Hormones and Reproductive Health

Hormones and Reproductive Health

Written by Michelle Violi, Pharm.D. – Women’s International Pharmacy


Couple expecting babyWhat would we do without the human reproductive system? True, we might have fewer hormonal ups and downs, but it wouldn’t be long before humans would no longer populate the earth. Let’s take a closer look at how this very important system works in both women and men.

The Female Reproductive System

A woman’s reproductive system is delicate and complex. In order for conception to occur, it is important for a woman’s hormones to be balanced and her organs and tissues healthy. Hormones such as estrogen and progesterone play leading roles; however, there are many other hormones that are important players in the intricate process that is the female reproductive system.

Immediately following menstruation, estrogen levels begin to rise, causing the lining of the uterus to thicken. At ovulation an egg is expelled from the ovary into the fallopian tube where it travels to the uterus. After ovulation occurs, progesterone is produced from the corpus luteum, which forms in the ovary from which the egg was released.

Progesterone causes the uterine lining to become secretory and ready for the egg to implant should fertilization occur. If fertilization occurs, the fertilized egg implants in the uterine lining. The corpus luteum continues to produce progesterone until the placenta takes over its production in the second trimester of pregnancy. If fertilization does not occur, the corpus luteum breaks down, estrogen and progesterone levels fall, menstruation occurs, and the cycle begins anew.

The Male Reproductive System

A man’s reproductive system is no less complex. The primary hormones involved in the functioning of the male reproductive system are follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone.

FSH and LH are produced by the pituitary gland located at the base of the brain. FSH is necessary for sperm production (spermatogenesis), and LH stimulates the production of testosterone, which is necessary to continue the process of spermatogenesis. Testosterone also is important in the development of male characteristics, including muscle mass and strength, fat distribution, bone mass, and sex drive.

Hormonal Effects on Fertility

Infertility issues are very complicated and have many possible causes, including hormone imbalances or deficiencies. The following are just a few ways hormones play a role in fertility.

Hypothyroidism, or low thyroid function, can affect fertility due to menstrual cycles without ovulation, insufficient progesterone levels following ovulation, increased prolactin levels, and sex hormone imbalances. In a study involving 394 infertile women, 23.9% had hypothyroidism. After treatment for hypothyroidism, 76.6% of infertile women conceived within 6 weeks to 1 year.

Luteal phase deficiency (LPD) is a condition of insufficient progesterone exposure to maintain a normal secretory endometrium and allow for normal embryo implantation and growth. Progesterone is used in patients who experience recurrent miscarriages due to LPD. In addition, studies have shown progesterone can reduce the rate of preterm birth in certain individuals.


The human reproductive system is delicate, complex, and affects the overall health of women and men. Hormones serve an important role in maintaining harmony and promoting fertility in this intricate system. Because of this, achieving hormonal balance is a crucial component to supporting reproductive and overall health.

  • Lessey BA, Young SL. Yen & Jaffe’s Reproductive Endocrinology. 7th ed. Amsterdam, The Netherlands: Elsevier; 2014. https://www-clinicalkey-com.ezproxy.library.wisc.edu/#!/content/book/3-s2.0-B978145572758200010X?scrollTo=%23hl0000927 Accessed July 3, 2017
  • https://my.clevelandclinic.org/health/articles/the-male-reproductive-system Accessed July 3, 2017
  • Liedman R, Hansson SR, Howe D, et al. Reproductive hormones in plasma over the menstrual cycle in primary dysmenorrhea compared with healthy subjects. Gynecol Endocrinol. 2008;24:508-513. Accessed April 11, 2017.
  • Hassan SS, Romero R, Vidyadhari D, et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol. 2011;38:18-31.
  • Barda G, Ben-Haroush A, Barkat J, et al. Effect of vaginal progesterone, administered to prevent preterm birth, on impedance to blood flow in fetal and uterine circulation. Ultrasound Obstet Gynecol. 2010;36:743-748.
  • Mesen TB, Young SL. Progesterone and the luteal phase. Obstet Gynecol Clin North Am. 2015;42(1):135-151.
  • Verma I, Sood R, Juneja S, et al. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012 Jan-Jun; 2(1):17-19.
Hormones and Reproductive Health 2017-12-05T12:33:07+00:00

The Hormones of Relationship

The Hormones of Relationship

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


After reading his classic and still best-selling book Men are From Mars, Women are From Venus many years ago, I was looking forward to hearing Dr. John Gray speak at a recent meeting to add to my understanding of the many ways that men and women are different.

