Are you one of the many people in Westlake who are burning the candle at both ends and maybe only getting 4 or 5 hours of sleep a night? Are you also one of those guys having problems with his sex drive and feeling out of sorts? Well, recent studies done in Westlake in the last 3 years show that these symptoms could all be due to the effect of sleep on testosterone – just how, though, may be a chicken and egg question!
While it’s true that lower testosterone levels can be the cause of a sluggish sex drive and irritability it seems to be a matter of research opinion whether low sleep levels cause low testosterone or low testosterone causes lack of sleep.
Are Low T-Levels and Poor Sleep Related?
There's a growing interest in testosterone hormone replacement for treating symptoms related to aging. You've probably seen advertisements of virile, muscle bound men in their 60's and 70's.
Along with the growing interest there's also a growing amount of information. But much of it is anecdotal stories, misleading data and flat out, unproven myths. Especially as it relates to testosterone replacement therapy for women.
The fact is that medically administered, testosterone therapy is also used to successfully treat symptoms of hormone deficiency in pre and postmenopausal women. And two physicians-Dr. Rebecca Glaser and Dr. Constantine Dimitrakakis-are dispelling the misinformation about it through scientific research.
Dr. Glaser and Dr. Dimitrakakis focus on subcutaneously implanted, bio-identical hormones (human identical molecule) and not oral, synthetic androgens or anabolic steroids.
With that in mind, here are the 10 myths of testosterone replacement therapy for women.
Myth #1: Testosterone is a "male" hormone
Although men have a higher circulating level of testosterone than women, from a biological perspective, men and women are genetically similar. Both sexes include functional estrogen and androgen (testosterone) receptors. And while estrogen is popularly considered the primary female hormone, throughout a woman's lifespan, testosterone is actually the most abundant, biologically active hormone with significantly higher levels than estradiol. And as early as 1937, testosterone therapy was reported to effectively treat symptoms of the menopause.
Myth #2: Its only role in women is sex drive and libido
There's a lot of hype about testosterone's role in sexual function. But in reality, it's a fraction of the overall physiologic effect testosterone plays in women. That's because testosterone governs the health of almost all tissues including the breast, heart, blood vessels, gastrointestinal tract, lung, brain, spinal cord, peripheral nerves, bladder, uterus, ovaries, endocrine glands, vaginal tissue, skin, bone, bone marrow, synovium, muscle and adipose tissue.
The function of these tissues declines as testosterone declines. The result of this deficiency in both men and women includes dysphoric mood (anxiety, irritability, depression), lack of well-being, physical fatigue, bone loss, muscle loss, changes in cognition, memory loss, insomnia, hot flashes, rheumatoid complaints, pain, breast pain, urinary complaints, incontinence as well as sexual dysfunction. And just like for men, these symptoms are successfully treated in women through testosterone therapy.
Myth #3: It masculinizes females
Testosterone therapy has been safely and successfully administered in women for over 76 years. Rather than decrease a woman's femininity it increases it. Testosterone stimulates ovulation, increases fertility and safely treats the nausea of early pregnancy without adverse effects.
Sure, large doses of supra-pharmacological synthetic testosterone are used to treat female to male transgender patients to increase male traits like body hair. But this requires high doses over an extended period of time. Even then, true masculinization is still not possible. And these effects are reversible by simply lowering the dosage.
Myth #4: It causes hoarseness and voice changes
Hoarseness is most commonly caused by inflammation due to allergies, infectious or chemical laryngitis, reflux esophagitis, voice over-use, mucosal tears, medications and vocal cord polyps. Testosterone possesses anti-inflammatory properties. There is no evidence that testosterone causes hoarseness and there is no physiological mechanism that allows testosterone to do so.
Although a few anecdotal case reports and small questionnaire studies have reported an association between 400 and 800 mg/d of danazol and self-reported, subjective voice 'changes' an objective study demonstrated the opposite.
Twenty-four patients received 600 mg of danazol (synthetic testosterone) therapy daily and were studied for 3 and 6 months. There were no vocal changes that could be attributed to the androgenic properties of danazol. These conclusions are consistent with a one year study examining voice changes on pharmaco-logic doses of subcutaneous testosterone implant therapy in women by Glaser and Dimitrakakis.
