we have data in men specifically that men with the lowest amount of testosterone have higher risk of depression and dementia

All right, so stop telling me testosterone doesn't help mood, y'all. This is a very large retrospective study looking at questionnaires filled out before treatment with estrogen, progesterone, and testosterone. Significant increase and improvement in mood, like by around 40%.

They work in the brain. They're not just for libido. They're not just for hot flashes. They help your brain function. And where does mood come from? Brain function. Louise Newson, Dr. Sara Glynne, and her team because I'm so sick of hearing that it's not for mood. Here you go.

We were only talking about testosterone for libido, but the research is really emerging often from Europe showing that there's many more benefits of testosterone, that there's some mental health benefits to it, that there's bone strength benefits to it. And so, it's exciting to see that emerging research.

Which is a mood. So when people say it doesn't help mood, but it helps libido, I'm like, you just said two opposite things. You don't you don't get to be right in all of those things.

I feel like my job is that I save marriages and I save jobs and mental health. We save mental health. Yeah, definitely a lot of women just present with anxiety right? And they they were never anxious before and uh they find that it's debilitating.

I had a woman who stopped vaping when we got her hormone doses like dialed in cuz she's like I just don't need it anymore.

Why are we waiting for depression and anxiety? Why are we waiting for diabetes to happen?

The research is really emerging, often from Europe, showing that there's many more benefits of testosterone, that there are some mental health benefits to it, that there is bone strength benefits to it.

I can remember being in perimenopause right sitting at home on my couch and I'm talking to Charlie I'm with my partner and I'm like, 'Holy shit, I'm having an anxiety. Something's going on. I'm having anxiety.' Like here I am a therapist. I know all about this polyvagal theory. And I'm like, 'Wow, this is just wildly uncomfortable.' And then, you know, when all that went away is whenever I started on the testosterone, the anxiety just was gone.

I have seen deprescribing data on anti-depressants. The data shows you're more likely to be able to get off the anti-depressants once you've added testosterone to your pet regimen than just estrogen alone.

Low testosterone in men is associated with not only osteoporosis, but depression, earlier death and dementia, I think also Parkinson's and diabetes.

One in four midlife women in America are on anti-depressants despite the risk of bone loss and reduced libido. New data shows more women can come off their SSRIs by adding testosterone than by just using estrogen alone.

New data shows more women can come off their SSRIs by adding testosterone than by just using estrogen alone.

Luis Newsome's clinic just published a paper looking at testosterone for mood, energy, being treated for like depression, right? Like there's so it works in the brain.

Libido is a mood, right? Where is libido located? It's located in the brain. This is where our libido, our sex drive, comes from, right? Not our elbow, not our heart. So, libido is a mood. Testosterone helps moods.

when you turn yourself on with testosterone, you have to know that it comes with all the things, not just this amazing sex life, right? It also comes with the ability to argue better and be passionate about all of the things in all the ways.

In 1985 a double-blind randomized control trial found that surgically menopausal women randomized to testosterone alone or testosterone combined with estrogen had more energy, improved well-being, and greater improvements in somatic and psychological symptom scores compared with women treated with estrogen alone or a placebo. Don't tell me there's no data on testosterone in mood. That's a paper from 1985, that's 40 years ago.

In 2006 a 24-week double-blind randomized control trial assessed the effect of adding synthetic testosterone... to venlafaxine in 72 women with post-menopausal depression. A trend towards increased remission rates was observed in each treatment group relative to venlafaxine plus placebo. That means hormones did better than venlafaxine alone.

Our results suggest that testosterone therapy also benefits mood and cognition and may be useful adjunct to estrogen and progestogen therapy for perimenopausal and postmenopausal women with neuropsychiatric symptoms. Further, testosterone therapy may obviate the need for higher estrogen doses in women with persistent menopausal symptoms after initiating HRT. Maybe you need a little bit of everything instead of a lot of one thing, seems like a no-brainer.

All nine cognitive and mood symptoms significantly improved across the study period. Mood improved more than cognition: 47% of women reported an improvement in mood versus 39% reported an improvement in cognition. They had a 34% versus a 22% decrease in mean symptom score respectively for mood and cognition. Regarding libido, 52% of women reported an improvement, mean symptom score decreased by 33%.

The three symptoms most likely to improve were loss of interest in most things at 56% of women reporting an improvement, crying spells, and loss of interest in sex. Memory problems were the least likely to improve at 34% of women reporting an improvement.

The prevalence of moderate to severe cognitive symptoms decreased by 31% versus moderate to severe mood symptoms decreasing by 37% versus moderate to severe loss of interest in sex decreased by 42%.

Cognitive and negative mood symptoms were highly prevalent in this real-world cohort of 510 perimenopausal and postmenopausal women despite use of estrogen with or without a progestogen for at least three months. Transdermal testosterone therapy for four months was associated with significant improvements in all mood and cognitive symptoms. They had reductions in both symptom frequency and severity.

Overall mood improved more than cognition: 47% of women reported an improvement in mood versus 39% of women reported an improvement in cognition. 37% of women with moderate to severe mood symptoms reported an improvement versus 31% of women with moderate to severe cognitive symptoms.

Testosterone improves mood in many people, many different domains of mood and cognition. Improves mood more than cognition. Doesn't help everybody.

If I had a dollar for everybody who said you can't use hormones for mood. And I'm like I'm like tell me anything like even antidepressants. The nothing's FDA approved for {quote} mood. Like mood is very vague. But what is more fulfilling as a doctor for a patient to come back and say, I feel like myself again?

I've seen these people be able to get off of their psych meds.

Mood is vague. Feeling like yourself is vague. You're never Are you going to wait around for the FDA to approve testosterone for feeling more like yourself? Like you know, it's never going to happen.