I had already learned about (and seen first-hand) how men need their “cave time” and women need men to listen and not try to fix everything. In his first book, Dr. Gray focused on the “what” of our differences; in his most recent book Venus on Fire, Mars on Ice he delves into “why” those differences occur.

As Dr. Gray so deftly and humorously explains, not only do we need a balance of hormones for managing PMS, post-partum depression, menopause, and andropause, but hormone balance also has a great deal to do with our relationships. Healthy, loving relationships require a healthy balance of hormones!

One of the primary ways that men and women behave differently is their coping mechanisms for dealing with stress. And, unfortunately, many men and women are constantly stressed from unrelenting demands of their life in the modern world. As a result, their production of cortisol, which is designed to reach peak levels when challenged with an emergency and then quickly drop down, stays at a high level. A chronic high level of cortisol tends to make them more emotionally unstable (among other things), which also affects their relationships.

Testosterone & Oxytocin

When trying to reduce or deal with stress, men release testosterone and women release oxytocin (a pituitary hormone). Ironically, high cortisol levels can interfere with the normal production of both testosterone and oxytocin, hampering both men and women from their attempts at stress reduction.

Women need to understand that men need that “cave time,” or downtime, when they come home and flop down on the couch in front of the TV or read the paper. That is how they replenish their testosterone, and disturbing them too soon will not allow them to recover. When a man’s testosterone level is adequate, it allows him to become “emergency man” in urgent situations where he needs to focus keenly, step up, and solve a problem. In fact, solving problems is so satisfying that it may cause some men’s testosterone levels to actually rise, while stress hormones like cortisol come down. On the other hand, oxytocin doesn’t help men deal with stress and can even bring their testosterone levels down. Oxytocin is the hormone that rises in men after sexual orgasm; it makes men sleepy.

For women, a release of oxytocin makes them feel safe and protected. They become more nurturing and cooperative. This nurturing, coupled with feeling like they are also being nurtured, then further raises oxytocin levels. Small amounts of testosterone will also help women feel good, in that they will feel sexy and capable. But too much testosterone will actually increase their stress levels. Higher testosterone levels in women might be useful for competing in the workplace, but that takes its toll. Dr. Gray relates studies showing that stress levels of cortisol while at work are twice as high for women as they are for men, and that difference typically becomes even greater when they get home.

When men get home and head to their “man cave” (or do whatever they prefer for relaxation), their stress levels drop. When women get home from work, their stress levels often rise even further as they face the pressures of all the things that need to be done at home (dinner, laundry, childcare, homework, etc.). They can’t understand how men can just sit on the couch or read the paper when there is so much to do.

Men don’t understand why women get so upset, and they don’t even typically notice the things that need to be done without being told. In fact, men will frequently procrastinate about doing things until they get a sense of danger or risk, which triggers their testosterone levels, giving them even greater stress relief.

Women tend to plan ahead, which stimulates oxytocin release, making them feel considerate and caring, which triggers even more oxytocin. With such polar primal hormonal responses and feelings, it is little wonder that men and women have trouble understanding each other!

Insulin & Serotonin

Other fundamental substances that play an important role in relationships include the hormones insulin and serotonin, and glucose (blood sugar). Every cell in the body needs a consistent supply of glucose to function, and insulin is the gatekeeper that controls how it is utilized. The brain is particularly sensitive to fluctuations in blood sugar, altering our moods, decision-making abilities, and other aspects of relationships.

When blood sugar drops, the production of serotonin (which has a calming effect) also drops. To make matters worse, the body then also responds by producing more cortisol, which feeds anxiety. This double-edged sword can be particularly hazardous for relationships, especially for women because they are more sensitive than men in their need for serotonin.

Creating & Maintaining Loving Relationships Requires Understanding Hormones, Too

Dr. Gray maintains that understanding these basic hormonal differences in each other is the key to maintaining loving relationships. It becomes even more critical as aging leads to lower levels of testosterone and oxytocin, as well as increased insulin resistance, creating even more difficulty in dealing with stress. Dr. Gray suggests that diet and lifestyle are important building blocks to producing and maintaining these hormones in proper balance.