Myth #5: It causes hair loss
Hair loss is a complicated, genetically determined process and there is no evidence that either testosterone or testosterone therapy cause it. In fact, from a medical perspective, dihy-drotestosterone (DHT), not testosterone, is considered the active androgen in male pattern balding.
There are many factors associated with hair loss. For example, it's common in both women and men with insulin resistance. Insulin resistance increases 5-alpha reductase, which increases conversion of testosterone to dihy-drotestosterone in the hair follicle.
In addition, obesity, age, alcohol, medications and sedentary lifestyle increase aromatase activity, which lowers testosterone and raises estradiol. Increased DHT, lowered testosterone, and elevated estradiol levels can contribute to hair loss in genetically predisposed men and women. But so can medications, stress and nutritional deficiencies.
In studies conducted by Glaser and Dimitrakakis, two thirds of women treated with subcutaneous testosterone implants have scalp hair re-growth on therapy. Women who did not re-grow hair were more likely to be hypo or hyperthyroid, iron deficient or have elevated body mass index. And none of the 285 patients treated for up to 56 months with subcutaneous T therapy complained of hair loss.
Myth #6: It has adverse effects on the heart
On the contrary, there is overwhelming biological and clinical evidence that testosterone promotes a healthy heart. Testosterone has a beneficial effect on lean body mass, glucose metabolism and lipid profiles in men and women. It is successfully used to treat and prevent cardiovascular disease and diabetes.
Testosterone also widens blood vessels in both sexes, has immune-modulating properties that inhibit plaque and strengthens the cardiac muscle. It improves functional capacity, insulin resistance and muscle strength in both men and women with congestive heart failure.
Myth #7: It causes liver damage
High doses of oral, synthetic androgens (e.g., methyl-testosterone) pass through the digestive system, are absorbed into the entero-hepatic circulation and can adversely affect the liver. But subcutaneous implants and topical patches avoid the entero-hepatic circulation and bypass the liver. So there is no adverse effect on the liver, liver enzymes or clotting factors.
Furthermore, non-oral testosterone does not increase the risk of deep venous thrombosis or pulmonary embolism like oral estrogens, androgens and synthetic progestins. And despite the concern over liver toxicities with anabolic steroids and oral synthetic androgens, there are only 3 reports of hepa-tocellular carcinoma in men treated with high doses of oral synthetic methyl testosterone. Even the report of benign tumors (adenomas) with oral androgen therapy is exceedingly rare.
Myth #8: It causes aggression
Although anabolic steroids can increase aggression and rage, this does not occur with testosterone therapy. Even supra-pharmacologic doses of intramuscular testosterone undecanoate do not increase aggressive behavior. But as stated before, testosterone can aromatize to estradiol. And there is considerable evidence among species, that estrogens, not testosterone, play a major role in aggression and hostility.
However, in studies conducted by Glaser and Dimitrakakis, over 90% of women treated with subcutaneous testosterone therapy have documented decreased aggression, irritability and anxiety. And this is not a new finding. Androgen therapy has been used to treat PMS for over 60 years.
Myth #9: It may increase the risk of breast cancer
It was recognized as early as 1937 that breast cancer was an estrogen sensitive cancer and that testosterone acted as a counter balance to estrogen. Clinical trials in primates and humans have confirmed that testosterone has a beneficial effect on breast tissue by decreasing breast proliferation and preventing stimulation from estradiol.
However, some epidemiological studies have reported an association between elevated androgens and breast cancer. But these studies suffer from methodological limitations, and more importantly, do not account for associated elevated estradiol levels and increased body mass index. And the cause and effect interpretation of these studies conflicts with the known biological effect of testosterone.
Although testosterone is breast protective, it can aromatize to estradiol and have a secondary, stimulatory effect on the estrogen receptor. But when testosterone is combined with an aromatase inhibitor in a subcutaneous implant, it blocks testosterone from aromatizing.
This form of treatment has been shown to effectively treat androgen deficiency symptoms in breast cancer survivors and is currently being evaluated in a U.S. national cancer study. In addition, Dimitrakakis and Glaser see a reduced incidence of breast cancer in women treated with testosterone or testosterone with anastrozole implants.
