Bio-identical hormones have the exact same chemical and molecular structure as hormones that are made in the human body. The difference between a “bio-identical” hormone versus a hormone that is not “bio-identical” is the molecular structure and shape of the hormone. Why is this important? Think of a hormone as a “key” and the receptor which it activates as a lock. In order for a replacement hormone to exactly replicate the function of the hormone that humans naturally produce, the bio-identical replacement I provide must exactly match the human hormone. It is the structural differences that exist between human “bio-identical” and “non-bio-identical” hormones that are responsible for serious side effects and sometimes fatal health risks that occur when “bio-identical” hormones are used in humans.

If you are deemed an appropriate candidate for testosterone therapy (and after baseline blood work and appropriate consultation), you will have a small area of skin over your buttock numbed with a local anesthetic. A small cut in the skin of about a 16th of an inch (2millimeters)is made in the numb area. A tiny metal tube with a plunger then painlessly inserts the testosterone pellet into the deep fat where you won’t be able to feel it. A steri-strip skin tape is used to cover the small skin opening which falls off in 4 or 5 days after the skin heals closed. That’s it! Come back every 3 months to repeat the process. (If you want to stop treatment – stop when you are willing to feel the way you did before treatment.)

Every woman is different in this regard. In general, most women notice improvements in mood and sleep with in the first week or so. However, change in body composition with decreased body fat may take multiple months and several treatments. By the time you are into your second set of pellets (month 4 through 6), you should notice significant improvements. Improvements continue for a year or longer until you reach your optimum condition. Healthy diet with lower carbs and regular exercise further enhance the results. While it is highly unlikely, there are rare cases (about 1% of the time in my practice) when the woman does not feel enough improvement occurred after the second set of pellets to continue. Dosing is highly individual and is done by an initial educated guess and then by symptom relief. You are a critical factor in determining what dose is best for you! As women have become healthier and happier on the program, I have noticed that the dosage needed tends to decrease slightly over time.

There has been a precipitous drop in male testosterone, an approximate 30% reduction occurred between 1987 and 2007 in the average 45-year-old. No one studied testosterone levels during this time period in females because doctors were taught that Testosterone was a “male hormone” and that Estrogen was the “female hormone”. Nothing could be further from the truth! It is likely that the same environmental factors that dramatically lowered male T levels have also lowered female T levels. Furthermore, except for their reproductive organs, male and females are physiologically identical and so is their dependence upon T and E for health.

Confronting False Teaching

Estrogen in our tissues is critically important to the health and well-being of both men and women. Neither sex would survive very long if we were magically depleted of all estrogen. Estrogen inside our cells is critically important in both sexes for the functioning of bones, brain, heart, vascular system, GI tract, skin, sexual organs, etc. In fact, most males likely have more total estrogen in their much larger bodies then do females, just based on tissue weight. Furthermore, a woman has elevated blood levels (not intracellular tissue levels) of estrogen for a very limited period of her lifetime, at most – 25 to 30 years. And yet, even during this fertile time in her life, her circulating levels of estrogen may be lower than her husbands for 5 to 7 days a month! So, to say a woman needs high levels of circulating estrogen to be healthy is scientifically absurd. Additionally, the circulating levels of estrogen in men and women has no relationship to the tissue levels of estrogen Furthermore, it is the individual cells inside our tissues that are dependent upon estrogen for health!

Our bodies have brilliant design throughout. No “mistakes” were made. It would have been foolish to design the human body dependent on a hormone critical to cellular health when circulation of that hormone rapidly fluctuates in females and is at a constant low circulating level in males. In 2000, Evan Simpson and colleagues stated that every tissue that depends on estrogen for its health and proper functioning produces an enzyme called aromatase that converts testosterone to estrogen inside the cells! In fact, they found that the circulating levels of estrogen had no relationship to the different levels of estrogen inside the cells of the different tissues of the body that require estrogen! For example, bone cells may have levels multiple times higher or lower than other tissues like brain or breast. Different tissues have different levels of aromatase in their cells to accommodate the estrogen levels needed and the amount of testosterone that is available and transported inside the cell.

Women make it of course! Most T is made by the ovaries with some T being made in the adrenal glands. Women are more sensitive to testosterone than men. In other words, they need a lower level in their bodies to provide for their physical, emotional, and neurological health needs. Their testosterone receptors are more sensitive to the hormone… but this can change as they age. This increased sensitivity leads to rapid problems when a small drop in available T occurs. A small reduction in T levels creates a big percentage change!

