The female body produces several hormones:

  • Estrogen
  • Testosterone
  • Progesterone
  • DHEA-S/Cortisol
  • Thyroid Hormones

Healthy women are meant to have about 60% estrogen and 40% testosterone in their body.


Estrogen is a pretty amazing substance. Its prime role in the body is reproduction. Every month eggs in the ovaries mature and are ready for fertilization. Over our lifetime, the amount of eggs used and level of estrogen that decreases causing a woman’s period to become more erratic. When our periods finally stop and the ovaries retire, we are in menopause.

Estrogen has an array of other functions in the body as well:

  • It helps to prevent our bones from breaking down, keeping them strong,and works with testosterone to promote new bone growth.
  • It stimulates collagen growth and helps to keep cells hydrated, resulting in soft, supple, and healthy skin.
  • It facilitates proper communication between brain cells, keeping our mental function sharp.
  • It protects us from heart disease by improving electrical conductivity, strengthening muscle cells and increasing the heart wall function.
  • It also keeps our blood vessels flexible by promoting endothelial wall dilation within the blood vessels.

Without estrogen, our bodies start to age rapidly, outwardly and internally.

Estrogen evokes fear in many, including many medical professionals. There are many different estrogens, but for the sake of simplicity, let’s look at the three main ones.

  1. Estrone (E1) – This is a moderate strength estrogen made in our fat cells. E1 is weaker but more toxic, which is why more overweight women have more breast cancer.
  2. Estradiol (E2)- This is good, strong estrogen. It keeps us feeling great and healthy. This is the one we want to replace.
  3. Estriol (E3)- It is very weak and helps balance overall estrogen by blocking estrone’s (E1) bad effects on estrogen-responsive cells. In theory it is supposed to protect breasts.

In addition to having 3 different estrogens, women have different estrogen receptors on which the estrogens mentioned above work.

ER Alpha are the “stimulators” which cause growth in various systems in the body, including breast and uterine lining which can lead to cancer. 

Estriol (E3) and testosterone also decrease levels of ER Alpha and cancer.

ER Alpha signaling is increased by:

  1. Being overweight
  2. Eating a diet that is high in junk foods
  3. Increased levels of stress
  4. Exposure to synthetic estrogens
  5. Excessive alcohol consumption
  6. Low functioning thyroid
  7. Vitamin D deficiency
  8. Bad genetics

               All of these can lead to development of cancer.


ER Beta is the “dampening” which prevents uncontrolled growth of tissue. So ER Beta protects lung tissue, the ovaries, the colon, the immune system, the bladder, and the brain.

ER Beta is increased by eating certain foods: cruciferous vegetables (eg cabbage, brussel sprouts, broccoli, kale), phytoestrogens (soy), and also vitamins D and E.

Given this information, it makes sense that women with estrogen deficiencies need the good, well-balanced bio-identical estrogen.

Testosterone Helps:

  • Keep up energy level
  • Regulate mood
  • Keep our feminine shape
  • Burn sugar 
  • Keep weight off our abdomen and mid-section
  • Keep our breast tissue healthy and cancer free

In women, testosterone is made in the ovaries (90%) and the adrenal gland (10%).

What happens when testosterone starts to decline (this usually starts happening in our 30s)? Women start to become more irritable and moody. Some experience severe depression and anxiety. Women can become apathetic and unhappy.

Testosterone is Mother Nature’s serotonin and affects how our brain processes information and our feelings.

Testosterones Role in the Libido

Testosterone fires in the sexual centers in the brain and promotes the desire for sex. It makes the genitalia, particularly the clitoris, spark with sensitivity and pleasure upon touch. It helps with intensity and longevity and boosts the ability to climax more quickly. It helps with lubrication of the vagina and enhances pleasure. It also helps the uterus contract during orgasm, increasing the intensity of the sensation.

Testosterones Role in Normal Brain Function, Particularly the Executive Thinking Function

It helps us to retain information, drives our short-term memory and recall and the ability to process new abstract ideas. When testosterone levels drop, the brain gets foggy. Replacing testosterone helps to maintain the brain’s top performance.