A loving relationship can go a long way to help relieve stress. Women need to recognize that men need their down time to replenish before they are ready to jump in at home. Men are usually happy to help with the seemingly unending chores but they need to see them as projects, with a beginning and an end, and be able to do them on their own schedule. When a man realizes that this makes a woman happy, his testosterone levels improve because he will feel more confident and competent.

Women need a partner that will listen to them—really listen—without trying to fix things. This is their primary source of stress relief and oxytocin. However, it is unrealistic for women to think that their partner can be their sole source for boosting oxytocin, just as they are not the sole source for boosting a man’s testosterone. Dr. Gray suggests women would be better off by relying on their partners for just the last 10%. Yes, they need hugs and a bit of romance, but they should also talk with their female friends and maybe even schedule a regular massage or spa day to replenish.

For more information on relationship hormone connections, please refer to these books by Dr. Gray:

The Hormones of Relationship 2017-05-12T15:29:49+00:00

Can Testosterone Protect Against Breast Cancer?

Can Testosterone Protect Against Breast Cancer?

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


Compounded testosterone therapy for women has been prescribed for years in this country. Since testosterone can convert to estrogen in the body, practitioners are sometimes hesitant to prescribe it, thinking that testosterone might increase a woman’s chance of getting breast cancer.

Dr. Rebecca Glaser and her colleague Constantine Dimitrakakis set out to examine this assumption. They designed the Testosterone Implant Breast Cancer Prevention Study to explore the relationship between testosterone subcutaneous implants and breast cancer. This study looked at 1,268 pre- and postmenopausal women who received either testosterone or testosterone-anastrozole (an estrogen blocker) implants. These same women were not using systemic estrogen therapy.

While the time period for this study is ten years, an analysis conducted at the five-year mark reported a breast cancer rate that was less than 50% of the rate reported in previous menopausal hormone replacement therapy studies. Study participants who most closely adhered to the testosterone regimen experienced an even lower rate of breast cancer. According to the National Cancer Institute’s surveillance program, more than twice as many cases of breast cancer would be expected in this particular study population if no specific interventions were made.

Dr. Glaser believes that these interim study results support her theory that testosterone use does not increase the occurrence of breast cancer. Further studies are warranted. Different dosage forms, as well as the possibility that testosterone therapy might protect against breast cancer, should be studied.

  • Glaser RL, Dimitrakakis C. Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrozole: a prospective, observational study. Maturitas. 2013 Dec;76(4):342-9. doi: 10.1016/j.maturitas.2013.08.002. Epub 2013 Sep 10.
  • Glaser RL, Dimitrakakis C. Testosterone and breast cancer prevention. Maturitas. 2015 Nov;82(3):291-5. doi: 10.1016/j.maturitas.2015.06.002. Epub 2015 Jun 24.
Can Testosterone Protect Against Breast Cancer? 2017-10-17T15:38:15+00:00

Testosterone in Women

Testosterone in Women – A Commentary

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Professor Susan Davis is a women’s health researcher. In 2005 she became the inaugural Chair of Women’s Health in the Monash University Department of Medicine at the Alfred Hospital in Melbourne, Australia. In addition, she is a consultant endocrinologist at Alfred Health and Cabrini Medical Centre, also in Melbourne.

Professor Davis has been involved in the study of the role of estrogens and androgens (e.g., testosterone and DHEA) in women. She has been investigating the effects of hormones throughout the body, rather than just how they affect reproductive functions. She has published over 300 peer-reviewed articles. She is indeed a giant in the world of research involving the use of testosterone in women.

In December of 1999, Dr. Davis published a commentary on the nature of testosterone replenishment in women. Almost 20 years has passed since this commentary was published, yet not much seems to have changed. Scientists and physicians are still unclear on what actually constitutes a deficiency of testosterone in women. The clinical picture of a woman with adequate testosterone has not been established or agreed upon. There is no agreement on how low testosterone levels must be before action is taken.

The following is a brief synopsis of a number of subjects taken from Dr. Davis’s commentary.

Declining Testosterone

It is well established that testosterone and DHEA production steadily declines with aging. There are also a number other reasons testosterone levels may be low:

  • 50% of testosterone production is lost when the ovaries are removed (oophorectomy) as part of a “complete hysterectomy.”
  • Chemical damage to the ovaries produced by chemotherapy in cancer treatments.
  • The use of estrogen only hormone therapies and oral contraceptives. Both increase sex hormone binding globulin (SHBG), which binds testosterone and prevents the body from using it.
  • Treatment with corticosteroid drugs like prednisone turns off the production of adrenal testosterone. This may be the cause of osteoporosis when using these drugs. It has been established that the best bone mineral density levels are associated with strong levels of testosterone and DHEA.
  • Premature ovarian failure.
  • Loss of cycling due to lost signaling from the hypothalamus.