Libido is a mood. Mood is mood is from the brain. So, testosterone acts in the brain. So, testosterone is a brain hormone. It helps with mood. Libido being one of them.

it's very very unusual for somebody to just have a distressingly low libido in pure isolation. Like I've never seen that. I mean, because everything's all mixed up together, isn't it? I mean, you're like, if you're feeling fantastic, you're likely to have a libido that's great for you. If you're feeling terrible in every other sense that your libido is likely to go hand in hand with that. So, you can't it's impossible to just kind of pick one small factor in isolation.

libido is a mood where do where do moods come from moods come from the brain okay so what you're saying is testosterone improves moods in the brain

if testosterone improves libido AKA changes your mood how come you say it doesn't work on your brain

and to all the people who are like we just have evidence for libido what's libido it's a mood moods are in our brain it's a brain hormone like you don't have to go like that's not even like one step separated right it's not like a jump right right that that's what we're saying it helps libido therefore it helps your brain

They're doing studies for sarcopenia and mood in Australia right now. There's some heart protective benefits and there's a lot of data showing protective against breast cancer. There is some breast health stuff with testosterone that's super exciting. I'm like why aren't people looking at that more? This is a fear disease. So yeah, I think testosterone's we're at the beginning and I'm excited to be part of the story.

don't think that just increasing your testosterone is going to change the stress, the lack of downtime, the stress, the lack of self-care, the health issues that all are wrapped up in the biopsychosocial model of human sexuality.

Progesterone is like the mellow thing and then testosterone is like the rage thing.

And I saw Dr. Cara said this on the FDA panel. He's like, 'Testosterone gives energy back.' And I'm like, here we are in mainstream medicine actually validating and we know this biologically testosterone helps mitochondria. Mitochondria is energy.

But I see it poo pooed so much. But it's like this is what these hormones do. These hormones make mitochondria function, which is energy. So, it's this I'm just noticing this the poo pooing of like helping people feel like themselves or like but we especially testosterone for women it's for libido not for energy and I'm like it still helps mitochondria function. Where do you think energy comes from? Like it comes from functions of the cell.

Exactly. So testosterone plays a major role in energy levels, right? It's not as simple as low testosterone equals tired. It affects multiple systems. Your muscle mass, your red blood cell production, your mood, your motivation, even your sleep quality. So, when you're thinking about testosterone supports muscle and mitochondrial function, so you get physical energy. It supports red blood cell production, so you get increased oxygen delivery in your body. Neurotransmitters like dopamine, that's your motivation. So, when levels drop, men and women can feel both physically and mentally drained.

testosterone is a motivation hormone

hormones can help you support you to lift heavier to motivate you to get to the gym

Your experience writes the play. I love that estro and testosterone increases mood and energy.

And I hate that testosterone's gotten stereotyped as libido. I think there's at least eight issues with that, but it's number one just how the body works, right? Like you don't have this like secret organ that's just for having sex and it's like one inch big and it's on the left side of the like like it's insane to be like just for libido like it's just for your left thumb of like libido is libido is a motivation.

Why did they ask for a promotion? It's a motivation towards something. This is a neuroendocrine drug that is a motivating thing, which is hard to study and it's hard to x-ray. It's like, how do I know Joanna isn't motivated today?

I want to run after my grandkids. Like I want to have energy and live a vibrant life and so what can I do? I think a lot about this like what can I do in my 30s, 40s and 50s so I can live the life that I want in my 70s and 80s and and that's a lot of what menopause care is quite honestly.

We can tell like you're on hormones, right? There's this vitality, there's this like speed of movement, there's this like effervescence of energy, right? They're not they're not worn down.

Another woman's like, 'I don't know if testosterone is really working, but I've had like several days of complete invincibility.' And I'm like, 'Okay, we're going to say that testosterone is further away.'

I had a gynecologist she did a bilateral oophorectomy with a hysterectomy in a woman in her 70s and you would assume and think like the ovaries aren't doing much right and she's like this woman literally hit a wall like she could hardly get out of bed. Like it was above and beyond what like surgery, you know, surgery is a hit and takes a while to recover. She's like, 'This woman acted as if I put her into menopause.' She hadn't had periods for decades, but she acted as if I put her into menopause that day from the surgery. Do you think I should put her on some testosterone? And I'm like, 'It's not going to hurt her. Put her on the testosterone.' She's like, So, she did. And she's like, 'She came back, man.' And so for us to assume that the ovary is doing nothing.

This is how you're sleeping. This is your energy. It hurts when you sit.

Women come back saying different things: I can finally make gains in the gym, I'm sleeping better, does help hot flashes a little bit, helps mood a lot. A woman's like I just want to kind of get up and do stuff my house again, I kind of want to like get up and get my to-do list accomplished.

surgical menopause takes out the entire Factory so it tends to be a little more dramatic... even after your period stop your ovaries still makes some testosterone... I've seen a woman she's been in menopause for 10 years then she gets her ovaries removed and she's like this is awful I can't get off the couch I have no energy I'm crying all time I'm foggy

a physiologic dose certainly lower above zero which some women do have zero testosterone but it reinforces that testosterone's not just for libido it's an important and certainly heart health behooves Sexual Health right if you don't have endurance it's hard to be athletic in any sport

you see enough 80-year-olds in clinic you get pretty damn good at who's coming in on hormones and who's not... you get the 80 year old coming in and sneakers in a hoodie finishing pickle ball... you're not curious that she's on testosterone estrogen and progesterone... it's a secret to vitality

sometimes all we hear is that somebody just doesn't feel as energetic as they once did, or they're fatigued, but it has a whole host of effects. And so the idea of testosterone therapy is really to bring people back to feel how they used to feel if what their problem is is hormonal.

the only legit reason for a woman to get testosterone is low desire... it's absolutely insane that that is the only reason you can get testosterone it's to sleep with another human... people that have normal levels of testosterone... they have more energy they feel better they sleep better they have better muscle mass... there's so many benefits.

