.nlm.nih.gov/pubmed/21961714


    In my case, my pattern does not follow the typical experience at all.

    Due to stage 4 endometriosis and large ovarian cysts, I had abnormally-high levels of estrogen (a higher number than the menstrual-cycle chart on Wikipedia even allowed for) for years, with normal levels of testosterone, but my DHEA results were always extremely low — lower than normal, the level of an 85 year old woman instead of a woman in her 30s and 40s.

    I look at the chart here of the average DHEAS levels in menopause, with people scoring in the hundreds both before and after menopause, while my DHEAS level is around ten (10)! Less than 1/10th of the normal woman of my age. And I’m still menstruating, my BMI is about 22, etc.

    Even though my DHEA has been abnormally low, and has been getting increasingly lower, for years (ever since it’s been measured by doctors), my testosterone is still in the normal range — so there isn’t a direct correlation of those two levels, in every woman.

    And that was also the case for years before I started using 1/4th teaspoon a day of progesterone cream, which I have done for the past year and a half (so my DHEA-testosterone relationship, or the lack of relationship!, was not confounded by any external hormone treatment).

    I finally was allowed to have surgery to remove my large ovarian cysts and the bulk of the endometriosis, which brought my estrogen levels down to “normal” levels (even though the endometriosis and large ovarian cysts grew right back after my surgery), so even with my estrogen in the normal range currently, the other hormones are at the same levels that they have been for years – DHEA very, very low, testosterone normal, LH and FSH normal.

    My energy level is terrible, motivation nil, and it’s not because I don’t *want* to have energy and motivation, it’s just like I’m pressing on a car’s gas pedal as hard as I can but it’s not moving because the tank is empty. You can push all you want on that pedal, but if there’s no gas, the car is gonna sit there unless you push it manually from the back, and that’s what I’ve been doing with myself for the last 15 years, getting out and pushing manually (metaphorically) in order to go a few feet forward, and it is hard. A few years ago I had to cut back on even doing that because I’m simply out of steam. It’s frustrating and embarrassing that my energy level is so low.

    With the permission and interest of my (good) gynecologist, after with the insulting disinterest of my (now-former) endocrinologist, I did a self-experiment where I tried to take supplemental DHEA (which is available over the counter from supplement manufacturers in the US, though in most countries it’s prescription-only, so that’s why it was a “self-experiment” because I obtained it myself and decided how much to take myself). I did a lot of research on my own, and decided to take it at a very low dose — just half of a 5 mg pill (which is 2.5 mg, of course) per day.

    2.5 mg is a really low dose. (My endocrinologist had said that nothing under 50 mg a day would even register in my body, and he felt that no amount, even over 50 mg, would do much for me.)

    I just wanted to see if I could increase my DHEA to the very minimum of the “normal” range for my age, which I think was between 35 and 300, or something like that (and I was at around 10). I didn’t want to go win a weightlifting competition or whatever!

    Well, I never got a chance to find out how much the 2.5 mg affected my blood level of DHEA/S, because within a week, it had made me develop male-pattern beard-type growth on my face – on my chin, upper lip, cheeks beside my nose, sideburn area – which I had never had in my life before then. It was not the outcome I had been looking for with the supplemental DHEA and I certainly didn’t expect such a low amount to cause such sudden masculinization for me. It was difficult.

    It’s still an issue, because 2 years on from that, although the unwanted male-pattern facial hair growth has reduced a lot, it’s still there, and I have to shave my face with an electric razor every once in a while. My gynecologist, whom I saw a few weeks after that, who agreed with me that my facial hair had never looked like that before in the years that she had been my doctor, and who agreed that it was the result of the tiny amount of DHEA that I took for only 1 week because nothing else in my life had changed in the month since I’d last had an appointment with her, said that it can take a very long time for the hair follicles to recover from something like that, if they ever entirely do.

    What has also happened since then is that some basic, normal vitamin and mineral supplements I used to take without any issues have noticably started the beard-type of facial hair growth to rapidly return (like the hair follicles enlarge, the pores get bigger, the hair strands stiffen and thicken, my skin in those areas gets red and rough, my facial skin gets more oily all over, my forehead develops acne pimples, and suddenly I have whiskers, all after a couple of days of taking a small amount of these things – it is extraordinary), and I’ve had to quickly cut them out of my supplement routine. The top offenders for rapidly re-energizing the male-pattern beard growth that was first created by the DHEA have been the B-vitamin biotin, the B-vitamin pantothenic acid (B5), and the mineral silica/silicon.

    I don’t take biotin or silicon in supplements at all now, and I have learned that I must avoid bottled mineral waters that are naturally very high in silicon (such as Fiji water from Fiji and Gerolsteiner from Germany).

    I do take a small amount of B5 still, because I don’t want my other B vitamin intake to be imbalanced — I take a moderate amount of most of the other B vitamins due to my MTHFR genetic variations (and general lack of energy etc.)

    After the beard-type of growth was calmed down for many months, because I was still so tired and hoped I could increase my DHEA another way, with the permission of my gynecologist I then tried a tiny bit of the hormone pregnenolone (which in the US can also be bought over the counter), knowing full well that it might just convert to whatever was fueling the male-pattern facial hair growth — and, yes, that is what it did only after a few days, so I stopped the pregnenolone immediately.


    Recently I was finally able to switch endocrinologists, and the new, much more open-minded one was happy to look into my abnormally low DHEA situation, and said that it can be a pre-warning sign of other sorts of adrenal trouble (naturally enough), but then the health insurance structure in my country changed in the late summer last year and my health insurance company shut down, so I had to get different insurance – it just became effective on Jan 1, and now I have to find a whole new set of doctors, call around and find out whose lists are not already closed to new patients, wait 4 months for the first new-patient appointments to be available in their schedules, get my medical records transferred over, and so forth.

    My experience is usually well outside the norm — I’m on a tail of most bell curves – like it or not, ha ha!,

    but from my experience, I would say that
    DHEA and testosterone levels don’t always track each other,
    some women don’t exhibit anything like the typical DHEA/S pattern shown in these menopausal-transition research studies,
    to be very careful if you are a female and are thinking of taking supplemental DHEA or pregnenolone,
    that even ordinary amounts of simple vitamins and minerals can power up male-pattern facial hair growth (if the ground for that has been prepped already).

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