It has been established that adequate testosterone levels are associated with sexual interest in a way that estrogen levels are not. However, because sexuality is complicated and multi-faceted, using libido and sexual activity as distinct markers for adequate testosterone levels is not reliable. One should also consider vaginal atrophy, pain during intercourse (dyspareunia), loss of interest in a partner, or other psychological factors as contributors to sexual dysfunction.

Bone Loss

Bone loss may continue to occur even with estrogen and progesterone supplementation. When testosterone supplementation is added, bone growth may be restored. Some suggest that testosterone acts as a prohormone for estrogens and that this interplay must be in effect for good bone health.

Body composition

In general, muscle mass declines in the elderly and fat mass increases. Testosterone has been demonstrated to improve muscle mass in postmenopausal women. Additionally, testosterone has been effective in restoring muscle mass in both immune compromised men and women.

Autoimmune disease

Women are more prone to autoimmune diseases. It has been theorized that the higher testosterone levels enjoyed by men contribute to this gender difference. Testosterone replacement has been used successfully in diseases such as autoimmune rheumatoid arthritis.

Premenstrual Syndrome (PMS)

Below average levels of circulating testosterone have been identified throughout the entire menstrual cycle in some women who have PMS symptoms. In Australia and the UK, testosterone has been used for treatment of PMS.

Forward to 2015

In 2015, Dr. Davis published another review article. She added cognition, cardiovascular health, and vaginal integrity, including pain relief to her documentation. She cites numerous studies about the anti-proliferative effect of testosterone in breast and ovarian cancer, but points out it is difficult to draw conclusions without considering the effects of multiple other hormones, including estrogens. In spite of testosterone being a much more prevalent hormone than even estrogen in women, we still don’t know much about its effects. Dr. Davis says that research in women lags about ten years behind where it should be. Too many studies are small and limited in their scope, making solid conclusions impossible.

In Closing

In spite of several attempts to obtain FDA approval for gels and patches delivering testosterone replenishment for women, nothing has been approved. This appears to be due to a lack of consensus on the function of testosterone in women. However, testosterone has been available to women for decades with the assistance of compounding pharmacists. Testosterone can be prescribed in oral capsules, creams, gels, suppositories, drops, troches, pellet implants, and injectables. Thanks to compounding pharmacies, practitioners may choose to treat each of their patients’ testosterone deficiencies and monitor the effects — one patient at a time.

  • Davis SR. Androgen Replacement in Women: A Commentary. J Clin Endocrinol Metab. 1999; 84(6): 1886-91.
  • Davis SR. Testosterone in Women: the Clinical Significance. Lancet Diabetes Endocrinol. 2015 Dec;3(12):980-92. doi: 10.1016/S2213-8587(15)00284-3. Epub 2015 Sep 7.
Testosterone in Women 2017-12-14T15:41:59+00:00

A New Treatment Program to Improve Memory Loss

A New Treatment Program to Improve Memory Loss

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

In spite of hundreds of clinical trials over the past ten years, Alzheimer’s disease (AD) has no effective treatment. AD affects 5.4 million Americans, predominately females. It is estimated that women have a greater chance of developing AD than breast cancer.

Research supports the theory that an imbalance in brain nerve cell signals causes this disorder. Specific signals make nerve connections to cement memories while others allow irrelevant memories to be lost. This signaling system becomes imbalanced so that new memory connections are inhibited while more information is forgotten. Reversible metabolic processes may be involved in the early stages of AD.

Dr. Bredeson and his colleagues at UCLA believe that a comprehensive, personalized approach is the best way to treat memory loss. They have developed a program that optimizes diet (no simple carbohydrates, gluten, or processed foods), utilizes meditation and yoga, and emphasizes the importance of sleep, hormones, good oral health, and exercise. Patients may use supplements as well as medium chain triglycerides like coconut oil or Axona.

The researchers believe that free T3 and T4, estradiol, testosterone, progesterone, pregnenolone, and cortisol need to be optimized. Nine out of ten patients in this pilot program had cognitive improvement.