Testosterone is just approved for desire. It's not really been shown to do much else for women as far as our health. Now, there are some people that say, 'Hey, it helps my energy. It helps my stamina and all of that stuff.'

there are other benefits like maybe an additional help for to prevent osteoporosis perhaps just vitality zest energy for life your drive

They've done lots of research looking at is there a role for testosterone in bone health, muscle growth, the overall feeling of get up and go wellness, the spark.

when the hormones exit when we live longer than our ovary hormone production things happen and sex is something that changes whether it's just pelvic dryness or desire or the brain or just focus focusing or being able to get sleep

I'm on oral estrogen, oral progesterone, and I have a testosterone pallet. And it has changed my life. I don't think that I would have been able to write a book and build my career to the level that it is now and have the focus to build a platform and speak my truth if I hadn't have access.

If you read the male data on the risks of low testosterone and the risk of depression and dementia, and then you think that doesn't apply to female brains. Like, neurons are fundamentally the same people.

And now you're telling me there's something that's cheap, fantastically safe, has data in men that it decreases the risk of depression and dementia, and we're not curious about this?

Testosterone is insane for its neurocognitive benefits. And I mean the aches and pains like people's bodies just don't hurt anymore.

Hormone shift, estrogen and testosterone are anabolic, they fight catabolism. And in the brain, catabolism can look like reduced repair and more oxidative stress.

I think testosterone is the missing link for dementia is multifactorial, don't get me wrong. Like, you better be exercising. You better not be drinking alcohol. But I think testosterone is a missing link for dementia. And that paper just helps emphasize it to me of like why does removing your ovaries after menopause put you at higher risk of dementia? Cuz now you make less testosterone.

From a biological point of view, the connection between hormones and the brain has been hiding in plain sight. And they talk about testosterone being produced by both men and women, which is very, very nice. So, proteins sensitive to estrogen are found scattered across many important regions of the brain. And studies have shown that hormones that this hormone can enhance memory formation, recall, decision-making, and problem solving. Progesterone and testosterone, meanwhile, exercise a calming effect via interactions with the brain region called the GABA receptor complex. I just love the economist that they're talking about this.

Proteins sensitive to estrogen are found scattered across many important regions of the brain. And studies have shown that this hormone can enhance memory formation, recall, decision-making, and problem solving. Progesterone and testosterone meanwhile exercise a calming effect via interactions with the brain region called the GABA receptor complex.

And my favorite, that scene from the Wizard of Oz where it goes from black and white to technicolor. That's my brain on testosterone.

Dementia is the fifth leading cause of death in women. An autopsy study showed that higher brain testosterone correlated with less dementia.

They start businesses. One said, 'My math is back.' Another, 'The German I learned as a kid has come back.' And my favorite, you know that scene from The Wizard of Oz where it goes from black and white to technicol? That's my brain on testosterone.

An autopsy study showed that higher brain testosterone correlated with less dementia.

there is a study that shows for women at high risk of dementia the APOE four carriers that low testosterone is associated with increased rate of dementia.

Testosterone specifically supports gal cells, which are the supporting cells to the neurons. And so like we have all this basic science and I'm like I'm to the point of like the basic science researchers have to be like rolling over in their beds being like what the f are we doing all this basic science for if you're not going to use it in clinical practice of like every piece of basic science says estrogen and testosterone protect nerves.

Estrogen, testosterone, progesterone all stimulate the little olodendrittes, which are the brain cells that produce myelin. So, we got, as you say, the basic science is there.

Testosterone improves libido and vulvovaginal health, has anti-inflammatory, cardioprotective, bone protective, and neuroprotective effects in men. Testosterone deficiency is associated with fatigue, depressed mood, and cognitive impairment. If you have low testosterone and you don't get it treated, your risk of dementia is higher in men. I think that it's no different in women, we just don't have the data.

I'm like with all the female testosterone research I've done, I'm like you guys this is a brain protective drug, prove me wrong. It absolutely is. We've got all the bench-top research what testosterone does, the male studies, the rat studies, all the things. We just haven't researched it in women because people are like obsessed with estrogen in women.

In 1988 a small randomized control trial demonstrated a decrease in cognitive symptom scores following bilateral oophorectomy that was prevented in women treated with estrogen, testosterone, or a combination of both hormones.

More recent randomized control trials have demonstrated a beneficial effect of transdermal testosterone on learning and memory both in women using and not using concurrent estrogen.

In this pilot study, use of a transdermal body-identical testosterone for four months was associated with significant improvements in cognition and mood in a real-world cohort of perimenopausal and postmenopausal women. This supports the notion that testosterone has neuropsychological benefits beyond libido and signals the need for further research.

Should every woman use testosterone? No. That's what gets me a bad reputation. Somebody's like you want every woman to take testosterone. I'm like I have never said that. I support a woman's interest in trying testosterone, but it won't help everybody with libido. Do I think it's probably going to help? Do I think testosterone has a role in dementia prevention? Yes. Does that mean I think everybody should be on testosterone? No. It's your body, your choice.

There's testosterone receptors in the brain of all all genders.

One of the biggest complaints that I get in post finasteride patients is brain fog. Like I can't I just wake up and I just can't find words and I don't remember things and I'm not as quick as I used to be or sharp as I used to be.

Can you push the testosterone up or what do you do? Sometimes yeah, that's one thing that we try to do.

