From the study “Testosterone for Women” We usually perceive anabolic and androgenic hormones only in the negative light of a doping affair or in the context of abuse of these substances by athletes. Unfortunately, many physicians still do not pay enough attention to these hormones, or do not use them even in cases where it would be appropriate. I recently came across a rather interesting study on testosterone and the female body published by Drs. Karlis Ullis and Josh Shackman on a medical server. It’s a study that looks at the use of hormones in post-menopausal treatment and in dealing with certain hormonal issues. This case study shows how these substances can help when used as medications under medical supervision.
In it, Dr. Ullis presents the case of a patient in her late twenties who had a seemingly trivial weight loss problem. Her problem seemed difficult to solve – she engaged in physical activity daily, her program consisting of aerobic and weight training exercises was balanced, her diet rational. All was well in this respect, according to Ullis. The woman was taking a combination of ephedrine and caffeine (this study dates from the time when ephedrine and caffeine were approved ingredients in fat burners in the US) and was also taking some weight loss medication. But nothing worked. Her hormone analysis showed no evidence of a low thyroid or any other problems – until Dr. Ullis focused on her testosterone levels. It was the only one that was extremely low. Dr. Ullis determined that this was the true cause of her problems.
Dr. Ullis points out that while the relationship of testosterone and low fat + increased muscle mass is already well known to athletes, in medicine this knowledge is often lacking and anabolic hormones are not used at all, even in clinical treatments where they could help. Especially in menopause the production of all hormones decreases, including testosterone, whose production can even stop completely. Many menopausal women today are already routinely given hormones such as estrogen and progestins, but no one has yet focused on giving testosterone. Due to the high levels of artificially administered estrogen and progesterone and the absence of testosterone, post-menopausal women can hardly get rid of body fat and the composition of the whole body changes in an unhealthy way.
Dr. Ullis wonders why the administration of testosterone to women is causing so much controversy, while estrogen, widely used by farmers to increase cattle weight, is routinely given to menopausal women whose risk of obesity increases with age? Many doctors refer to a 1997 study where women receiving estrogen were said to have lower weight gains than women taking no hormone. Ullis points out, however, that this study did not include an overall approach to physical activity.
Conversely, he points to studies that say women who take birth control pills (estrogen and progestin-based) gain an average of 1.5 to 3 kg of fat, and women who use oral estrogens after menopause can expect to gain 2.5 to 4 kg of fat tissue. A recent study (O’Sullivan et all, 1998) explains that administration of estrogens, or increased levels of estrogens, causes muscle loss and an increase in % fat by lowering IGF-1 levels in the body.
Ullis says that many doctors claim that it is testosterone that causes obesity. This is pointed out by studies done in women with higher natural testosterone levels in their bodies who develop a higher percentage of so-called male-type obesity (i.e., in the upper torso and abdominal area). Ullis points out, however, that pathologically elevated testosterone levels in these women were accompanied by overall hormonal imbalances and high insulin levels as well as low insulin sensitivity. They often suffered from insulin resistance, which is associated with obesity.
According to Ullis, due to the poor publicity of testosterone and anabolic hormones in society, studies on testosterone and on men are very controversial and difficult to conduct. Conducting such a study on women is therefore almost impossible. Still, there are a few smaller studies on the subject. Lovejoy in 1996 conducted a study comparing the effects of nandrolone decaonate and the anti-androgen spironolactone on the body structure of postmenopausal women. Lovejoy created 3 groups of women, the first received 30mg of nandrolone every other week, the second group was on placebo and the third took the anti-androgen. All the women had to follow a 500Kcal calorie deficit diet and were told not to alter their physical activity in any way. Studies showed that the anti-androgen group of women lost no fat and the nandrolone group lost twice as much fat as the placebo group. In addition, the women taking nandrolone gained an average of 2 kg of lean muscle mass during the experiment, even though they were in a calorie deficit. In contrast, the placebo and anti-androgen groups lost over 1 kg of muscle. Lovejoy points out that nandrolone has no effect on insulin resistance, which is thought to bind to androgens. In addition, the group on nandrolone received only very low doses, and for an extra week, had no drastic diet and did not exercise. Ullis believes that with a high-protein diet and exercise, these results would have to be even better.
