#174: Should I Get Testosterone Replacement?

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Hi, I'm Dr. Tabatha, the Gutsy Gynecologist.

I'm a triple board-certified OB-GYN and functional medicine physician.

I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health.

After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall health. And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I wanna be your gutsy gynecologist. So welcome.

Should I be on testosterone treatment? That is a question from Pam out of New York City. She, it sounds like, is taking estrogen and progesterone. So that's a really good start. And she wants to know if she should be on testosterone as well, because she's reading that some women take testosterone. She's a little nervous. So that is a great question, and I will tell you testosterone is super important for us as women. If you look at the data, we actually have more testosterone than estrogen and progesterone. It's just that when you have it measured in the blood, the measurements are in different units, so estrogen looks Like there's a lot more than there is testosterone, but that's not true. Testosterone is actually very necessary for us women. Estrogen definitely is our growth hormone, stimulating the growth of the lining inside the uterus. It stimulates breast tissue growth. It stimulates fat growth around the hips, all of that necessary, important stuff for carrying babies and making babies and having babies and feeding babies. But like I've said a gazillion times, we have these hormone receptors all throughout our bodies. So it is not just about reproduction. And what we understand now is women who go into menopause continue or should continue to make these 3 sex hormones, not progesterone as much, but estrogen and testosterone a little bit more. After menopause in a healthy woman without any kind of medical conditions. That woman is very hard to find in this day and age because of all our, our environmental stressors and the crazy busy lives that we lead. So I'm sure you've heard me talk about this on the podcast a gazillion times about how all of this impacts our ability to make our sex hormones. So. Here's an important point: our ovaries make the majority of our sex hormones before menopause, but not all of them. Our adrenal glands—I point back because they sit on top of the kidneys toward our back—they're really small; they're like the size of walnuts or something. But they also make sex hormones; they make. DHEA, which turns into testosterone and estrogen. And so if you are very healthy going into menopause, when those ovaries stop producing, we find our backup ovaries, our adrenal glands, and we say, hey, keep making that estrogen and testosterone. And your adrenals do that until you die. That is how God created our bodies to function. But if you go into menopause with adrenal dysfunction, your adrenals are tapped out. They're not producing properly because you have led a very stressful life, whether that's emotionally stressful, physically stressful. It doesn't matter where the stress is coming from. If the stress is coming from running marathons, if it's coming from a job you hate, if it's coming from chronic gut infections or tooth root canal issues, or just absolute nutrition deficiency from eating the SAD diet, the Standard American Diet, any of those stressors, that's enough to cause your adrenal glands to not be producing efficient amounts of DHEA, testosterone, and estrogen. So you go into menopause, you say, hey, backup ovaries, start working. And they say, we got nothing left. We can't help you out. So you go into menopause in this totally depleted state and you really don't have any sex hormones. Not only are they low, but they're just gone. They're beyond low. So that is a really big deal that makes menopause so much harder and really sets in the disease processes and all the disease states. The cardiovascular system hardens, things start to shift. And when your arteries harden and your heart has to struggle to pump the blood through your body, your blood pressure goes up. And then sometimes your heart rate has to increase to pump through those harder vessels that no longer are elastic and pliable and functioning well because your hormones are so low. So you see blood pressure increase, you see your heart rate increase, you might get more headaches because of that cardiovascular issue. You start to see some bone loss, and the list goes on and on. So what we often recommend is hormone replacement therapy because your body is not making the hormones that you need. And so we standardly will give estrogen, even though it's still controversial in the medical world. They will sometimes agree and give that too. They have yet to adapt the practice of adding progesterone to keep that balance going, and they definitely are not on board with giving you testosterone replacement. As a conventional gynecologist, the only time I even tested testosterone levels were patients that I was worried had PCOS, polycystic ovarian syndrome, and who have high testosterone levels. So I was using it to rule out a disease, and that was pretty much the