Suddenly you have these young totally normal sexual functioning guys being like, wait a minute, like I can't get an erection anymore or like I don't want to have sex anymore or I can't get my school work done because I can't concentrate anymore.

everything comes back to testosterone in my world um let's go back to the to premin the conjugated equin estrogens there is a a a thought in the menopause world that perhaps the benefits of the brain specifically on the women who were taking conjugated equin estrogen was better than estradi on the brain and we don't know why that's but this is what I've heard is it possible because there's some androgens in there am I making too big of a leap because I'm just excited

I'm a big testosterone proponent for all bodies at this point. The effects on the brain, the female brain with testosterone, is insane. They're like it's only for libido, and I'm like where does libido come from? The brain, right? This is a brain hormone. That's why we have a libido is because the brain's functioning. And like memory, recollection, curiosity... somebody's German they learned as a child has come back since starting testosterone. Like the brain is waking up on testosterone. And to me, there's not enough studies, and women don't want to wait around for studies. They want to feel like themselves.

I think the male testosterone data is a lot stronger, there's just more of it, probably a gender bias. I think Lisa Mosconi's 2023 meta-analysis looking at estrogen early for prevention... again, hormones prevent, hormones don't treat. I think that paper is people are being way too quiet about it. People are sitting around like we don't have anything FDA approved for prevention, and I'm like we can't sit around and wait for the FDA to approve something. It's going to be years and billion dollar studies. What where have you gotten with the role of hormones for... we'll just narrow it down to brain prevention of debilitating diseases.

I think testosterone's the missing element for dementia like I will go that far. We've got the data in men, we've got the data in frailty, we have a new paper got published looking at phosphorylation of the tau protein specifically in women who have the APOE4 allele for Alzheimer's disease.

when I put women on testosterone and they come back the stuff they tell me like one woman was like the German I learned as a child is coming back like this is a brain hormone... people say I'm more Curious my husband says I'm asking more questions I actually done around the house... of course libido's good... I actually see results in the gym... it's not just libido

there's about two papers on this... women on testosterone have a 50% decreased risk of breast cancer... bone health mus muscle lean body Mass brain we have dementia data in men... testosterone is heart protective... cognitive benefits just women saying like I can think sharper I have more interest in the world

we've got data on older women testosterone in mood, cognitive ability, visual spatial improvements, and from there I extrapolate and just listening to women come back on testosterone like testosterone is a brain drug ... I guarantee you there's dementia improvements with prevention with testosterone

the weird thing about taking testosterone as a female to normal female physiologic doses not any higher not to man doses the unique thing about taking testosterone and giving testosterone as a physician to women is really the only legitimate reason right now is low sexual desire which is silly because testosterone's not just in our bodies for libido it's in our bodies for all the body things reminder we have more testosterone in our bodies in our 20s and 30s than estrogen you just don't know that because we gendered hormones but the interesting thing is when women come back after having been on testosterone the stuff that comes out of their mouth on the effects on the brain is absolutely fascinating and mindblowing I'm more curious about the world I'm asking more questions the world seems like it's in color more I can do math better I'm being able to pull up the second language that I used to be able to speak the word

women in their 20s for example when they have a lot of estrogen at some points in their cycle still have more testosterone in their body than estrogen we have a lot of testosterone we have one tenth the level of testosterone of men but we still have a lot of testosterone but what we did is we said that's the male hormone estrogen is a female hormone so we have very little data on the role of testosterone number one in people who have periods but number two postmenopause and the role of testosterone on muscle mass bone health brain health and sex drive so right now we have enough data to say that testosterone supplementation postmenopause is indicated for low desire you usually take it for three to six months it's slow going and if it doesn't help for your your sexual desire after that then stop it because low testosterone wasn't the reason for your low desire

What it actually cares about is whether you have enough of these things to protect your brain, your bones, your muscles, your mood, your libido.

Because these secondary hypogonadism, low libido, not feeling like yourself, decreased energy, are the exact same reasons we consider testosterone in women and men.

It plays a role in desire, energy, motivation, well-being.

So, when a woman says, 'I don't feel like myself anymore.' That deserves as much attention as a man gets and a full evaluation.

There's a fundamental disconnect in how the system works and what people want. I think about that a lot with testosterone, right? Like it fundamentally improves quality of life.

Ask her what she thinks about stopping hormones. I always say or people tell me all the time they can tell who's on testosterone, women, right? That there's like a certain look of women who are on testosterone and they look a little happier than everyone else.

I have So like my rough study is I know eight people who started businesses since starting testosterone. And people are like, you can't tell you can't say you can't say women start and I'm like, Yeah, no, I've heard that too. I mean I've heard that they got started on testosterone. They definitely feel really good and you know, feeling really good enables you to do a lot of things.

I think if I had to choose because my sexuality and my sex span, which is lengthening my health span and it's building muscle and it's making my libido strong, I might choose testosterone if I had to. And I think what I like about it the best of all those things isn't even any of those things. ... It gives me balls. How many women have started businesses after starting on testosterone?

women don't come back and they're like testosterone only helps me with libido. Like it's a brain neurochemical helps with like the the I feel more like myself is absolutely huge. You'll never get an indication for that. But it helps for more than just libido.

Once I got to the levels I wanted to, I was like, 'Oh gosh, wow, do I feel different.' And same with testosterone.

Women never come back to see me after I give them testosterone and say this only helps with my libido. Usually it's many other mood, cognition, energy, and really the classic feeling like myself, which is not a medical term. It's very hard to measure, but a very common thing that women say is I just feel more like myself.

your quality of life matters. Your energy matters. Your sex life matters.

Where's libido? Libido's in the brain. Testosterone works on the brain. You give a woman testosterone she'll come back she might say my libido is better or it's not and then she'll say but I feel better. I had a woman last week... she said you know that part in The Wizard of Oz where you go from black and white to Technicolor she's like that's what my brain does on this... she's like the world is interesting again.