Despite the fact that the study confirmed the assumption that androgens are important in eliminating obesity problems, the study authors ultimately did not recommend the use of nandrolone in hormone therapy. They point to slight abnormalities in blood lipids and a slight increase in the waist fat layer in the group that received nandrolone. Ullis, however, believes that if testosterone had been used in the study, these symptoms might have been even less, or even nonexistent. He also says that the most ideal would be to use a testosterone gel that could be used daily without hormone levels fluctuating.
Ullis says that testosterone doses don’t have to be very high for the desired effect. Moreover, he notes that the problem is not necessarily limited to postmenopausal women, but also to young women taking hormonal contraceptives. The use of these products leads to an increase in estrogen and progesterone levels, while at the same time reducing testosterone levels. Therefore, these women gain fat, their libido decreases and they are often moody. Returning testosterone to the correct ratio to estrogen leads to improved mood and return of energy. Estrogens do not raise energy levels, although they are often presented as such, natural progesterone has a calming effect on women, while synthetic ones can have the opposite effect – irritability, aggression and even acne.
Ullis began giving his female patients testosterone preparations. He says the goal is not to raise levels above normal, but to get the hormones and their ratios back to normal. Dosages are around 0.25 – 1 mg/ every other day. Ullis recommends using a gel that is applied under the jaw or in the armpit. She also replaces synthetic progesterone products with natural ones and reduces patients’ estrogen doses (she describes transdermal estradiol as the best). He makes up the levels by increasing phytoestrogens in the diet – especially by adding soy products.
The key is to get the hormones into the right balance. Once this balance is achieved, these women start losing weight again and can even reverse the loss of bone density and muscle loss.
Ullis points out, however, that the same therapy is not suitable for very young women who still want to be mothers but are having problems due to their use of hormonal contraceptives. Of course, the same rule applies to them as well – that is, increase testosterone levels, but much more appropriate for them, according to Dr. Ullis, is to use the prohormone 4-androstenediol (4-adiol) for those women who do not want to have a child anytime soon. Because 4-adiol has a short half-life and is in the body for a short period of time, it does not cause as many side effects, nor will it affect gonadal function and gonadotropin production in the long term if used irregularly. The only problem is that 4-adiol is only made for men in 100 mg capsules (until 2004, prohormones were legal in the US and could be bought without a prescription). Yet the appropriate doses for women, according to Dr. Ullis, are around 10-50 mg. Ullis advises using tablets that can be divided and taking ¼ – 1/3 tablet per day. This should be sufficient for hormone comparison.
From the “Testosterone for Women” study, Dr. Ullis says that while traditional “female” hormones have their place in preventing osteoporosis, heart disease and Alzheimer’s, testosterone therapies may prove more useful to women than men in addressing some conditions in the future. Testosterone and other androgens may also have a place in the treatment of obesity – especially obesity of the estrogenic “female” type. So far, very little research has been done to confirm that the reason women are far more prone to overweight and obesity is related to their low testosterone levels. In addition, testosterone in women increases the amount of muscle mass and thus increases their metabolism. Dr. Ullis does not deny the side effects, but points out that these effects are far minor compared to the side effects of commonly used medications in the treatment of obesity, whose positive effect also disappears quickly after discontinuation. He even says that the use of testosterone in the treatment of obesity is more safe and longer lasting than liposuction.
He expresses the hope that medicine will soon abandon the traditional concept of male hormones for men, female hormones for women and replace it with the universal concept of balancing ALL hormones in the human body, because – as he states – the same controversy is now caused by the use of female hormones in the treatment of some male problems.
PS: this article does not encourage women to use testosterone without a doctor’s supervision! As stated, for now, these methods are still under study and not commonly prescribed (not in Europe). Female athletes are subject to WADA regulations on the use of banned substances. The article illustrates the use of anabolics in medicine.