Myth #10: The safety of testosterone use in women has not been established
Testosterone implants have been used safely in women since 1938. Any real concerns would be well established by now.
Long-term data exists on the successful and safe use of testosterone in doses of up to 225 mg in up to 40 years of therapy. In addition, long term follow up studies on supra-pharmacologic doses used to 'female to male' transgender patients report no increase in mortality, breast cancer, vascular disease or other major health problems.
Many of the side effects and safety concerns attributed to testosterone are from oral formulations, or are secondary to increased aromatase activity due to elevated estradiol. This effect increases with age, obesity, alcohol intake, insulin resistance, breast cancer, medications, drugs, processed diet and sedentary lifestyle. Although often overlooked or not addressed in clinical studies, monitoring aromatase activity and symptoms of elevated estradiol is critical to the safe use of testosterone in both sexes.
Adequate testosterone is essential for physical, mental and emotional health in both sexes. Abandoning myths, misconceptions and unfounded concerns about testosterone and testosterone therapy in women allows physicians to provide evidence based recommendations and appropriate therapy
Testosterone Replacement Therapy or a Testosterone Booster?
Menopause is a natural occurring process in aging women. It is the biological way of stopping the body's abilities to produce babies. Time has no mercy on anyone. Being natural, the actual menopause doesn't need any treatment; the drugs that are used, are used to treat symptoms and to help with some chronic conditions.
Studies made on a special kind of recent treatment have proven some interesting things. Hormone therapy has both benefits and side effects. Studies have shown that in certain women, the administration of different dosages of both estrogen and progesterone can increase drastically the chances of having a later heart attack or to even experience breast cancer. Studies on the women where quickly halted. Still, the actual fear was bigger of the side effects than it was supposed to be. Yearly, not even 10 of 10 000 develop these conditions as side effects, and they are under the treatment of several forms of estrogen and progesterone hormone therapy. Depending on many factors, doctors should prescribe the most correct and adequate hormone treatment for menopausal symptoms.
Low-dose antidepressants are also some of the drugs that are being used, mostly in combating hot flashes, fact witch they do very well. As with all drugs the side effect problem is very present: nausea and dizziness and even sexual dysfunction.
Another drug that has proven to do very well against hot flashes and nerve related pains and other chronic symptoms is a certain gabapentin, with roughly the same symptoms as in anti depressants. Pills or even patches may be used to reduce the blood pressure and again the all so common hot flashes.
A most severe problem in aging women, with menopause is the appearance of osteoporosis and the risks of fracture that it presents. Some different medication has been released to combat this but side effects do exist, in milder forms.
Vaginal problems have also been known to be distressful for women. For this purpose a variety of creams and tablets have been developed that administer vaginal estrogen to the specific area in small adequate dosages. Talking to the doctor to decide the best of treatments would be a very wise thing to do.
Knowing how to stay away from symptoms is a very important thing. It is best to know what are the causes that trigger the hot flashes and it would be a very wise choice to avoid them. For vaginal problems water based lubricants are god to be used. Relaxation and getting the right amount of sleep is an imperative thing. Exercising before bed time usually helps, or knowing different relaxing techniques. Staying healthy in general usually does a lot of help to the body because of the fact that you are giving him the right tools with hum to fight the disease. Exercising and having a healthy diet greatly increases chance of not having complications. A good daily workout also helps, the body having better way of dealing with problems.
Perimenopause Treatment - Beware of HRT
Are you one of those guys who are burning the candle at both ends and maybe only getting 4 or 5 hours of sleep a night? Are you also one of those guys having problems with his sex drive and feeling out of sorts? Well, recent studies done in the last 3 years show that these symptoms could all be due to the effect of sleep on testosterone - just how, though, may be a chicken and egg question!
While it's true that lower testosterone levels can be the cause of a sluggish sex drive and irritability it seems to be a matter of research opinion whether low sleep levels cause low testosterone or low testosterone causes lack of sleep.
Here's what we know about sleep, and testosterone to date as it relates to men:
After age 30, men's testosterone levels drop between 1 and 2% a year! By the time they reach 40 they start experiencing trouble sleeping. They complain of less deep sleep time, the period of sleep where the body repairs itself.