A New Treatment Program to Improve Memory Loss 2017-12-13T17:39:33+00:00

Testosterone and Heart Disease

Testosterone and Heart Disease

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Evidence continues to mount that there is no scientific basis for the assumption that testosterone supplementation causes heart problems. The European Medicines Agency (EMA) recently reviewed the risk of serious cardiac problems in men using testosterone replacement.

EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) looked at major heart problems, particularly heart attacks. PRAC reviewed all recent negative studies plus data from positive studies and available safety data. They concluded that there is “no consistent evidence of an increased risk of heart problems with testosterone medicines.” PRAC also noted that there is evidence that low testosterone can increase the danger of heart problems.

This position has been adopted by the European Union. The EMA does support the conservative position that only men who are low in testosterone should receive replacement. They recommend periodic monitoring of hemoglobin, hematocrit, liver function and cholesterol. They caution that men with severe heart, kidney, or liver disease avoid testosterone altogether. Patients should talk to their doctor or pharmacist for further information.

Testosterone and Heart Disease 2017-12-12T17:17:01+00:00

Sex Hormone Binding Globulin

Sex Hormone Binding Globulin

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Hormone levels in the blood must be just right. Steroid hormones, including testosterone, estrogens, DHEA, and progesterone, among others, are fat-soluble, but our blood is mostly water. Therefore, hormones and the blood do not mix very well. The body’s solution to this problem is sex hormone binding globulin (SHBG), a protein created by the liver which connects with the fat-loving hormones. The resulting complex becomes water-soluble and can move freely in the blood stream, carrying these hormones throughout the body. It also acts as a reservoir for the hormones it carries and protects the hormones from hyperactive liver metabolism and kidney excretion.

Hormones combine with SHBG to different degrees of affinity or attraction. The most strongly bound hormone is dihydrotestosterone (DHT), the active form of testosterone, followed by testosterone itself.

Although to a considerably less degree than DHT and testosterone, SHBG also shows affinity for estrogens, DHEA, and even progesterone. Estrogens increase SHBG production in the liver if the liver is functioning correctly. Adiponectin, a hormone released by the fat cells, is also involved.

Hormones related to testosterone decrease SHBG production by the liver. Insulin, hypothyroidism, and liver disease may also decrease SHBG. Low levels of SHBG are predictive of metabolic syndrome, diabetes, sleep apnea, PCOS, kidney disease, and obesity.

A useful test for checking hormone levels involves collecting urine for 24 hours and measuring the amount of hormone leaving the body that day. If a patient has low SHBG levels, testosterone will come out in the urine in greater amounts and may be interpreted as the patient having plenty of testosterone when their level is actually low. In order to accurately interpret the urine test results, the urine test should be accompanied by a blood test to measure SHBG.

An interesting scenario happens when testosterone is used as a supplement. As mentioned previously, testosterone decreases SHBG production by the liver. With less SHBG available over time, the supplemental doses of testosterone are more rapidly excreted by the body and don’t have an opportunity to build up in the blood and get to the tissues. It is important to test for SHBG especially if testosterone supplementation does not appear to be working.

Low SHBG causing low testosterone availability puts one at risk for sleep apnea. Poor sleep can, in turn, cause a decrease in testosterone, SHBG, and growth hormone production, creating a viscous circle. Regaining weight after weight loss can be predicted by low SHBG, and Polycystic Ovary Syndrome (PCOS) is also characterized by low SHBG.

If SHBG levels are too high, both testosterone and estrogens are bound. High levels of SHBG increase one’s risk for osteoporosis because the testosterone and estrogens needed to assist with bone formation are not available for use. Birth control pills can increase SHBG greatly, and high SHBG can be predictive of blood clot formation while on these drugs. High SHBG can also be predictive for cardiovascular disease.

Understanding SHBG is another tool to use in evaluating hormones. We are often tempted to label functions in our bodies as “good” or “bad” and some might apply this thinking to SHBG levels. There isn’t good or bad SHBG, just the levels that provide the best functioning for our bodies.

  • Fogle S. SHBG: What is it good for? Presented at the Age Management Medicine Group meeting, Las Vegas, NV: 2014 November.
Sex Hormone Binding Globulin 2017-10-18T11:02:27+00:00

Testosterone: A Possible Treatment for Dry Eye Syndrome

Testosterone: A Possible Treatment for Dry Eye Syndrome

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

An estimated 4- to 6-million older Americans suffer from mild to severe dry eyes. Dry eye syndrome (DES) has a wide variety of causes. This condition, while not life threatening, can be quite uncomfortable and distressing. (See our newsletter about Dry Eyes for more information.)

