Let's Talk Testosterone
Dispelling some myths
One of the most common questions I get from my clients is about whether or not testosterone therapy will help with body composition. As with all things hormone therapy, there is a lot of conflicting information.
Testosterone is traditionally thought of as a “male hormone”, however, it plays important roles in sexual function, mood, muscle, bone, and metabolic health in women. The ovary produces half of a woman’s testosterone, and the other half is produced by the adrenal glands. Physiologic levels of testosterone in reproductive-age women are 1/10 (20-60ng/dL in most US total testosterone assays) of physiologic male levels. During perimenopause and menopause, testosterone production shifts toward the adrenal glands as the primary producer of testosterone as ovarian function returns to quiescence beyond menopausal onset. As a result, total circulating testosterone decreases with age.
The physiologic changes in muscle and bone are complicated during mid-life because changing estrogen dynamics during this stage of life also impact muscle physiology, so parsing out the specific effects on body composition and lean mass related specifically to testosterone compared to those specifically related to estrogen is extremely difficult, since these hormones are changing simultaneously during the perimenopause and menopause transition. Layer onto that differences in baseline muscle mass, body type (ectomorph, mesomorph, endomorph), fitness level, and athletic activities, creates a highly variable situation where generalizations are impossible to make.
Fortunately, the peer-reviewed literature lends some clarity in some key areas:
Testosterone therapy targeting blood levels in the female physiologic range has been shown to be safe and effective for low libido (hypoactive sexual desire disorder) and overall drive in menopausal women. Favorable data is emerging in the perimenopausal population as well.
Testosterone therapy dosed in the female physiologic range has little impact on lean muscle mass/body composition. Much higher doses (approaching the male physiologic ranges) are required to appreciably impact lean mass and muscular strength. However, higher doses of testosterone can be accompanied by side effects, including hair growth, male pattern balding, irreversible voice changes, acne, insulin resistance, and rarely, enlargement of the clitoris.
Resistance training/intense exercise results in transient increases in testosterone levels surrounding training sessions, but has little impact on resting testosterone levels, particularly in women. Males appreciate a greater testosterone response to exercise than females. However, these transient elevations can be beneficial for supporting muscle, bone, and metabolic health, along with other factors.
So, where do we land on this? The time-tested, most effective way to support muscular health and function and the development of lean body mass that promotes metabolic health is through regular and varying exercise, appropriate fueling with adequate total caloric, carbohydrate, and protein intake, and adequate recovery.
Hormone therapy (estrogen, progesterone, and testosterone) plays a critical role in “setting the stage” to help make these workouts happen by treating symptoms such as hot flashes that interfere with sleep, resulting in sometimes debilitating fatigue, supporting healthy libido and drive, and that “mojo” that helps you push limits. These things matter because this is what gets us out of the starting gate to making those changes through exercise, nutrition, and recovery. This distinction about what hormone therapy effectively does is important because knowing the roles that all of these “tools” play can affect meaningful and sustainable change.
Today’s workout is one of my favorite weight-training workouts because it targets upper and lower body strength, has an element of real intensity, and is incredibly efficient, requiring minimal equipment. This workout travels well because it can be done with a single set of dumbbells.
Today, we are performing the chest press and the front squat. Ideally, this workout is done with 2 different weights. However, if you have only one set of weights available, no problem! If your bench press weight is too light for your front squats, simply double the front squat reps with that same weight!
Warm Up
4 Rounds – light load
*1 round = Up-downs, then push-ups, then air squats
Movement Practice
If you have the available equipment, choose a barbell for one movement and dumbbells for the other. Both options should be on the heavier side with the goal of doing all 5 reps unbroken, but reps 4 and 5 are VERY challenging.
If you do not have a barbell, use dumbbells for both movements and choose one weight that is challenging for both. Do not change weights between movements as there is not enough time. Take 5-10 minutes to practice 3-5 repetitions per movement to find the appropriate weight.
Modification: If you do not have heavy weights available, use lighter weights and do a “tempo” sequence for the movement with a slow count of 3 in the direction of resistance and a count of 1 to release for the 5 repetitions.
Workout
EMOM 20:00 (every minute on the minute x 20 minutes). Set your SmartWOD app for EMOM (1:00) x 20 minutes or set a 20-minute timer. On even minutes, perform the bench press. On odd minutes perform the front squat. Use a barbell or dumbbells for either or both of these movements. THESE SHOULD BE ON THE HEAVIER SIDE! Reps 4 and 5 should be hard but not ugly. All repetitions should be done unbroken.
Minute 1 (and odd minutes) – 5 dumbbell or barbell flat bench presses (rest for the remainder of the minute)
** If you don’t have a flat bench, do the dumbbell presses lying flat on the floor.
Minute 2 (and even minutes) – 5 heavy barbell or dumbbell front squats
TIP! Avoid the need to change weights each minute due to time constraint. If only one sent of weights is available, find your heaviest bench press weight. If this weight feels light for your front squats, then DOUBLE the front squat repetitions!
Cool-Down
Enjoy this 15-minute post-workout stretch that will help your upper and lower body on its way to fast recovery
NOW TAKING NEW CLIENTS!
If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!
It is with great excitement that after more than 2 years of preparation, I have FINALLY launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.
Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists. We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!
You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!