Abstract
Testosterone. Present in both men and women, this hormone helps maintain muscle mass and bone density, controls sex drive, stimulates physical and mental energy, and helps regulate mood. At normal levels, testosterone encourages good health and well-being. However, a prolonged decrease in this hormone can have extremely negative effects. Among other problems, low levels of testosterone have been linked to depression, obesity, osteoporosis, sexual dysfunction, fatigue, cognitive lapses, and a slew of other ailments. While most of the emphasis has been put into research on androgen deficiency in men, there is an increasing amount of data to suggest that many adult females suffer from a natural deficiency in testosterone. However, this data, collected from many different experts and studies, has never been collated into one solid hypothesis. The purpose of this paper is to present evidence to support the theory of an evolutionary androgen deficiency in women, and encourage more research into this fascinating concept.
Testosterone
Dictionaries and encyclopedias list testosterone as the principal male sex hormone (Columbia Electronic Enyclopedia, 2008). It is the primary androgen, the group of hormones that control secondary sexual features in men, like a deepening voice, facial hair, and an Adam’s apple. Testosterone is also thought of as the “impulsive” hormone; for example, men with higher levels of testosterone are more likely to engage in risky behaviors such as smoking, drinking, gambling, or extreme sports. Unfortunately, this myopic definition of testosterone has been ingrained into our collective psyche to the point that there is little or no connection to female chemistry. In truth, testosterone is an important hormone in the regulation of overall health in both sexes. A physician’s training manual reads:
“Maintenance of normal testosterone levels in women is associated with many of the same benefits as those in men. In women, maintaining normal testosterone values is associated with better lean mass retention, less fat mass, lower glucose and insulin levels, increases in libido and sexual responsiveness, mood improvement and stress reduction.” (Cenegenics Foundation, N.D.)
In addition to the benefits listed above, another doctor reports that testosterone improves memory, boosts energy, and in general just gives an increased sense of well-being (Arrington, N.D.).
In women, testosterone is produced by the ovaries, as well as through the conversion of hormones produced by the adrenal glands, such as androstenedione, DHEA, and DHEAS. Levels of free testosterone, the amount of hormone that can actually interact with tissues, are determined in great part by the presence of Sex Hormone Binding Globulin (SHBG). SHBG and another protein called albumin will bond to testosterone, making it essentially inert. In reality, only 1%-2% of the total testosterone in the average woman is unbound and free to interact with the body. Naturally, when levels of SHBG rise, levels of free testosterone decrease. For example, the estrogen in birth control pills will cause SHBG levels to rise, causing free testosterone to decrease. Another interesting fact about testosterone is that it provides the basic building blocks for estrogen production. The women’s health program at Monash University in Australia states that “without the ability of our bodies to make testosterone, we cannot make estrogen.” (Monash University, N.D.)
Although there is no clear consensus on normal levels of testosterone for men or women, a science reporter writes that “men’s bodies generate more than twenty times more testosterone than women, an average of seven milligrams per day” (Mitchell, 1998). This disparity is quite important to note; it implies that small fluctuations in this hormone won’t affect men as much as it affects women. Angela Garcia and her associates point out that women’s “bodies are sensitive to smaller degrees of change in testosterone level. A small drop in testosterone [10-15 ng/dL] […] may not be noticed by a man, but could result in clear symptoms for a woman” (Garcia et al, 2002).
In summary, testosterone is an extremely important hormone in the regulation of mental and physical health in both men and women. Without sufficient testosterone in our bodies, we lose muscle mass and bone density, we are more likely to feel tired and lacking energy, we retain more fat, we are more likely to have feelings of depression, we lose interest in sex, we have problems concentrating and remembering, and estrogen production could be diminished. Only 1%-2% of testosterone produced is actually free to interact with our bodies, and small fluctuations in this hormone have a much larger impact on women than men.
Female Androgen Deficiency Syndrome
It would be an understatement to say that the existence of a female androgen deficiency syndrome is controversial. The first problem is, there are only weak links to levels of testosterone and the symptoms associated with androgen deficiency. The second problem is the lack of a clear definition for the syndrome. Third, it is very difficult to measure levels of free testosterone in women, since most of the tests currently used were created for men (with 10 – 20 times more testosterone to measure). Also, to throw fuel on the fire, the FDA in the US recently refused the introduction of female testosterone patches.
