22-05-2025
Canadian Sports Illustrated swimsuit model Nicole Williams English says she was 'literally crawling out of bed' before starting treatment for low testosterone
Nicole Williams English is back to feeling like herself again. The 41-year-old Canadian model recently told Yahoo Canada that she's prioritizing her health by working out regularly, eating healthfully and continuing hormone replacement therapy (HRT) for low testosterone. Williams English, who appears in the latest issue of Sports Illustrated Swimsuit, said she began noticing she was extremely run down when her daughter, India Moon, was about 18 months old.
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.
'I would get 10 hours of sleep and wake up feeling like I had one-and-a-half hours of sleep. I couldn't open my eyes. I was dizzy, I wasn't feeling myself,' she said. "…I was very moody. I was snapping at everybody in the morning. I wasn't depressed, but I was just kind of mad. Angry at everything. Everything was a catastrophe for me… I was having really bad anxiety.'
Williams English's husband, retired NFL player Larry English, put her in touch with a doctor based in Florida who ordered bloodwork and a full hormone panel. The results showed that she was low in testosterone, and would require daily medication to help balance her testosterone levels.
'I thought I would just go to (the pharmacy), get my iron pills, get my D3, but no. Until I did a deep dive and they really looked at my blood, I never would have known," she said. "I was literally crawling out of bed. I was really, really exhausted."
Now that Williams English has found a dosage that works for her, she has the energy to keep up with a toddler and continue to grow her career. But what is HRT and how do you know if you have low testosterone? Keep reading to learn more.
Hormone replacement therapy (HRT) is more than just a treatment option for women in menopause. Although HRT gained popularity in the '90s as a form of treatment to help lessen menopause symptoms — which greatly impact a woman's quality of life — its uses are not limited to treating brain fog, hot flashes and other side effects from low estrogen and progesterone. HRT can also be used for women with low testosterone levels. But it's not as straightforward as it may seem.
'Testosterone is a really important hormone in women… but it is one that has been poorly studied and really only focused on niche areas like libido and sexuality,' said Dr. Michelle Jacobson, an OBGYN and co-founder of Coven Women's Health, in an interview with Yahoo Canada.
While testosterone does impact women's libido, it also impacts things like mood, energy levels and bone and muscle health, as well as menstrual cycle and fertility.
Symptoms of low testosterone in women can include:
Decreased libido
Anxiety
Depression
Fatigue
Irritability
Trouble sleeping
Thinning hair
Muscle weakness
Jacobson, who did not treat Williams English, explained that the lack of quality information and evidence makes it difficult to measure and understand lower levels of testosterone in women, since women already naturally have lower testosterone levels than men. Without sufficient research, there's a gap in understanding what testosterone levels in women mean for their functioning and how they feel.
'We're left with many years of kind of poor evidence that don't really answer the questions that we should have been asking,' Jacobson said. 'So we don't have strong evidence to direct the use of testosterone one way or another.'
Although there are currently no Health Canada approved testosterone medications for women in Canada and no federally approved testosterone drugs for women in the U.S., Jacobson said healthcare providers can repurpose and prescribe testosterone medications that are approved for men at much lower doses.
HRT for testosterone can be in the form of gels and creams, injections, implanted pellets or oral medications. Although there are benefits to using testosterone HRT for women, there can also be side effects.
Potential side effects can include:
Acne
Oily skin
Excess hair growth
Weight gain
Male pattern baldness
Although some side effects are reversible with hormone level adjustment, there are some like deepening of the voice or clitoral enlargement that are permanent.
Blood tests can help determine if your hormone levels are low, however Jacobson noted it's important for healthcare providers to consider the patients symptoms and the potential benefits of testosterone HRT.
"We really need to figure out a way to meet in the middle in order to attend to not only the patients needs but their quality of life," she said. "So much of medicine ignores quality of life and focuses on what is medically necessary or indicated or contraindicated, but that informs a big part of function and compliance and well being."
There are many reasons why women can have low testosterone levels. Testosterone levels naturally begin to drop as women age, particularly around early menopause. However, certain medications, like birth control and acne medications or medications for hair loss can also lower the body's level of free testosterone (testosterone not attached to protein).
Women who have had their ovaries surgically removed or who live with polycystic ovarian syndrome (PCOS) can also have lower levels of testosterone.
There are multiple factors that impact testosterone levels, including lifestyle factors like poor nutrition, sleep deprivation, prolonged stress, substance abuse, alcohol use and smoking.
Outside of taking hormone supplements, Jacobson said there are things women can do to help naturally raise testosterone levels.
"Things that you can do to help improve your testosterone are to build more muscle mass and eat more protein," she said. "It's sort of a positive reinforcement feedback loop, and that's just outside of taking exogenous (external) testosterone."
