Posts Tagged ‘adrenal glands’

Testosterone For Females: Is There A Role?

October 31, 2015

Andrew Siegel MD   10/31/15

Many of my recent entries have been male-oriented. It’s time to give the fairer sex some equal time.


(Above image entitled: Mujer culturista mostrando la musculación de la espalda y los brazos, author: roonb, created November 2007, no changes to original image, creative commons license 2.0, link to license:

Female sexual dysfunction (FSD) is a common condition that may encompass diminished desire, decreased sexual arousal, difficulty achieving orgasm and pain with sexual intercourse. The most prevalent issue is decreased or lack of sexual desire, now given the formal medical title: Hypoactive Sexual Desire Disorder (HSDD), although I prefer the less formal, non-medical version: “Honey, I’m not in the mood.”

Testosterone (T)—the key male sexual hormone—has a strong role in stimulating sexual drive in both men and women and has long been used to manage diminished female libido and other sexual issues, despite it not being approved by the FDA for this intent. It has been shown to improve libido, arousal, sexual pleasure and overall sexual satisfaction.

Testosterone In Women

Although T is the major male sex hormone, it is also vital in females, similarly to how estrogen is the key female sex hormone, but has important functions in males as well.  In pre-menopausal women, the ovaries and adrenals (those paired glands that sit atop each kidney) each produce about 25% of T, with the other 50% produced by muscle and fat cells. The two biggest factors leading to a decrease in blood T levels are aging and menopause.

Pre-menopausal women produce about 0.25 mg T/day. (Men produce 6-8 mg T/day, about 25 times as much as females). Even after menopause, the ovaries continue to produce T.  Women who have their ovaries removed experience a dramatic decrease in T.

One of the major limitations of measuring T levels in females is the lack of reliable and accurate assays to precisely measure T levels at such low concentrations. Another shortcoming is that there is no concensus on what precisely is the lower level of T in females.

Symptoms of low T in females may include diminished libido, fatigue, lack of energy, decrease in well being, impaired concentration, depression and difficulties with arousal and orgasm. These symptoms of low T are very non-specific and have quite an overlap with the symptoms and changes that accompany normal aging, insufficient or poor quality sleep, overworking and/or an unhealthy lifestyle. Signs of low T in females are decreased muscle mass, increased body fat, thinning hair and bone wasting (osteopenia).

Decreased Female Libido

This is defined as absent or reduced interest in and arousal from sex, erotic thoughts, fantasies, or written, verbal, and visual cues.  There is usually a reduction in initiation of sex and reception to partner’s initiation attempts. When sexual activity does occur, there is often absent or reduced sensation (both genital and non-genital), excitement and pleasure. Although low T is an important cause of decreased sex drive, there are many other competing causes including other sexual issues such as pain with intercourse or inability to orgasm, medical diseases, medications, unhealthy lifestyle, fatigue, pregnancy, breast-feeding, menopause, boredom, stress, many other psycho-emotional factors and relationship issues.

Treatment Options

T has been shown to improve sexual function in both pre-and post-menopausal women. Testosterone replacement therapy (TRT) should only be a consideration after other causes of diminished libido have been eliminated.  It is challenging to predict which women will respond best to T therapy. Another concern is the safety and potential side effects with the long-term use of TRT.

There are currently no FDA-approved TRT products for women in the USA, so any usage is off-label. Products designed for TRT in males are available in a variety of preparations, including skin patches, gels and creams, buccal (gum) preparation, nasal gels, injections and long-acting pellets implanted in fatty tissue. Common side effects of TRT include unwanted hair growth, acne and mood or personality changes.

Addyi (Flibanserin) is a new oral medication for diminished libido.  It is currently being marketed largely to females, but is purportedly effective for both genders. It is the first FDA- approved prescription for diminished sex drive and has been referred to as “pink Viagra.” It is not TRT, but works centrally by affecting serotonin levels. It just became available this month.

Excellent reference on this subject: Khera, M. Testosterone Therapy for Female Sexual Dysfunction. Sex Med Rev 2015;3:137-144

Wishing you the best of health,

2014-04-23 20:16:29

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Tainted By Testosterone: The Ultimate Double-Edged Sword

August 10, 2013

Andrew Siegel, MD  Blog #115

Many brilliant men have experienced their demise and downfall that can be explained in part— perhaps a large part—by a potent hormone known as testosterone, or more commonly as “T.” Bill Clinton, Elliott Spitzer, Anthony Weiner, John Edwards, Mark Sanford, Arnold Schwarzenegger and San Diego Mayor Bob Filner are all members of the “tainted by testosterone (TBT) club,” who have sustained career derailments partially attributed to the powerful effects of this chemical produced by the testicles and adrenal glands.  Aside from these well-known political celebrities, many a lesser-known man—just your average Joe—has similarly succumbed to the influence of T and joined the TBT club.

The nickname “T” has become very much in vogue these days. Many of my patients come into the office specifically asking for me to check their T levels—thank you, America Pharma.  The pharmaceutical industry is largely responsible for increasing grass-roots awareness of testosterone issues via direct-to-consumer advertising and promotion of testosterone replacement products. Once a subject that was primarily the domain of urologists and endocrinologists, T has gone mainstream.