Nevertheless, there is STRONG empirical evidence to support this theory. First, we could call into question the validity of the claim that there is only a weak link to levels of testosterone and symptoms of androgen deficiency. Although many studies indicate that testosterone levels in women do not predict sexual dysfunction, it should be noted that accurate levels of free testosterone are nearly impossible to obtain with current technologies, and may not fully reflect the levels SHBG present at the time of testing (Sadovsky, 2001). However, in similar studies, “women with low sexual function were 3-4 times more likely to have a DHEAS level in the lowest 10% for their age.” (Monash University, N.D.) While we know that DHEAS is one of the basic building blocks for testosterone, it is also more available with concentrations 1000 times greater than testosterone, and is therefore an easier marker to measure. We also know that the addition of testosterone in female patients “improves sexual satisfaction and wellbeing.” (Monash University, N.D.) Therefore, it would be ridiculous to argue that there is no relationship between testosterone and symptoms of androgen deficiency like sexual dysfunction.
Next, the fact that women are twice as likely to suffer from depression than men (Harvard University, 2006), are 4 times as likely to suffer from anxiety than men (gynob.com, N.D.), are 33% more likely to suffer from sexual dysfunction than men (Chicago University, 1999), are twice as likely to lose interest in sex as men, (Phillips, Slaughter, 2000), and are four times as likely to suffer from osteoporosis than men (US Department of Health & Human Services, 2004), should be a clear indication of potential androgen deficiency across the board. While it could be argued that any one of these symptoms alone does not mean that androgen deficiency is the cause, it is difficult to ignore the link when a good portion of the female population generally displays all of these signs.
Evolution
Could it be that women just evolved this way? One study in particular may be able to shed some light on this topic. In 2002, a study at the State University of New York in Albany, conducted by Dr. Gordon Gallup, showed a direct relationship between male semen and depression in women. In this study on the sexual practices of 300 women, those who reported that they engaged in sexual intercourse without condoms, categorically scored lower on the Beck Depression Inventory (BDI) test, a widely used measure of depressive symptoms. Interestingly, no other factors in the study showed a direct relationship to depression. What this means is, there is no difference in the mental health of someone who has sex every day, or someone who has sex once a month. However, the woman who has sex once a month without condoms is happier than the woman who has sex every day with condoms. The study also showed that women who didn’t use condoms “were most likely to initiate sex and to seek out new partners as soon as a relationship ended.” (Kary, 2002). In addition, it was “found that women who routinely had intercourse without condoms became increasingly depressed as more time elapsed since their last sexual encounter. There was no such correlation for women whose partners regularly used condoms.” (ibid) Dr. Gallup was quoted saying that this behavior suggests a chemical dependency.
But a chemical dependency on semen? Well, this is not as ridiculous as it sounds. We know that “semen contains hormones including testosterone, estrogen, prolactin, luteinizing hormone and prostaglandins” (ibid). We also know that many of these hormones are absorbed vaginally (Gallup, 2002), and small changes in hormones such as testosterone can have significant effects on women. Therefore, Dr. Gallup may have inadvertently discovered a hidden function of sex; whether it is the effect of testosterone absorbed directly from semen or a boost in natural testosterone production as a result of other absorbed hormones, sex is a natural replacement method for the androgen deficient human female.
Dr. Gallup’s study suggests a strong possibility that women are predisposed to seek out a sexual partner in order to maintain a healthy body and mind. This seemingly evolutionary deficiency serves to perpetuate the life cycle; while men seek to satiate their almost limitless libidos, women may actually be trying to supplement their low androgen production in order to improve their health and sense of well-being. This would also explain why women are generally more attracted to “bad boys” – men who engage in high-risk behavior normally have more testosterone, making them more sought after by [androgen deficient] females. In addition, the ramifications of this theory would force us to redefine the female libido. While men’s switches are permanently in the “on” position, women may base their sexual needs on fluctuations in mood and health as a response to androgen levels. The theory of an evolutionary androgen deficiency in women also raises hundreds of topics like the proliferation of condom use and the rise of clinical depression in our society. Naturally, more research is required to determine if this theory is true. Nevertheless, the empirical evidence makes a strong case.
