Alvin Pettle, M.D., FRCS(C) (OBS & GYN)




 In 1996, Dr. Susan Rako wrote a book entitled “The Hormone of Desire,” referring to the use of transdermal testosterone for women.  Please refer to this book if you wish more detailed discussion of the bio-identical hormone testosterone.


            When patients come to the “Ruth Pettle Wellness Center” (a clinic my wife, Carol, and I named in memory of my late mother), they will have a hormonal assessment through either blood or saliva testing.  Our clinic approaches women’s wellness with an awareness to prevention as well as treatment of women’s issues.  The patient and the clinic explore all available natural options of bio-identical hormone replacement. 


Carol, who is a Registered Nurse, and I also discuss with the patients an over-all preventative look at wellness including exercise, nutrition, vitamins, minerals, and herbal and homeopathic remedies.  We attempt to assist each patient to find their optimal natural personal balance needed to navigate life in a healthy body, mind and soul.  This often includes prescribing the use of  transdermal testosterone cream.


            Testosterone is both a female and male hormone, although men produce about ten times the level of women.  All women have a measurable free testosterone blood level of .1 to 9 [PMOL/Litre]. The total testosterone in their bodies is less important, because only the free testosterone is available to attach and effect the appropriate receptors in the female body.


            One of the scientific observations that has been made is that if you swallow any hormones, such as estrogren (i.e., birth control pills, synthetic HRT), the hormone goes “first pass” through the liver before being transported to the body.  The liver responds to oral estrogen by producing Sex Binding Globulin (“SBG”) which transports estrogen, but also attaches itself in the blood to free testosterone and therefore lowers the sex drive of women.   For this reason, I discourage intake of oral hormones.  We strongly recommend that hormones be absorbed through the transdermal route, which eliminates the “first pass” phenomenon through the liver, and allows direct use to the body without the SBG downside effect.  (Other effects of oral hormones will be discussed in another article.)


            Prescriptions for transdermal testosterone start off with a very low 2.5 mg. dose, applied in the morning only below the waist.  Testosterone is an energizer, so is best taken early in the morning.  It is applied along the pubic hairline or inner thighs or on the clitoris, as the side effect of hair growth, if it occurs, will then be less noticeable.  Local application is more effective with fewer adverse side effects.  It is recommended that blood levels be tested after an interval of four to six weeks, on a day when the patient has applied the cream.  If not effective on one daily dose, we gradually increase the dose to twice daily and/or increase the individual dose levels from 2.5 to 5 or 10 mg per dose as required to bring the individual woman’s levels into normal range for them.




 Nature often is particularly unfair to women when it comes to the balance of their hormones at menopause, and this is certainly true for testosterone. When a woman ceases regular ovulation, she no longer produces the natural progesterone to help produce her ovarian testosterone levels.  During her reproductive life, a woman’s natural production of progesterone and testosterone is the underlying biochemical reason why “a man looks better to a woman when she ovulates.”  That is, a man is more sexually attractive at the time of her ovulation, when progesterone production is at its highest levels because testosterone is produced naturally from that progesterone. Enhancement of sex drive is a complicated balance, and increasing testosterone is not the only requirement.  The healthy and respectful relationship of the couple is always the most important aspect of sexual response.



Use of natural testosterone has many other proven additional advantages, including:  (i) bone density improvement;  (ii) increased muscle strength and tone;  (iii) increased sense of personal well-being; and (iv) greater self-confidence and assertiveness.  Negative side effects which may occur include:  (i) possible hair growth where cream is applied; (ii) in 25% of cases, a possible elevation of total cholesterol and LDLs (reverses on discontinuance); and (iii) aggressiveness.


            Most women continue on testosterone cream once they have established their personal comfort level dosage.  Often they will ask their partners to have their testosterone levels evaluated as well (Dr. Greg L. Pugen 416-638-4757).


            With patients who have had an estrogen receptor positive breast cancer, I prescribe methyl testosterone cream in one tenth the dose.  This synthetic form of testosterone cannot be transformed by the body into estrogen as readily as natural testosterone.  Prior to prescribing testosterone to a patient who has had breast cancer, I would have advised the use of natural progesterone to balance their natural hormones.  This was also the recommendation of the late Dr. John Lee in his book, “What Your Doctor May Not Tell You About Breast Cancer.”  Use of natural progesterone transdermally, and also the use of vaginal estriol   (E-3, the safest form of estrogen), can and should be used for these patients to rebalance their natural hormones to healthy natural levels.  Studies show that progesterone protects you [Chang, 1995]. (Future articles will discuss breast cancer prevention.)


            Some women avoid intercourse because they experience pain (dyspareunia).  Treatment in these cases includes use of natural vaginal estriol cream (.5 to 2.0 mg per dose), which should be applied around and into the vagina before sleep every two to three days.  This will encourage the body to produce natural lubrication and is extremely safe, as only 15% of vagainal estrogen is absorbed by the body, and estriol is the safest of the three forms of estrogen.


            Testosterone is the key hormone when it comes to thinking sexually, and it  will enhance the female orgasm.  Therefore, I agree with Dr. Susan Rako that “Testosterone is the Hormone of Desire.”