Currently in the U.S., the average woman at 40 has less than half the testosterone she had at 21. What often happens when that drop occurs? In brief: Menopausal Symptoms. It simply does not matter what your estrogen levels are when your testosterone levels drop below what is sufficient to adequately stimulate your testosterone receptors and supply intracellular tissue estrogen production. That is the paradox of “menopause” as we doctors have been taught to artificially define it. You can be fertile and menopausal! The symptoms of menopause often occur years before the ovaries cease producing eggs and estrogen. With testosterone too low for your individual tissue needs – you can still be fertile, have normal “premenopausal” cycling of estrogen, and yet develop the following early menopause symptoms:

diminished sense of well-being
increase in fat not related to change in diet or exercise
dysphoric mood (sadness, depression, anxiety, irritability)
fatigue
decreased libido
hot flashes, bone loss
decreased muscle strength
changes in cognition and memory
insomnia

These are the early symptoms that usually progress to include some of the following as defined by the ZEG International Menopausal Rating Scale:

Hot flashes, sweating
Heart discomfort (heart skipping, racing, tightness)
Sleep problems (difficulty falling asleep, waking)
Depressive mood, feeling sad, down, lack of drive, mood swings
Irritability, feeling nervous, inner tension, feeling aggressive
Anxiety, inner restlessness, feeling panicky
Physical exhaustion, decrease in performance
Mental exhaustion, impaired memory, decrease in concentration, forgetfulness
Sexual problems, (change in desire, activity and satisfaction)
Bladder problems (difficulty urinating, frequency, bladder incontinence)
Dryness of vagina (burning, difficulty with intercourse)
Joint and muscular discomfort (pain in joints, rheumatoid complaints)

Needless to say, there are thousands (millions?) of women treated with antidepressants for the onset of dysphoric symptoms with the early menopausal T drop… and it doesn’t work well in them.

No! Just as women are much more sensitive to testosterone than men, individual women have different levels of sensitivity to testosterone. Some women are fortunate to keep an adequate level of testosterone production from their aging ovaries and adrenals for a long time – blessed by genetics, exercise, and unknown factors. Unfortunately, they are in the small minority, and eventually they also suffer from lack of T. The remainder (including most all women that have had their ovaries removed) start suffering the above symptoms in their 30s, 40s, or 50s while their health declines. The sensitivity to testosterone seems to decrease as we age as well, meaning levels appropriate to treat your symptoms without any negative effects may be several times higher than what you needed in your 20s to be healthy.

Yes! A German study recently demonstrated that low testosterone in women is associated with an increase in mortality during the next 4 and ½ years compared to women with higher levels levels. (Their most dramatic finding was for women in the lowest 20% of measured T levels having an over 50% increase in mortality risk compared to the top 80% combined!). Low testosterone levels have been linked to heart disease, osteoporosis, obesity, diabetes, breast cancer, cognitive disorders such a memory problems and balance problems, and more…

The sensitivity that women have to T complicates their treatment. Too little T and the treatment is inadequate. Too much and you have the temporary but bothersome side effects of excess hair or hyper-sexuality.

Additionally, various tissue regulate how much aromatase they make in order to create intracellular estrogen based in part upon how much T is available. So, if the T levels fluctuate rapidly the tissues will temporarily make too much or too little estrogen inside the cells leading to other problematic conditions.

Thus, the ideal treatment for females would be something that provides a long term constant supply of testosterone into the circulation at a constant rate of release. Furthermore, the testosterone must be molecularly identical to what the human body creates naturally!

Creams, Injections, and Dissolvable tablets have inferior absorption profiles that result in insufficient, erratic, or spiking levels, or require extremely frequent dosing. All oral “testosterones” are not molecularly identical human testosterone and are potentially very dangerous.

The best solution I have found is one that has been available in the US as an approved treatment since 1939 – highly compressed molecularly identical testosterone pellets given every 3 months!

Yes! A German study recently demonstrated that low testosterone in women is associated with an increase in mortality during the next 4 and ½ years compared to women with higher levels levels. (Their most dramatic finding was for women in the lowest 20% of measured T levels having an over 50% increase in mortality risk compared to the top 80% combined!). Low testosterone levels have been linked to heart disease, osteoporosis, obesity, diabetes, breast cancer, cognitive disorders such a memory problems and balance problems, and more…