Testosterone as a Treatment
Suggesting that women should go out and have unprotected sex in order to improve their overall health would be unethical and ill-advised. Receiving supplemental testosterone the seemingly “natural” way is no longer a viable option for most women in our society based on current realities like sexually transmitted diseases, gender equality, career progression, and family planning. However, it is unnerving to think that certain changes in our culture over the past century may have caused generations of women to unknowingly suffer from androgen deficiency, a mentally and physically limiting syndrome.
Short of prescribing a sexual partner to the androgen deficient female, doctors need viable alternatives. Currently in North America, there are no widely accepted treatments for women with androgen deficiency. In addition, most available treatments were created for men with 10-20 times more testosterone than women. In other countries, such as the UK, testosterone treatments are available in the form of a skin patch, but are only licensed for women who have had their ovaries removed (Women’s Health Concern, N.D.). Other possible therapies include skin gels, implants, or injections. Although there are also some pills available such as Estratest, there may be serious side effects and an increased risk for some cancers. Estratest was never developed as a testosterone replacement therapy, and should be avoided if androgen deficiency is the problem.
The obvious side effects of testosterone treatment, such as masculinization, appear to be mild if correct doses of the hormone are administered. However, without proper studies and funding, correct levels of supplemental testosterone are impossible to calculate. Suffice it to say, there is a long road ahead for researchers who want to tackle this controversial topic.
Conclusion
Perhaps the answers to this theory are right under our noses. Until such time as new methods for detecting free testosterone in women are available, and an acceptable definition of androgen deficiency in women is agreed upon, it couldn’t hurt to experiment with natural ways of increasing testosterone. Although semen has yet to be proved as a real source of supplemental testosterone, the evidence indicates a strong possibility. I would invite the input of any couples who want to participate in an experiment to see if regular intercourse, without condoms, alleviates the symptoms of androgen deficiency in women. Please send all reports to the author of this paper, Stephen Minkoff.
steve@personalcoachingsolutions.com
References
http://www.cbsnews.com/stories/2006/11/16/fyi/main2189347.shtml (CBS News, 2006)
http://health.msn.com/health-topics/sexual-health/mens-sexual-health/articlepage.aspx?cp-documentid=100051070 (MayoClinic.com, 2006)
http://www.healthywomen.org/resources/womenshealthinthenews/dbhealthnews/testosteroneofferswomenbenefitsrisks (Reinberg, 2006)
http://www.power-surge.com/educate/testosterone.htm (Smith, N.D.)
http://www.cenegenicsfoundation.org/physicians_training/testosterone/page1.html (Cenegenics Education and Research Foundation, N.D.)
http://www.abc.net.au/science/slab/testost/story.htm (Mitchell, 1998.)
http://psychologytoday.com/articles/pto-20021002-000009.html (Kary, 2002)
http://albany.edu/news/releases/2002/june2002/gallupstudy0602.html (Gallup, 2002)
http://men.webmd.com/testosterone-15738?page=2 (WebMD.com, 2006)
http://www.anti-agingmd.com/testoterone.html (Arrington, N.D.)
http://www.gynob.com/testost.htm (GynOB.com, N.D.)
http://blog.cleveland.com/pdworld/2007/11/testosterone_still_not_stirrin.html (McEnery, 2007)
http://jcem.endojournals.org/cgi/content/full/90/8/4970 (Bhasin, 2005)
http://body.aol.com/conditions/men-and-depression (Harvard Medical School, 2006)
http://www.thebody.com/content/art14092.html (Garcia et al, 2002)
http://www.miannegolf.com/refs/testosterone-in-women.pdf (Monash University, N.D.)
http://www-news.uchicago.edu/releases/99/990210.laumann.shtml (University of Chicago, 1999)
http://www.4women.gov/faq/osteopor.htm (US Department of Health & Human Services, 2004)
http://www.unc.edu/news/archives/sep99/udry3.htm (Williamson, 1999)
http://www.diagnose-me.com/cond/C569738.html (Diagnose-me.com, N.D.)
http://www.aafp.org/afp/20011215/tips/6.html (Sadovsky, 2001)
http://www.womens-health-concern.org/help/factsheets/fs_androgendeficiency.html (Womens-health-concern.org, N.D.)
Testosterone. (n.d.). Columbia Electronic Encyclopedia. Retrieved April 29, 2008, from Reference.com website: http://www.reference.com/browse/columbia/testoste