only time I was checking testosterone as a conventional gynecologist. But we now know there is a multitude of research and literature that shows women need their testosterone levels to be in balance, and definitely when they go into menopause. One of my girlfriends calls it the get shit done hormone. It doesn't give you just a sex drive, it gives you a drive for life. When your testosterone is in the toilet, when it's super low, you don't even want to participate in life. You just aren't interested in anything, not just sex. You're just not interested in life. You're like, whatever, I got to get through this day. I'd rather just sit on the couch or whatever. Testosterone is really important for you to be able to maintain your muscle mass and your muscle. That's like the biggest organ group that you have in your body. Your muscle maintains your blood sugar balance and your insulin balance, so it protects you from. developing diabetes and insulin resistance. It keeps your weight in check. It keeps you at an optimal weight. So if you want to lose weight or you want to keep your weight where it's at, you need good functioning, healthy muscle metabolizing your blood sugar and all of that. And you need testosterone to maintain your muscle mass. The cool thing is when you work your muscles, it helps you produce testosterone. So if you're working out and you're lifting weights and doing all that stuff, you're probably making testosterone unless you don't have the ingredients you need to make it. That's a whole nother episode. But some women are so depleted because of their stress, because of their chronic cortisol problems, that they are not making the testosterone they need, and therefore they need replacement. And once you get Get the testosterone that you need, then you can start to strengthen your muscles and get in the gym and have the energy and the drive to even do that, and that will help you make more testosterone. So it is a win-win. Testosterone is now being shown to decrease the risk of breast cancer coming back and metastases. There's a ton of research going on right now. They're giving testosterone therapy to breast cancer patients to study all of these outcomes. There's so much good research going on. Everything looks so promising that testosterone is beneficial for women. So you want those hormone levels to be up where they need to be, to be in balance. You shouldn't have to walk around with no testosterone. Okay, here's the other piece of it. DHEA is a precursor hormone. It's made from the adrenal glands, and that gets made into testosterone and estrogen. If your adrenals are not making DHEA, your anti-aging, keep you young and healthy hormone, you're going to have low testosterone and estrogen levels, especially after menopause. So we need to love our adrenals, stop being stressed out, get rid of all those stressors, and we might even need to replace our DHEA. We might not be making it because we've stressed our adrenals and they've said, we're done. We don't make these hormones anymore. We can't keep up with you for all the reasons we talked about. So DHEA is actually a supplement. Don't ask me. The FDA doesn't make any sense about any decisions they make. We just know that this hormone can be purchased as a supplement, whereas testosterone is a controlled substance that has to be gotten by a prescriber with a controlled DEA license. So from one extreme to the next, it's kind of funny. So if you can't find a provider to give you testosterone if you need it, And your DHEA level is not in the triple digits, you know, it's not 150 or 200, it's like 50, 70, something like that. You need DHEA. And just taking that might be all you need to make enough testosterone to feel better and have that drive again and to build your muscle mass and get back into the gym and enjoy your life again. I've had women who all I've given is DHEA, and they say I've given their life back to them. So it's pretty awesome. It's pretty cool. You can get a really small dose of five milligrams. I have DHEA Lift on my supplement store. Five milligrams—that might not be all you need. You might need ten or twenty-five. I have DHEA Lift Plus, which is twenty-five milligrams. If your DHEA levels, your DHEA sulf. Faded, S, is less than 100, give 25 milligrams a try. See how you feel. If you're really sensitive, start with 5 or 10 milligrams and see how you feel just taking that once a day earlier in the day. See what your energy's like. See if your drive is better, your motivation, your desire to go work out, participate in life. Be intimate with your partner, all of that stuff. It's amazing. It's such an incredible supplement that can give you your life back. So there is a workaround way to get back into balance. You don't just need a white coat with a prescription pad. There are solutions, and there are other doctors and providers out there who understand hormones. So if I can't help you or whatever, there are workarounds. So I hope this episode was helpful. Like, don't be afraid of testosterone. Don't be afraid of hormones. Hormones make you who you are. Hormones are our friend, I promise. Don't be afraid of hormones.