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.