David Sullivan, a medical research scientist with the Schepens Eye Research Institute (a Harvard Medical School Affiliate), has spent the last 32 years studying the interrelationships between sex, sex steroids, and dry eye disease. His work has focused on the essential role that androgens play in the health and vital functioning of tear-producing glands.

Dr. Sullivan’s research suggests that testosterone deficiency contributes to tear instability and evaporation of the oil component of the tear layer. He supports the use of testosterone in the treatment of DES.

C.G. Connor studied the use of testosterone cream in DES. He found that testosterone cream, when applied to the eyelids, provided both symptom relief and an increase in overall tear production.
Additional Resources:
Testosterone: A Possible Treatment for Dry Eye Syndrome 2017-12-13T16:44:00+00:00

Testosterone: Friend or Foe?

Testosterone: Friend or Foe?

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


There have been few medical debates more contentious than the current controversy surrounding testosterone replacement therapy (TRT) and cardiovascular disease (CVD).

Two recent studies highlighted a possible, though far from probable, association between TRT and myocardial infarction (MI) or stroke. However, the Androgen Study Group (ASG), which was formed to respond to inaccurate attacks on TRT by the medical and public media, quickly discovered misreporting that resulted in two published corrections to one of the studies. With support from medical societies, researchers, and scientists around the world, ASG petitioned the Journal of American Medical Association (JAMA) to retract one of the misleading studies.

Dr. Neal Rouzier, a geriatric specialist who routinely prescribes testosterone to his male patients, has also been vocal in his criticism of the JAMA study. He reports that none of the 2,000 male patients he has treated with TRT experienced MI, and he maintains that 40 years of radiologic and laboratory studies demonstrate long-term protection against plaque buildup. Although low levels of testosterone have consistently been associated with an increase in CVD and mortality, Dr. Rouzier supports a cautious approach when prescribing TRT in older men with CVD or significant risk factors.

A new study, presented at the 2013 meeting of the European Association for the Study of Diabetes, found that low testosterone levels are associated with an increased number of acute MIs in diabetic men. Another recently published study found that older men who received testosterone injections did not appear to have an increased risk for MI. In fact, testosterone injections actually appear to be protective in men at high risk for MI. Clinical data compiled from 40 Low T Centers nationwide also found no association between TRT and MI or stroke.

Testosterone: Friend or Foe? 2017-11-20T10:57:22+00:00

Book Review – The Secret Female Hormone by Kathy C. Maupin, MD, and Brett Newcomb, MA, LPC

Book Review – The Secret Female Hormone by Kathy C. Maupin, MD, and Brett Newcomb, MA, LPC

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Dr. Kathy Maupin suffered greatly from the loss of testosterone when she had a hysterectomy and oophorectomy due to endometriosis. Replenishing with testosterone pellets has literally given her back her life. She writes passionately about what she and her patients have experienced when testosterone is restored. One of her goals is to enlighten other physicians about her practice model with the hope that more people get access to testosterone.

Dr. Maupin observed positive effects in many aspects after treating her patients for testosterone deficiency, including the following:

Loss of Libido

“Sex is science and not magic,” as Dr. Maupin asserts. Restoring testosterone relieves the loss of interest in sex, the loss of wanting to be touched, and the tendency to create grocery lists in your mind rather than enjoying intimacy. You can get it all back with testosterone restored.


Fatigue is at the top of the list of complaints that brings women in to see a physician. There are many causes for fatigue, including low testosterone. In addition, other complaints that contribute to fatigue (such as depression, hypothyroidism, hypoglycemia, and loss of interest in exercise) can be triggered by low testosterone as well.


Sleeplessness related to a testosterone deficiency occurs when there is a loss of deep sleep and dreaming, wakefulness in the early morning hours, and waking up feeling fatigued and not restored. Insomnia typically first occurs after the age of 35, just as testosterone levels start to drop.


Testosterone is responsible for the secretion of serotonin and norepinephrine, which helps mood, energy and focus. There are many other hormones involved in the manifestation of depression. Investigating hormone deficits, including testosterone, is essential for treating the problem at its core.