Progesterone is related to estrogen and necessary to properly maintain our reproductive capability. High progesterone levels are thought to be partly responsible for symptoms of premenstrual syndrome (PMS) such as breast tenderness, bloating, and mood swings.

Estrogen stimulates growth of the uterine lining, causing it to thicken. If the egg does not implant, estrogen and progesterone levels drop, the endometrium breaks down, and we have our period. 

The estrogen and progesterone should be in balance. Progesterone protects the overgrowth of uterine lining and breast tissue.

During the perimenopause, testosterone is always the first to decrease, which causes symptoms from the fluctuating estrogen and progesterone levels even worse.

Thyroid Hormones

The signs of low thyroid include fatigue, weight gain, intolerance to cold, hair loss, muscle aches, constipation, irritability, depression, and memory loss.

The signs of high thyroid can also cause fatigue, along with diarrhea, intolerance to heat, sweatiness, nervousness, anxiety, high blood pressure, itching, irregular pulse, difficulty sleeping, and weight loss.

Low functioning thyroid, or hypothyroidism, is much more common than hyperthyroidism. Approximately 1 in 3 women and 1 in 5 men will have functioning thyroid (hyperthyroid) by the time they are fifty.

There are several thyroid hormones:

  1. TSH – thyroid stimulating hormone is made by the brain. It travels to the thyroid gland which is located in the front of the neck.
  2. T4 – made in the thyroid gland, T4 is an inactive molecule that needs to convert to its active form, T3. 

Every cell in the body has receptors that accept the T3 molecules. But if T4 does not convert to T3, the thyroid can make all the T4 it wants but it will never trigger the cellular response.

The Role of Androgens in Women

  1. Estrogens are the principal sex hormones responsible for female reproductive maturation and sexual characteristics.
  2. In women, the androgens testosterone and dehydroepiandrosterone (DHEA) play important physiologic roles in reproductive tissues, mood, cognition, the breast, bone, muscle, vasculature, and other systems.
  3. For women, 25% of androgen production occurs in the adrenal glands, 25% occurs in the ovaries, and the rest occurs peripherally. 
  4. Androgen levels decline with age throughout a woman’s life,starting in her mid-30s. Postmenopausal testosterone production still occurs in the ovaries and slowly declines. Ten years after the beginning of menopausal symptoms circulating testosterone are half of promenopausal levels.

Genitourinary Syndrome of Menopause

The common symptoms of GSM include:

  • Painful intercourse
  • Vaginal dryness
  • Vaginal irritation
  • Painful urination
  • Urinary frequency
  • Urinary urgency
  • Recurrent urinary tract infections
  • Alkaline shift in vaginal pH

Non-hormonal therapies, such as vaginal moisturizers and lubricants do not restore the integrity of genitourinary tissue. Androgen and estrogen receptors are present in the vaginal mucosa, muscle (vaginal urethral bladder), and blood vessel walls. In the vagina, androgens regulate vaginal mucin production, improve blood flow, and increase nerve ending density (sensitivity).


Hormonal therapies, including estrogen, testosterone, and DHEA, are safe and the most effective treatment for the symptoms of GSM.

Despite studies showing potential benefits in sexual health, no testosterone formulations for women have been approved for use in the United States for these indications. However, testosterone can be administered using compounded formulations: topical cream, oral, injections, and pellets. 

Oral testosterone undergoes first – pass metabolism in the liver and tends to be associated with a lot of side effects. 

Topical products should be applied to the inner thigh, buttocks, abdomen, or vulva and could be transferred during contact with another person.

Injections are intramuscular and give a fast increase in levels then a sharp drop when the effect wears off. This rollercoaster of levels can cause a lot of emotional and physical side effects.

Pellets are placed under the skin once every four months. They slowly release testosterone with a steady level of medication and no problems transferring to another person.

DHEA intravaginal 6.5mg – Prasterone is an FDA-approved vaginal androgen which improves local ex hormones.symptoms such as vaginal dryness and painful intercourse.