I always check blood beforehand and then just to know where you are and then I check it in about six weeks... most women just get a very nice physiologic dose where they're like it's subtle but I'm glad I'm on it some women will be like I'm back baby... a lot of women will be like I feel more like myself again it's a brain hormone so feeling like yourself is very hard to study but I would say when the most important things we can do is to feel like yourself again

people come back and they say I'm more like myself I feel like myself the veil's been lifted I can think sharper I can do math better Western medicine does not care about quality of life and it's very hard to measure how do you measure you feel more like the self you used to know it's very hard for studies to measure that and I think that's why we're not getting traction with hormones but I would argue if a physician's job isn't to make some feel more like the them that they know what is more important than that

transdermal testosterone dosed in a normal premenopausal range improves sexual desire and reduces sexually Associated personal distress in naturally and surgically menopausal women with hsdd with and without concurrent estrogen and progestogen therapy it also improves the frequency of satisfying sexual events arousal orgasm frequency pleasure responsiveness and self-image

More and more people think there's a huge role for quality of life low libido in post-menopausal women.

We took patients that had metabolic syndrome and we did lifestyle, diet, exercise plus or minus testosterone in two different groups again and we saw significant increases in weight loss and reversal complete reversal of metabolic disease in the patients that you did the testosterone to versus just the lifestyle diet and exercise alone.

And I would say hormone replacement. We've got data for testosterone cuz the pelvic floor and core strength. We've got data for vaginal estrogen.

women on testosterone at 6 months after a frail fracture, 50% decreased risk of needing a cane or walker.

Can a woman get muscles if she takes testosterone? I'm like, 'No, not if she doesn't exercise and feed them.'

People who were on PET therapy, progesterone, estrogen, testosterone, aka hormone therapy, lost 35% more weight with Tzepide than if they were on trizepide alone.

Testosterone helps musculoskeletal aches and pains a lot.

Does testosterone also help with bones? Yeah. So testosterone is anabolic, which means it's a builder. So it builds bones. We don't have great recent data on it because nobody's been studying testosterone. But we do have older data on it and it does in the estrogen testosterone arm. They rebuilt better than estrogen alone.

Testosterone, I think, out of all of them can increase weight. And I'm not talking like 30 pounds here. I'm talking like 2 to 10, right? So, testosterone actually increases lean body mass. And that weighs something.

We have several studies looking at estrogen testosterone together has better bone density improvements than estrogen alone

conversely testosterone systemic testosterone there's at least two papers looking at testosterone and stress incontinence that it helps stress incontinence and I know several people whose stress incontinence has gotten better on systemic testosterone therapy

I don't think we have that much data and I can give you hormones and you will not grow any muscles if you don't feed them properly and weightlift them properly hormones don't work in a bubble you got to have resistance training as part of exercise

I saw a woman yesterday wheelchair multiple Cor morbidities and she grabs on to she knows how to get around her house by what she can grab on to right like she's literally a hip fracture away from being institutionalized and I'm looking at her with my hormone lens she's there for a completely different Urology issue and I'm like have I lost my freaking mind that I want to put her on testosterone and like this we care a lot about this like you know young menopause and get on the horn prevent the horn but I'm like can I talk for a second about the 78-year-old who's maybe got a couple of years and I'm trying to just not get her fall to fall like the role of hormones and I would say testosterone more than estrogen just CU I've seen that data more looking at fraility

We've got some studies showing that estrogen plus testosterone has better bone markers than estrogen alone.

Do I think giving women testosterone to stave off sarcopenia is going to work? Absolutely not. It won't do anything if you don't behave in a way to create muscles in your body.

I think there's going to be more and more out there with testosterone as far as bone density and muscle. We do not know enough about the role of muscle and longevity.

Testosterone is very interesting because some people's sleep gets better and some people's sleep gets worse. So make sure you're taking it in the daytime, not at night is one thing if you tend to be somebody who gets, you know, energy from your testosterone. That would be my first thought. But yeah, some people will say like nothing got me sleeping like testosterone did and then other people say it makes me not sleep. So we need more research on that for sure.

testosterone works well for Sleep

I don't have a lot of studies on testosterone and sleep but somebody should do that

Vaginal estrogen and DHEA reduces urinary tract infections like nothing else. 50 to 60%.

Sometimes you need an androgen. Sometimes you do need DHEA. Sometimes you need it on the vulva if that's where the pain is.

Estrogen and testosterone receptors are everywhere in the body. Toenails, ears, brain, hair, everywhere.

If we look at at certain studies, women with lower testosterone levels tended to have more autoimmune disease. I mean, hormones definitely play a role in all of that.

But we try. We try with DHEA, estrogen and testosterone to try to bring it back. Do those women need both systemic and local hormones for maximum return to normalcy?

If we have two association studies, so they're not these are not strong studies. They're association studies looking at women who are on testosterone have less stress incontinence. And we have zero other medical.

Hormones are really good for the eyes. Testosterone actually is very good for the eyes. And so there are several studies showing that hormone therapy decreases the risk of macular degeneration.

I would like to see more data on the role of testosterone in hair growth, specifically eyebrows. Highly interested in that.

Another line of evidence, this one is a pellet data. So this treatment with subcutaneous 17 beta estradile and testosterone pellet in perry menopause was shown to prevent or reverse collagen loss. So very cool.

I think people don't understand the role of testosterone and pain receptors. Like we've got data looking at migraines are less when people have higher testosterone. There was just an abstract. ... Testosterone correlated with the risk of Parkinson's disease.

Testosterone correlated with the risk of Parkinson's disease.

There's a couple of papers on incontinence for stress incontinence for testosterone. Certainly off label, most people do not know about those papers. I know several people whose stress incontinence has gotten better when being on testosterone.

