Fertility and Hypogonadism

Starting around age 30 women are encouraged to no longer postpone childbearing. The reason given is that as a woman ages through her 30's into her 40's her fertility will continue to decline, along with her ovarian function, until she suffers ovarian failure (menopause) and is no longer fertile. This is true if nothing is done. The reason that ovarian function and fertility continue to decline is an illness called hypogonadism, which starts at about age 30 in both women and men. Hypogonadism (hypo-meaning less than and gonad meaning ovary or testis) occurs when any of the many gonadal hormones (dhea, estradiol, testosterone, progesterone, and others) drop below normal levels. Since the gonads of women (ovaries) and men (testes) produce all of the same hormones it is diagnosed the same way in both women and men. That is, if you are looking for it.

Fertility goes down because the ovaries are being over stimulated. Increased FSH (follicle stimulating hormone) is produced by the brain to increase production of deficient hormones. The increased FSH over stimulates the ovaries and causes the eggs to mature too fast. Maturing too fast can cause chromosomal problems which can lead to an increased risk of birth defects or cause the pregnancy to fail long after fertilization. Additionally, inadequate amounts of progesterone may be produced thereby making the uterus inhospitable to implantation.

Rising FSH not only causes the eggs to mature too fast, but also causes more eggs than usual to be used every month. Using more eggs than usual means the ovaries will run out of eggs and fail sooner than they have to because the ovaries only have a fixed amount of eggs. This causes ovarian failure to occur before it has to. Scientists have calculated that if the usual number of eggs were used every month, instead of the increased amount from the increased FSH as a result of untreated hypogonadism, then the ovaries would last into a woman's 70's. Treating hypogonadism in women means an opportunity to remain fertile longer, perhaps until about 50 years old. Then, even after the ovaries would no longer be fertile, they would continue to function and spare women the devastating health effects of untreated chronic profound hypogonadism (menopause).

Hypogonadism is treatable. Treatment would reduce FSH levels by restoring normal levels of the gonadal hormones so the feedback loop between the gonads and the brain is normalized.

How can you do this?

First, recognize that you are treating a real illness, hypogonadism.

Second, understand that testosterone plays an important role in helping eggs mature at a normal rate. Testosterone is one of the gonadal hormones that begins to drop below normal levels in women and men starting about age 30. Supplementing testosterone can help normalize the gonad-brain feedback loop. Bringing levels of testosterone up to normal will prevent a higher FSH, maintaining it at normal levels.

Third, understand that progesterone also has an important role in helping eggs mature at a normal rate and helps assures implantation. Supplementing testosterone can help the ovaries work better which in turn helps produce more normal levels of progesterone.

Through my research foundation I have seen women who were told they were infertile become pregnant once they started on a very small dose of testosterone cream, 1-3 mg daily. The National Institutes of Health has also started testing this theory. It takes over 3 months for eggs to mature and one study done by the NIH demonstrated that supplementing testosterone for only 1 month was not enough.

The gonads, like any organ, if given what they need to function, will function better and for a longer time before they fail.

Women should not have to adhere to outdated expectations of when to have children. Women can remain fertile longer, if given the opportunity. Testosterone is not the only gonadal hormone in the brain-gonad feedback loop but it is an important one. Using testosterone cream in a dosage that raises levels to normal would not hurt a developing fetus as long as bio-identical hormones are used.

Maintaining normal levels of gonadal hormones can help to normalize ovarian function which also gives the entire body the benefit of ovarian hormones. You'll be healthier for it and may even improve and extend your fertility.
5/20/2009 7:07:19 AM
Beth Rosenshein
Written by Beth Rosenshein
View Full Profile Website: http://www.diamondrf.org/

My gyn told me that FSH & LH would not go down with BHRT. Would you mind posting something about this, please, so I can take it to him? Recently my primary care (who I adore) turned me down for testosterone saying that the role of testosterone in female health remains unproven. Again, what can I show her? Or where can I find a hormone expert in Los Angeles? I like my primary care. I just need someone for BHRT. Plenty of people say they do it but they aren't experts.
Posted by Priya
Hi Beth, I can hardly hold the tears of joy in right now at having found your site and you. I have been searching for a reason to keep the hope that some day I might feel better and be able to reverse the effects of the hypogonadism which I have been experiencing for quite some time now. About a year ago when I was told by my OB/GYN that my FSH was very high and I was in menopause, I refused to accept that diagnosis and began to furiously do research on the internet. I was 40 at the time, and while I know that is not exactly young, I thought there must be something I can do. After days of research I came to the conclusion that I had likely developed hypogonadism due to prolonged (12 years) use of opioids. (which I took due to joint pain from lupus) After many years of mild menopausal symptoms, I noticed some improvement when decreasing the opioid dosage. (I actually conceived a child at age 39 but miscarried at about 7 weeks). Last year I read that DHEA supplementation could help women with high FSH. So I tried that and it worked. My FSH's which were usually in the 30's and 40's dropped to 10.3. A pretty dramatic improvement! I see that you recommend testosterone supplementation. My question is that, since DHEA is a precursor to testosterone (or at least that's how I understand it), could it be as helpful as testosterone for hypogonadism? Or should I consider changing to testosterone supplementation instead of DHEA? Thank you so much for putting this information out there! There are so many older women desperate to conceive who are having such difficulty. I hope word can spread to all of them that there is hope, and I hope every last one of them can find a physician who can assist them with treating this condition. THANK YOU! THANK YOU! THANK YOU!! :) Sherri
Posted by sherri90036
Dear Beth, I’m so happy and grateful for all the research you have done about the area of ovarian function. I need desperately your help. I’m only 30 years old and suffer already about ovarian dysfunction and fear premature ovarian failure. I don’t have any baby yet. Please help me to extend my fertility. My Anti-Müllerian hormone level is about 1,00 µg/L (7,13 pmol/L) FSH 11,8 UI/L LH 5,1 UI/L Total Estradiol 91 ng/L (334 pmol/L) Total Testosterone 0,2000 µg/L (0,69nmol/l) Progesterone 0,6 ng/mL (1,9 nmol/l) Thanks a lot - very kind regards Isa
Posted by Isa2009
Dear CarolAnne11, I’m glad to hear that you are taking control of your health and looking into the best treatment for yourself. If you have any questions on transitioning from your ovaries providing your ovarian hormones to using products to replace your ovarian hormones, please let me know. Thanks, Beth
Posted by Beth Rosenshein
I am so grateful that you are explaining this in clear terms. This answers a lot of questions for me. I agree completely with you that the medical community has not treated this condition properly. Mostly male practitioners have made menopause into an untreatable medical condition when it is something that should be addressed. At 48 I'm looking into this, on Prometrium, and probably looking at Estrogen replacement down the line. However, my hormone issues [endometriosis in 20s, chronic fatigue 30s] have never been correctly addressed through the medical establishment.
Posted by CarolAnne11