What exactly is this powerful chemical that can have such a profound influence on a man’s behavior?  Many of us who enjoy the company of canine friends can attest to the dramatic change in behavior of our male pets after they are “fixed” by surgical castration. Man’s best friends become less aggressive, more docile, less alpha male, and less likely to hump your guest’s leg.  The term “fix” seem to imply that something was broken.  Extrapolate to human beings and one can understand how, when our brains are bathed in T, our thoughts, behaviors, and actions are influenced and modulated.

T—manufactured primarily in the testicles although a small percentage is made by the adrenal glands—is an all-important male sex hormone that goes way beyond male sexuality.  T is regarded as a key element in driving and maintaining men’s health. Current evidence suggests that a man’s testosterone level might serve as a very good indicator and marker of general health.  Aside from contributing to libido, masculinity and sexual function, T is responsible for all of the physical changes that occur at the time of puberty, including pubic, axillary and facial hair, deepening voice, prominent Adam’s apple and increased bone and muscle mass.  Additionally, T contributes to mood, bone and muscle strength, red blood cell count, energy, and general mojo.

T is nothing short of being a drug with profound psychopharmacological effects. One can appreciate the potency of this powerful chemical simply by observing the physical, emotional, and libidinal changes that result in the transition from “little boy” pre-pubertal status to “big man” post-pubertal status. Not in any way to diminish the role of environmental factors that most certainly play a role, T is the difference between the little boy in the backyard playing with the toy soldier and a water pistol and the little girl on the porch playing with her dolls and jacks.  T is rocket fuel that can make a man all “piss and vinegar.”

T is most certainly a double-edged sword—on the one hand, it is essential for male health and masculinity, but at the same time it can drive our libido to the danger zone in which temptation and opportunity conspire, with potentially perilous results in terms of relationships, careers, lives, etc.  By no means am I implying that this hormone is solely responsible for man’s impulsiveness, improprieties and indiscretions, but it unquestionably plays a significant role.  Assuredly, “It wasn’t me, it was my T” would be an unsatisfactory justification of the behaviors of Clinton, Spitzer, Weiner, Edwards, Sanford, Schwarzenegger and Filner.  However, the role of T cannot be discounted and helps explain the biochemical basis of male behaviors.  If we treated the men of our species similarly to the way in which we treated our male canine pets by “fixing” them (I am not in any way suggesting this), then we most probably would not bear witness to the kind of career-slamming, self-destructive and life-disruptive indiscretions that have been such common occurrences.

Having a low T is clearly not a good thing.  We know this from observing two populations of men—those who have suffered the consequences of low T that has developed coincident with the aging process and those who are put on medications that purposefully lower T, usually for the management of prostate cancer. Most men will have an approximately 1% decline of T each year after age 30; however, this will not always be symptomatic.  40% of American men aged 45 or older have low or low range T.  Low T is associated with metabolic syndrome and diabetes, bone mineral loss, and altered sexual function.  Specifically, symptoms of low T may include one or more of the following:  fatigue; irritability; depression; decreased libido; erectile dysfunction; impaired orgasmic function; decreased energy and sense of well-being; loss of muscle and bone mass; increased body fat; abnormal lipid profiles; and more. Essentially, low T accelerates the aging process.

So, low T is bad and normal T can influence men to behave badly. Is it possible to find a balance between healthy masculinity and unhealthy philandering and other inappropriate male sexual behaviors?  I sure hope so.  For the record, I don’t really care what politicians do in their free time as long as they do their jobs well. Clearly, they face tremendous stresses and pressures and need outlets for release.  However, it certainly would be nice if they didn’t make such a public spectacle and so embarrass themselves and their families. One has to consider that the very potent chemical T plays a vital role in determining the powerful alpha-male personality that is so fundamental to political ambition and ascent. Unfortunately, it is the very same T that contributes to influencing men to behave badly and stupidly, ending up in sabotaging political intentions and, more importantly, causing their lives to spiral down into a freefall. As borne out by the activities and affairs of many politicians in power, T can be thought of as “fertilizer” for the penis and the very brain that governs and guides that penis.

For some men, T engenders a situation akin to walking around with a loaded shotgun that begs to be unloaded, and the longer it’s been since the weapon has been fired, the greater the need to unload.  T has undoubtedly played a major role and influence in terms of male aggressiveness, violence, homicides, destruction, power struggles, wars, and death that run rampant in our civilization.  Our male gender has been both blessed and cursed by this powerful chemical that is one of the drugs within our internal pharmacy.  The challenge is to use this drug responsibly.

Who Knew?  Many women claim that men think with their “little brains.” All joking aside, there is genuine scientific merit for this insofar as testosterone is a hormone that has many biochemical functions and effects.  Men’s brains are literally bathed in this hormone that can profoundly influence emotions, behavior and thoughts. As a Yiddish proverb from Phillip Roth’s ‘Portnoy’s Complaint’ stated: “Ven der putz shteht, ligt der sechel in drerd,” translated as “when the prick stands up, the brains get buried in the ground.”

Who Knew? The comedian Robin Williams famously said: “God gave every man a brain and a penis, but only enough blood to make one work at a time.”

Who Knew? Too many of us use our penises as our compasses, navigational instruments that give us “direction.”

Who Knew? The athletic “cup” is the device that provides protection to the male genitals for those participating in sports like baseball, hockey, soccer and boxing. The cup was devised years before the first protective helmet for one’s head was used.  This tells you where men’s priorities lie—big head/little head!


Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

The Who Knew?  quips are from my forthcoming book, Male Pelvic Fitness: Optimizing Sexual and Urinary Health (in press).

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