Testosterone (FMV urine, menopause)

Like estrogen and progesterone, testosterone normally declines with age. However, because women make testosterone in the ovaries and the adrenal glands, a low level of testosterone could indicate a problem with the function of either organ. Estrogen replacement therapy can also lower the level of testosterone.

If your testosterone level is low for your age and menstrual status, then you could be experiencing symptoms of low testosterone including:

- Decreased libido
- Muscle weakness
- Fatigue
- Depressed mood
- Weight gain

Testosterone also has some health-protective roles after menopause and low levels can increase some areas of health risk including:

- Bone loss/osteoporosis
- Muscle wasting/sarcopenia
- Obesity
- Depression
- Heart disease

Potential ways to increase testosterone:

There may also be some ways to boost testosterone naturally, including:

- eating a more balanced diet focused on fresh foods

- avoiding overeating

- avoiding obesity

- doing regular exercise

- getting plenty of sleep each night

Some foods can boost testosterone because they are high in certain vitamins or minerals, such as vitamin D or zinc, which are associated with increasing testosterone. The following foods can boost testosterone levels:

- Asparagus
- Beans (white/kidney/black)
- Pomegranate juice

Depending on your age, consider testosterone HRT or supplements that support low testosterone symptoms include Zinc, Maca, Tribulus, and Shatavari. If there are no symptoms of low testosterone, also carefully look at the 5a-metabolism and testosterone's downstream metabolites, 5a-androstanediol and 5b-androstanediol to confirm a low androgenic state.

If you are of Asian descent: 

There is a very common genetic variant in this population that, if present, disallows much of testosterone from being converted into the water-soluble form found in urine. Actual testosterone levels, if this genetic variant is present, would be better assessed in a blood serum test (ideally total and free testosterone). This variant metabolism has no known clinical impact and impacts testosterone, 5a-DHT and 5b-androstanediol. It is not known to impact epi-testosterone, 5a-androstanediol or ther androgens as they are metabolized by a different enzyme.

If your testosterone level is very low (less than 1 ng per mg):

Androgens (DHEA and testosterone) in women help with muscle and weight maintenance, memory and brain function, mood, libido and a sense of wellbeing. If testosterone is very low, or low but without symptoms of androgen deficiency, it is best to test serum levels to confirm before starting a treatment program due to the potential of falsely low urinary testosterone. Lifestyle and diet modifications alone could be helpful to increase androgens such as:

- weightlifting

- high intensity interval training

- DHEA or TRT (testosterone replacement therapy) if appropriate and indicated. 

- Tribulus, shatavari, maca

- Mitochondrial support and/or zinc

While low testosterone can contribute to health concerns, exceptionally high levels of testosterone are more often a health concern for women, particularly during their reproductive years. A high level of testosterone can occur for several reasons, the most common being polycystic ovary syndrome (PCOS).

PCOS is one of the most common causes of infertility in women, affecting about 27 percent of women of childbearing age. Although it runs in families, it is unclear whether PCOS is or is not a genetic disorder. PCOS is closely related to insulin resistance and metabolic syndrome. Although many women who have PCOS focus on irregular periods and fertility, PCOS is a condition that lasts for life. 

Symptoms of high testosterone in women:

- Hair loss on the scalp
- Excess body hair (especially upper lip, chin, chest and abdomen)
- Infertility
- Acne
- Oily skin
- Increased body odor
- Sleep disturbance
- Irritability, aggression

Causes of high testosterone in women:

- There can be several mechanisms at play, but one of the most common causes of elevated testosterone levels in women is Polycystic Ovarian Syndrome (PCOS).
- Insulin and blood sugar dysregulation. Chronic insulin overstimulation can trigger ovaries to produce testosterone. 
- High inflammation

How to treat high testosterone levels:

- Peppermint anad spearmint [L, L]

- Green tea (it increases Sex Hormone Binding Globulin "SHBG", a protein that grabs onto excess testosterone.)

- Eat fresh ground flax seed (in your morning musli for example). Flax seeds are a great source of anti-inflammatory omega-3 fatty acids and have been shown to also raise SHBG. [L]

- Decrease overall inflammation and stress (regular sleep, regular meals, excercise, yoga, etc.)

- Saw Palmetto

- Zinc

- Cruciferous vegetables such as Broccoli, Brussels sprouts, Cauliflower, and Cabbage (they contain DIM)

- Licorice root [L]

Other references:

- https://www.ncbi.nlm.nih.gov/pubmed/22293900

- https://www.ncbi.nlm.nih.gov/pubmed/23568953

- https://www.ncbi.nlm.nih.gov/pubmed/30770069