Extending and improving fertility is possible

We are all taught that there is little or nothing that can be done to extend the fertile years for a woman. This is incorrect. A woman’s fertility can be improved and extended. The key to understanding how to extend and improve the window of fertility in women is to understand that the ovaries, like all other endocrine organs, work in a feedback loop with the brain. In this feedback loop the brain senses if there are normal levels of ovarian hormones, if the levels are too low stronger signals are sent to the ovaries to increase production and if levels are too high weaker signals are sent out to the ovaries to turn down production.

The main sources of the sex hormones are the eggs in the ovaries and the adrenal glands. Around age 30 the level of sex hormones coming from the adrenal glands starts going down. The brain senses the drop and sends out stronger signals to the ovaries to kick up production to bring sex levels ups to normal. Since the ovaries have a limited supply of eggs there is only one way to make more sex hormones – to use extra eggs. If a woman could supplement her sex hormones with medication (healthy HRT) instead of getting the extra hormones needed from the ovaries then the egg supply should last decades longer.

Here is a graph that shows accelerated usage of eggs starting about age 37 years for all women. The red line shows how eggs are currently used to try to keep hormone levels normal. The blue line is how much longer the ovaries should last if the extra needed hormones came from medications instead of from extra eggs from the ovaries.


Too little hormones causes reduced fertility and causes the ovaries to fail decades too soon

With recognition that lower than normal hormone levels of any of the ovarian hormones causes illness, it is easier to understand the name for this illness, hypogonadism (pronounced hi-PO-go-nad-ism).

While both men and women begin to experience hypogonadism at about age 30, women have the unfortunate experience of an accelerated version. Unlike men who will have a slow, gradual decline of hormones over 30-40 years, women have a steady and swift decline over 10-20 years.

Left untreated hypogonadism will continue to advance in both women and men to a more severe illness called profound or advanced hypogonadism also known as menopause. Left untreated hypogonadism will take a toll on your health and fertility. Like high blood pressure it will harm your health whether you feel it or not.

Why does hypogonadism advance more quickly in women than men?

The answer is in the math. Quite simply, women have a set number of eggs to provide hormones and fertility. Starting at about age 30, as hormone levels begin to drop, the pituitary, the master gland in the brain, notices the drop and increases signals to the ovaries to produce more hormones. This stronger signal from the brain causes the ovaries to turn up the production so more hormones are made.

Ovarian eggs are the source of ovarian hormones so producing more hormones means using more eggs.


Since there are only so many eggs in the ovaries and new ones aren’t made, eventually the eggs all get used. The ovary empties and literally runs out of eggs and can no longer provide the hormones necessary to keep a woman healthy. Peri-menopause is the time the ovary accelerates it use of eggs and menopause is when the ovary has run out of eggs.

If a woman supplemented her low hormones rather than the ovary providing extra hormones by using extra eggs, her ovaries wouldn’t empty as fast and would potentially postpone running out of eggs for many years. Continued hormonal production means the elimination or significant reduction of menopausal illnesses like osteoporosis, breast cancer and dramatic loss of sexual function and response.

Are women being denied full use of their ovaries?

Supplementing testosterone started around age 30 years could help a woman’s hormone levels decline at a slower rate meaning her ovaries could last her into her 70’s or more. Interestingly, it is about the same time men’s gonads start to significantly reduce production of hormones.

Unsupplemented hormone levels

Supplemented hormone levels

Ovaries work 24/7, all day and every day, not just once a month

Ovaries are working all day long, every single day of the year. Like the beating of the heart, the ovaries never take time off. Ovaries work to provide their hormones so every organ in your body can work better. Ovaries work until the day they run out of eggs.

Treatment for hypogonadism will improve health and may extend fertility

The best thing a woman can do to preserve her health and fertility is to maintain normal levels of her gonadal (ovarian) hormones for her entire life. So instead of the ovaries recruiting extra eggs every month to keep levels up in the normal range she can use hormone supplements to provide the extra ovarian hormones her body needs and conserve her eggs for later use. Working together with her ovaries, instead of her ovaries doing all of the work alone, may help the ovary use its eggs with normal recruitment instead of accelerated recruitment, perhaps helping them last decades longer.

Supplementing ovarian function theoretically should be able to extend the life of ovaries and fertility until the mid 40-50’s. There are charts that you can use to confirm that your ovaries are using their eggs at a slow, steady pace instead of an accelerated pace. To monitor your success you will need to obtain an ultrasound to measure the dimensions of the ovaries. Once you have the dimensions of your ovaries you can compare their size to a chart that can predict when the ovaries will run out of eggs.

What you have the power to do

The reality is that hypogonadism is a real and treatable illness. It should be your choice to seek treatment or not.