Use it or lose it is a myth. Anybody telling you you need to put something in your vagina to prevent atrophy, that's a myth. There is some data, a new study, that if you take a vibrator and you put it on the outside of the vulva, not putting anything inside the vagina, just outside of the vulva, I think it's 5 to 10 minutes three times a week just sitting chilling vibrating the vulva, it actually improves lichen sclerosis, it improves atrophy scores on exams by trained people, decreases intimacy, increases sexual function.

the changes on the pelvis the vulva the clitoris the labia the vagina that happens because your testosterone and your estrogen go low

can testosterone help you climax yeah a lot of people on testosterone say it's just easier to have an orgasm just happens faster

intermittent hormones can actually improve migraines. There's data for testosterone, there's data for estrogen.

Testosterone works quite well in uh decreasing pain.

just in case anybody is confused we do have lots of data on women and testosterone not just for low desire so if you're somebody who's telling women that there's no data on testosterone number one you're not looking for the data on testosterone or number two there's some reason you are telling women that there's no data there's data a lot of it's pellet data because it's hard to research something we don't have an FDA approved medication for but we've got data just look it up we've got brain it helps hot flashes it helps tons of testosterone studies looking at volar Health uh testosterone plus estrogen is better than estrogen alone looking at bone health there's tons of data stop telling women there isn't

I do love the intravaginal DHEA it makes pelvises beautiful

we do have some data on systemic estrogen, some studies on systemic testosterone as well, but those are not FDA approved for the treatment of bladder leakage

I put her on estrogen testosterone cream so it's compounded I kind of wanted to kick start the blood flow with a little bit of testosterone.

one study shows that women with higher Androgen levels have less work-related neck and shoulder pain than women with low Androgen and differing levels of testosterone may explain some of the gender related differences in pain perception. can you supplement that testosterone and improve the pelvic pain has anybody played with that?

Women should have had access to this decades ago. We've been studying testosterone in women since the 1940s. So, here's some more data when everybody says it doesn't work or it's just placebo or it only works for desire. No, orgasm is the big winner here.

Androgens matter. Testosterone isn't just a male hormone. It plays an important role in vulvovaginal and urogenital health.

Maybe we just give it to people when we give them antibiotics, especially in perimenopausal women. Because of the women tested, most had low free testosterone. Women deserve answers beyond your culture is negative.

The range that we have in the big labs in America for women is so narrow. Don't go above 40. Look at the normal data, look at the libido data. The high-step study that was published in JAMA which had hip fracture 73 year olds, they titrated testosterone to get them between 100 and 140. Here we are being like, 'Oh, a woman's got 47.'

Testosterone is the most important biomarker, one of the most important biomarkers of a man's overall health. You should all be going and getting an annual screening of your testosterone, men and women, to look at for your overall health as a marker.

if your mother-in-law has a 50% decreased risk of needing a cane or a walker at 6 months and the medication is safe and effective and cheap, it seems like a no-brainer.

This is a swearable offense. So, a clinician of mine, a friend, tried to prescribe Intrarosa, which is an intravaginal DHEA product. Chef's kiss, it's in the guidelines for GSM, genitourinary syndrome of menopause.

How come we have six different types of Viagra? How come we have over a dozen different types of testosterone? How come we had an incorrect box warning on vaginal estrogen for 25 years?

Because you could go to a country where hormones are over the counter and buy whatever you want. If you really want to do, you can get testosterone in the airport in Mexico, my friend. Next to your cheeseburger and ceviche.

When a woman in midlife has low estradiol, low progesterone, low testosterone, hot flashes, insomnia, brain fog, joint pain, low libido, vaginal atrophy, mood changes, we call that what it is in literally every other organ system, hypogonadism. When testes don't produce testosterone, we treat it. When thyroid doesn't produce thyroid hormone, we treat it.

I think there's a difference between normal range and optimal function and it really you know, there's a lot of impact it has on the way that women experience midlife and quality of life.

I do refer out for topical estrogen. and I'm a huge fan of it and you know DHEA suppositories if people don't want to use topical estrogen.

For those of you who don't know, PET is the new nomenclature for HRT. PET meaning progesterone, estrogen, testosterone, or precision endocrine therapy.

The other thing I asked for is when we get a female dose testosterone to have it FDA approved for hypogonadism to not have low libido or hypoactive sexual desire disorder be the indication because for two reasons. Number one, insurance often has exclusionary riders on sexual health, which is fine if your Viagra costs $2, but it's not fine if your testosterone formulations are hundreds of dollars.

Fasttrack female dose testosterone under the new FDA commissioner's national priority voucher. It meets all four criteria. Clarify and simplify regulatory guidance so companies can make costconscious medications based upon strong established safety data. Approve it for hypogonatism, not low desire. work with the DEA to declassify lowd dose testosterone for women. The Olympic doping scandals of the 1980s shouldn't dictate hormone access in 2025. Testosterone is the most abundant gonatal hormone in the body and women deserve access. The science is solid and the need is undeniable.

So, everybody deserves a healthy vagina. I would say estrogen, vaginal estrogen or vaginal DHEA for all post-menopausal people with vaginas is where we should be.

Australia has like three times the amount of people on hormones that America does. And Australia has androof, which is a female dosed testosterone product. It's a cream and so does New Zealand and so does South Africa.

Testosterone's been trending down since your 20s. So, by and large, testosterone's low for the majority of people in pmenopause. And I think more and more, me and the menopausy, like the pe the experts are, and this is not just America, this is the experts. We're treating pmenopausal people with systemic natural hormone therapy. So, estradile, progesterone, testosterone.

The FDA has rejected two attempts at female dose testosterone, not because the products didn't work, but because they cited insufficient safety data, a legacy of the WHI backlash. But testosterone has been used in women since the 1940s. And trans men receive 10 times the dose.

Testosterone stereotype is that it's just for libido. It's a halftruth.

Approve it for hypogonatism, not low desire.

going back to like a woman getting brave enough to ask for testosterone and then the physician asking them, 'Are you sexually active with a partner and declining her hormone that her ovaries naturally make because she doesn't have a partner?' Like, it reeks so badly of I won't give you a checking account or a mortgage because it's the 1950s because you don't have a man involved in your life. Like, it reeks of that and it really bothers me. We're not letting a woman replace them unless she has a partner in her life.

