I’m going to share my testosterone story with you. If you are my colleague, my mother, or would prefer to think of me as someone who knows everything about hormones and does everything right all the time, I suggest you stop reading right now.
I tried testosterone pellets for the first time in 2013. I was 38 years old and had just completed my Age Management Medicine certification through Cenegenics, where I learned that anything less than the “upper range” of free testosterone on the lab test was suboptimal. At the time, my anesthesiologist-turned-hormone instructor (great guy, I really liked him) was a fan of pellets, so that’s what I tried.
I don’t remember the dose. Probably something around 100 mg, which is a typical starting dose for women. Nothing really bad happened but I did get some acne on my face, which I didn’t love. And, more importantly, I didn’t notice much improvement, so when it came time to re-up at 4 months, I casually let that fall off my plate.
Two years ago, as I noticed my muscles and libido slipping away at the same frantic rate, I decided it was time to try again. I opted for a cream this time and went with a reasonable starting dose of 5 mg/day. I applied it to my inner thighs, inner arms and behind the knees (thin-skinned areas without much body hair). After three months I hadn’t noticed much, good or bad, so I increased the dose to closer to 10 mg/day. I say “closer to” because I wasn’t always completely reliable about applying it. When I traveled, I often left it at home. I probably missed at least 2-3 days per week, so the daily dose was probably closer to 7.5 mg. After another three months I noticed something major.
OMG. I could NOT stop thinking about sex.
I’d be at the grocery store or airport and I’d be looking around, thinking about what everyone looked like naked. I’d be at home, trying to work on my book or clinical protocols for my clinics, and instead of drug doses I was thinking about sex. It was fascinating, fun, and pretty darn distracting. Is this what it’s like to be a man, I thought? How did they get anything done?
That part was weird, but enjoyable. What came with it was less so. One day I looked down at my legs while shaving in the shower and realized that I had DARK hair, like, everywhere. I was a blond-leg-hair kind of gal. I’d shave at least once a week so it didn’t get too shaggy, but it wasn’t all that offensive. But suddenly, it was DARK. And plentiful. Like, ALL the way up my legs plentiful. To the tip-top plentiful.
That wasn’t all. I remember being at an event where I was supposed to speak. I went to the bathroom just before going on stage and noticed, in the glaring, irritatingly magnifying light, that I had SEVERAL dark hairs on my upper lip and my chin. Now, this was before I’d started carrying tweezers in my purse (lesson learned), so I spent several minutes trying to pluck them out with my fingers, thinking all the while that I should have spent more time rock-climbing so I’d have stronger fingers for situations like this.
Interestingly, when I got my labs back during this time, my total testosterone was 100 ng/dL (higher than physiologic range, but not THAT high for a woman taking testosterone), but my free testosterone had only moved from 1.2 to 1.6 pg/mL (reference range 0 – 4.2 pg/mL). If you’re doing some quick math, you’ve probably realized that I have a pretty high SHBG level. Not abnormally high, but high end of the “normal” range. I’ve always had this. And, generally speaking, a higher-end SHBG is better than a lower SHBG, as it’s more often associated with better insulin sensitivity and metabolic health. Certainly, a too-high SHBG (like, outside the lab’s reference range) warrants a full evaluation, as it can be caused by things like hyperthyroidism, eating disorders, and liver disease. Mine wasn’t too high, but it was high enough to bind up a fair amount of my free testosterone, thus taking it out of commission. But that slight bump in my free testosterone had sent my body into a hair-growing, sex-filled-brain-having, still-not-muscle-building spiral. So, I stopped. Cold turkey.
I gave it 6 months. Luckily, increased hair growth and an out-of-control libido are both reversible side effects of testosterone. And, if we’re being honest here, increased face and body hair is one of the most common side effects of testosterone therapy in women and happens even at low doses, as evidenced by Susan Davis’ meta-analysis, which found a 69% increased rate of mild face and body hair compared to placebo, even at small doses of testosterone (150-300 mcg/d patches).
The side effects that are NOT reversible, by the way, are rare and generally only occur at higher doses. Those are voice changes and clitoromegaly (swelling of the clitoris). Those are very much dose-dependent, which is why one must exercise some caution before driving testosterone levels sky high.
Okay, back to me. I stopped the testosterone and, within 3 months, noticed that my libido was back in the gutter. It was another 3 months before my ape legs had (mostly) returned to normal. I continued to have very little muscle (which, full disclosure, is probably more due to my lack of consistent protein intake than it is to my low testosterone). So, I weighed the risks and benefits and decided, “What the hell, let’s try again at a lower dose.”
I went back on the 5 mg/day (ish), which is where I’ve been now for about 6 months. The truth is that I think it’s helped my libido somewhat (although, honestly, who’s to say, since I spend most of my waking hours in front of my computer or traveling to speak at conferences. Everything else has been back-burnered. Sorry, husband). I feel good from an energy standpoint (although that was never really an issue). And the rogue face and body hair is mostly under control (however, I will say that, as I recently learned during my now-scheduled “rogue facial hair check” session, the combination of tiny new hairs in hard-to-reach places plus eyes that don’t see well up close is not a good combination). I often forget my reading glasses, which doesn’t help.
That’s where I am. Oh, I forgot. I also briefly tried testosterone subcutaneous injections (twice weekly) because there’s a theoretical benefit of less conversion to DHT with injections compared to creams. But I was even less consistent with those than I was with the cream, so I stopped. (And, because testosterone cypionate is pretty viscous, you have to use at least a 27G needle to inject it, which is bigger than I like, so that probably contributed to my “forgetting” to take my shots.)
The point of this entirely too long diatribe is that testosterone is pretty freaking tricky. I love testosterone for women. It’s a great drug for those who need it. But it does not come without its side effects and, when dosed too high, risks. I’ve written several other articles about testosterone, so if you want to know more about potential benefits, dosing, routes, and side effects, check those out (see links below).
This particular “article” (aka “overshare”) was to let you know that I see you. I am you. And even with a head full of knowledge about hormones, I still sometimes get them wrong.
Want to learn more about testosterone for women? Check out my previous articles.
Testosterone: The Boss Babe – Understanding Your Body’s Power Hormone
Testosterone Therapy for Women: A Delivery Methods Deep Dive
Testosterone Therapy in Women: Dosing and Follow-Up
Testosterone Therapy and Hair Loss in Women: Is it Really a Problem?
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