In fact, as a man gets older, the most recent studies assert, he can lose deep sleep time altogether! That means the older a man gets, the more his testosterone levels continue to decline, the less deep sleep he gets, the more his body's repair mechanisms decline and the higher his risk climbs for disease!
The reason for this decline in deep sleep time is thought to be due to a loss of neuron activity, which synchronizes brain activity. These neurons are responsible for about 20% of achieving deep sleep. They are intact in young men and get further scrambled as a man ages.
To further complicate things, low testosterone levels are thought to contribute to this loss of neuron activity in the brain. The take away of these studies, then, whichever perspective you come from, seem to say that restoring testosterone to healthy, youthful levels would likely help a man not only achieve deep, restorative sleep again, but also keep him healthier, re-invigorate his sluggish sex drive and keep him in a happier frame of mind.
Do You Have Symptoms of Low Testosterone?
One of the most frequent complaints I hear from my over-40 patients is that their sex drive has diminished significantly from when they were younger. One of the first things I do is to check a testosterone level and most often find that it is decreased. Interestingly, as well, is that they also often complain of not sleeping very much and are depressed!
Now whether their lack of sleep is from a too hectic lifestyle, stress, or from their decreased testosterone level, is not clear. However, when I recommend that they try to get between 6-8 hours of sleep a night their testosterone levels seem to naturally increase and their mood is brighter!
But decreased testosterone levels don't just affect men over 50, it can start as young as the 30-40's! Many men don't seek treatment because they think it's just a part of getting older and they're embarrassed to talk about it! Like menopause in women, low testosterone is not something men have to suffer through just because it's associated with getting older. Here are some other symptoms you may not associate with low testosterone levels:
•Emotional changes, like depression, irritability, "grumpy old man" syndrome
•Decreased muscle strength
•Loss of height
•Weight gain, especially belly fat
What Does Cause Low Testosterone?
Low testosterone levels can be caused or aggravated by a number of things both nutritional and environmental. For my patients who have lower than optimal testosterone levels, here are some other things I tell them to pay attention to in their diet and lifestyle:
•Xenoestrogens - in food and water supplies. These are "environmental estrogens" from soy products and plastics that get into our food and can decrease testosterone levels. Stay away from foods containing soy, most notably protein bars and soymilk. If you buy frozen foods, transfer them from their plastic container into a glass dish before heating.
•Lack of Protein - men need between 0.5 to 1 gram of high quality protein per pound of body weight per day to both build muscle strength and testosterone. Sources include pork, beef, and chicken, which also have higher levels of zinc, which is testosterone friendly.
•Lack of Cholesterol - many men over 40 are watching cholesterol intake for the sake of their arteries, but too little cholesterol will stop testosterone production. Aim for about 30% fat, mostly monounsaturated (nuts, olive oil) and some saturated (red meat, eggs) to build testosterone. Go very light, or leave out, polyunsaturated fats (fish, vegetable oils) as studies have shown they can decrease testosterone perhaps because they may contain xenoestrogens.
•Lack of Nutrition - zinc is a major building mineral for testosterone. The B vitamins, especially B1, B6, and B12 are helpful in keeping testosterone levels healthy. Be sure that your vitamin/mineral supplement includes these.
•Too Much Alcohol - alcohol increases blood sugar levels, which decreases testosterone. Limit to a few drinks per week.
•Lack of Sleep - as mentioned earlier, less than 6 hours of sleep a night can seriously rob your body of its repairing mechanisms and this includes the re-manufacturing of hormones like testosterone. See that you get at least 6-8 hours of sleep at night, more if you have been ill or under a lot of stress. Try some natural sleep aids like Valerian, calcium/magnesium supplements with some warm milk before bed. Cut back caffeine to not past 4 pm, and limit heavy meals to 2-3 hours before bedtime.
Researchers may finally decide which comes first; low testosterone then poor sleep, or poor sleep then low testosterone. In the meantime, I'm going to continue to counsel my patients that adequate sleep is at least a significant factor in low testosterone levels. However, before you start thinking dangerous steroids or prescription testosterone replacements, try the natural suggestions offered here. I believe your T-levels will be up to optimal levels and your sex drive and pleasant mood back on track in no time!
Mark Rosenberg, M.D.
Institute For Healthy Aging
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