When I was in Australia, seemed like everybody was on vaginal DHEA. You guys have Intrarosa or progesterone just like we do. But unlike America, you guys are actually on this product. And so at some point I was like, why is everybody on vaginal DHEA here? And they're like, cuz it's only $40 a month here.

It's amazing that go to their find a provider. These are people who not only care about your sexual function, but also understand the role of testosterone in desire and mood because they're part of the international guidelines. Yes, there's international guidelines on how to dose testosterone properly for women, which will be coming your way more and more as we're getting closer and closer to an FDA approved female testosterone dose.

And keep in mind, one-third of women don't have a last period because they have IUDs and ablations and hysterectomies. So, the fact that there's a hard line in the sand that you have to wait till menopause to be on testosterone makes no sense. Number two, testosterone is a slow linear decline from your 20s. Again, there's no cliff that falls off at menopause. Physiologically, biologically, it makes no sense. Many, many women are on testosterone in perry menopause. And again, age ain't nothing but a number.

I'm looking forward to a time, not so far in the future, when we have an FDA approved female testosterone product because number one, it's going to legitimize the conversation that ovaries make testosterone and testosterone declines and testosterone is a brain chemical neuro hormone.

that I talk about how vaginal estrogen and DHEA are female Viagra, but they prevent urinary tract infections. They are better than Viagra.

There is no data to show that vaginal lubricants and moisturizers help with urinary tract symptoms and urinary tract infections. It makes very bold statements about breast cancer about saying that there is no evidence linking low-dose vaginal estrogen to the development of breast cancer and in patients who have a history of breast cancer we recommend low-dose vaginal estrogen in the context of multidisciplinary shared decision-making. This guideline it says the word androgen... it's at least eight times it's mentioned throughout the guideline. In multiple statements, it talks about how vaginal DHEA, which is the only FDA approved product that has androgen in it, is just as good for all of these pain with intercourse, urinary symptoms, and UTI prevention.

I do a lecture that I talk about how vaginal estrogen and DHEA are female Viagra, but they prevent urinary tract infections. They are better than Viagra.

if we're like hey go get treated with hormones so your sex life is better. That's kind of an understatement of like what's possible.

what we have the most data on for anything for testosterone is low libido and there's a reason for that it's because the FDA said hey we'll approve this for low libido so then the companies did the research for low libido which is complete gender bias because men get to have testosterone approved for low hormones which is what I think women should get testosterone approved for is low hormones libido is One symptom of low hormones in men and I believe libido is One symptom of low hormones in women but that's the only indication we're going to get from the FDA

the FDA has undo gender bias against Some Humans

women's testosterones going to get approved for low libbido and it's like it's not even it's not it's missing the whole point that this hormone is naturally occurring in our body and is used everywhere in our body and that the libido is a brain mood so of course testosterone's in the brain right and it's infuriating the gender bias or sexism that's coming in what these hormones are approved for

even the guidelines for low libido for testosterone for low libido which supports testosterone for low libido says you know an indication is postmenopausal low libido and it's like then you don't understand that testosterone starts going down in the 20s and it has nothing to do with your last period nothing to do with your last period And so it's like these artificial lines in the sand of like well if you're if you're 39 you can't have testosterone but let me know when your period stop so you can have testosterone it makes no sense

once you see that you have 50% of your testosterone at 40 than you did when you were in your 20s and realize really what the benefits of testosterone are... testosterone's got its own host of things

some people do need the Androgen that's provided by the Intrarosa which is intravaginal DHEA

the only reason a woman can get testosterone is to sleep with another human it's absolutely crazy I know... people that have normal levels of testosterone have more energy they feel better they sleep better they have better muscle mass

why can't we talk about bone health why can't we talk about our brain why can't we talk about cardiovascular events why can't we talk about the fact that getting diagnosed with breast cancer sucks but it has a 90 stage one breast cancer has a 98 relative survival to people who do not have breast cancer at five years so we do need to think about brains and bones and sleep and all the other things but it was very interesting the argument that we have to give men with low testosterone testosterone to protect their bones like why is that not the primary argument it certainly gets drown out when we're talking to women

vaginal estrogen cream does not give you orgasms on the general so vaginal estrogen cream restores blood flow collagen tissue resiliency can help with sensation all of those things can lead to ease of orgasm but you can't be like I'd like the vaginal estrogen cream to have an orgasm it's not how it works

so many of us think so rigidly and I want to again life coaching expand the view of like could I be thinking about this too rigidly to the point that it's actually you know not helping me right so like so women will like swear off of estrogen after like trying it for a couple of weeks and being like no no I just you just didn't have the right dose or the right formulation or you know went in too fast after not having estrogen in your body for a couple of years

you don't need progesterone if you don't have a uterus that one's easy you don't need to be on testosterone but you can it's a little harder to come by a doctor who's going to prescribe testosterone they have to be comfortable with that there are national guidelines international guidelines on testosterone at this point if you go to ishwish the guidelines on dosing testosterone for postmenopausal women for low desire so what you do i would get that paper and bring that paper to your doctor so that's my step one and it is you can get a testosterone two different ways there's no fda approved testosterone for women for women's dosing so we use the male dose which is one tenth the dose which is dirt cheap because it's one tenth the male product so test them on one percent you dose it instead of one packet a day which is the male dose it's one packet dosed in ten days so one packet should take you ten days to use always check your testosterone before you get started so you know where it is check it after three months to see if you need more or less depending upon your symptoms again no fda approved indication except for low desire in postmenopausal women but a lot of women on testosterone say they feel like themselves they feel energetic they've got their muscle mass back they feel more vibrant women have testosterone and that testosterone goes down with menopause we just don't talk about it as much it is not as researched

dhea not any great data to say that it does anything for you. it might cause harm, it might convert into estrogen or testosterone and give you more issues. testosterone topical - for women it's one-tenth the dose, it's dirt cheap.

if you do the fda approved test them mail formulation divided by 10 you're looking at a 300-day supply for about a hundred and forty dollars so i just dropped your cost by a factor of 10.