Migraine Headaches

Testosterone can cross the blood brain barrier and modulate the activity of the hypothalamus. Headaches may occur when the hypothalamus fails to produce its usual hormone stimulation. Often, other hormones deficiencies are also involved with migraine headaches.


When testosterone decreases, muscles shrink and less oxygen is delivered to the surrounding tissues. A “scarring” occurs in the connective tissue, leading to dimpling of the skin known as cellulite. Restoring testosterone can reduce cellulite.

Mental Acuity

Estrogen is well-known for improving memory, but testosterone also crosses the blood-brain barrier. Testosterone not only improves neurotransmitter production, it can also increase the number of brain synapses and brain cells.

Exercise Tolerance

As testosterone levels drop, exercise becomes more and more of a chore. The very thing that can increase testosterone production becomes more difficult. Testosterone increases blood flow to the muscles, increases uptake of the amino acid building blocks to restore tissue, and even helps clear out lactic acid, which is responsible for the pain in muscles experienced after overexertion.

Dry Eyes

A testosterone deficit may not be the only cause of dry eyes, but dry eyes become more prevalent as testosterone drops with aging, and this is especially common in women. Dr. Maupin found that systemic treatment with testosterone pellets often relieves age-related dry eye syndrome in her patients.


Although we most often think about estrogen deficiencies in relationship to loss of bone, Dr. Maupin writes that nothing helps restore bones as well as estrogen and testosterone used together. They are both powerful bone-building hormones.

Rheumatoid Arthritis

Testosterone can help reduce deterioration of the joints and balance overstimulation of the immune system, decreasing inflammation.

Systemic Lupus Erythematosus (SLE) or Lupus

This autoimmune disease is twelve times more prevalent in women than men. Dr. Maupin found that treating testosterone deficiency halted progression of the disease in her patients.


This autoimmune disease is also more prevalent in women. It is characterized by attacking the blood, and forming fibrotic and scar tissue. Testosterone helps relieve the scarring by reducing inflammation in the blood vessels.

Multiple Sclerosis

This autoimmune disease presents when the myelin sheath, which covers nervous system tissue, is attacked and damaged. Because testosterone can help modulate inflammation, it can help stop the progression of the disease or put it in remission.

Chronic Fatigue and Fibromyalgia

Both of these syndromes arise from a disordered immune system. Testosterone can help modulate both diminished and excessive immune system activity, and can be a key component in the treatment of either condition.

Dementia and Alzheimer’s Disease

Both estrogen and testosterone can have a dramatic impact on stopping the progression of these diseases. Early treatment seems to be a key factor of success.


This is the medical term for the muscle and tissue wasting and frailty that we associate with aging. The question facing Dr. Maupin was: Could intervention with hormones in the very elderly make a difference? Little is understood about first using hormones in the 80s but Dr. Maupin found, to her delight, that testosterone restoration could make an astounding difference in quality of life.

Insulin Resistance and Diabetes

Dr. Maupin writes that testosterone restoration can stop the progression of insulin resistance and forestall the development of diabetes.

Heart Disease

Both estrogen and testosterone restoration can help protect the vascular system against the damage that leads to plaque build-up and ultimately a stroke.

The Secret Female Hormone is a treasure about the very positive effects of identifying and treating testosterone deficiencies. Dr. Maupin is extremely excited about the results she sees in her patients in her clinical practice. Information is often presented in a theoretical fashion, but backed up with real life results. Unfortunately, many practitioners would not even consider that a testosterone deficiency could be involved in many of the diseases listed above. Perhaps after reading this book, they will.

In my opinion, the one thing this book falls short on is an emphasis on the importance of progesterone, especially in women who have had an oophorectomy. Progesterone has more than one target organ (the uterus); there are progesterone receptors throughout the body. Like testosterone, progesterone is a powerful neurosteroid and anti-inflammatory. Progesterone is a hormone that is usually produced abundantly in the adrenal glands and independently by nervous system tissue. Achieving a balance in hormones should always include the consideration of progesterone as well.

  • Maupin KC, Newcomb B. The Secret Female Hormone: How Testosterone Replacement Can Change Your Life. Carlsbad, CA: Hay House, Inc.; 2015.
Book Review – The Secret Female Hormone by Kathy C. Maupin, MD, and Brett Newcomb, MA, LPC 2017-12-14T12:26:27+00:00