75% had pelvic floor hypertonicity or spasticity. And among the premenopausal women who had hormone testing, almost all had low free testosterone. Low free testosterone. This matters because the vulvar vestibule, the entrance to the urethra and the and the bladder are all hormonally responsive tissues.

We have androgen receptors on almost every organ in the body.

testosterone helps glial cells which are the support people for the marathon of the neurons. It helps myelin sheaths and estrogen and testosterone help mitochondria

my thoughts on a compounded estradiol testosterone for the pelvis, both the external and internal genitalia, thumbs up. But, don't call it a troche because to be pedantic, it's not what it is.

Androgens, which are testosterones and androgen, increase your serotonin and increase your dopamine.

Androgens make nitric oxide and prevent dopamine uptake. So there's more dopamine around in the brain.

Understand how testosterone fundamentally works which is neuronal support muscle support, bone support. Like it's a brain neurohormone.

These tissues needed estrogen. They also need androgens and testosterone and we can get into DHEA but it helps flexibility of the tissue like stretching, elasticity, blood flow which is arousal. Blood flow is arousal. ... I mean it's not every woman but some women they'll start on vaginal estrogen and they'll be like my desire is back because sex is great again.

After menopause, estrogen production from the ovaries ceases, shifting the burden to peripheral tissues like the skin. Specifically, peripheral tissues convert DHEA into estradiol and estrone postmenopause. All of these act through estrogen receptors.

I see that especially in dosing testosterone of like if you have high sex hormone binding globbulin, maybe you're going to need a slightly higher dose of testosterone just because we kind of need to push more through because you've got so much of the protein that's hanging onto it.

Anything that supports mitochondrial function, which estrogen does, our mitochondria are covered in estrogen receptors, probably progesterone receptors and testosterone receptors, too. Mitochondrial health is the key to longevity.

I recommend DHEA. It is chef's kiss for beautiful tissues down there because DHEA is a precursor hormone that changes to both estrogen and testosterone. And yes, all bodies have testosterone. Makes for beautiful, healthy, functional pelvis.

the clitoris loses its blood flow when our testosterone and estrogen goes down amazing study giving women testosterone and actually ultrasounding their clitoral artery watching it dilate

This means testosterone can help menopause symptoms. So, no. If anybody says, 'I want to give you testosterone because it's just going to convert to estrogen.' Yeah, some of it will convert to estrogen, but that's not why testosterone's working. Testosterone's working because you have testosterone receptors everywhere. Because you have a body that has testosterone receptors everywhere because you have ovaries that make four times the amount of testosterone compared to the amount of estrogen that you make. Nobody knows this.

we do have observational studies looking at older women postmenopause those with higher natural testosterone these are not being treated or supplemented but women with higher natural testosterone levels seem to have a lower risk of major cardiovascular events and that's published and some stud show that make a good point that it's really low testosterone closer to your endogenous levels meaning your natural what your natural levels were in your body as opposed to high levels so it's a great example of more doesn't mean more doesn't mean better right and so we want to make certain that we understand kind of what that what that level is and and so far the data does seem to be showing that high levels is not what we should be aiming for in women

estrogen in the vagina creates an acidic environment... facilitates a lactobacillus which creates lactic acid which creates an acidity in the vagina and that actually acts as a barrier like a moat between rectal flora and the bladder so when you lose your estrogen you lose your normal microbiome

hormones like testosterone might be a pathway for exploring how nurturing versus erotic systems can be up or down regulated due to our behaviors so fascinating with us

We need to normalize it because we know that lower testosterone levels have higher rates of all cause mortality, but it doesn't mean it's a save all be all. It's not the end all catchall for something. It's one of the pieces of the pie.

Fast forward to today. Women ask about testosterone, a hormone their body naturally makes and declines with age, made in their ovaries nonetheless. And they're told, 'You'll grow a beard.' Same fear, same tactic, same complete lack of evidence. ... I know men men that can't grow beards. Pants didn't ruin women, bicycles didn't ruin women, and physiologic testosterone isn't going to turn you into somebody you don't recognize. You are not broken.

It makes me think about the studies we have looking at decreased incidence of breast cancer in women who are on testosterone pellets. And there's a couple of studies. There's like a three-year study and there's a five-year study comparing it with national SEIR database incidence of breast cancer. And off the top of my head, it's looking like in these studies, testosterone decreases the risk of breast cancer by about 30%.

We have more testosterone in our body than estrogen. Testosterone is the most abundant sex hormone in women.

Remember, transoral testosterone does not increase stroke risk.

There's more data on the safety of estrogen post breast cancer than testosterone. There's just less bad press against testosterone. See an expert.

Prostate cancer is testosterone positive for receptors and we don't say testosterone caused prostate cancer because it didn't.

Female dose testosterone incredibly safe. Basically the biggest risk with female dose testosterone is if you push it too high, too high too fast, you're going to get masculinizing side effects, hair growth or hair loss or acne, change in mood. Again, very rare stuff.

We know that testosterone has a little bit of call it a surge, call it a bump, whatever you want in the 70s. And the theory is that's actually heart protective for those people.

If you take super high dose testosterone, trans level, male level, you can get enlargement of the clitoris. You being on one milligram of transdermal testosterone for 3 days did not grow your clitoris. But what could it have done? Testosterone to the clitoris increases arterial blood flow. Might have been a little bit of a lady boner.

I think one of the big limitations and maybe it's perpetuating the myth or the bias is that these hormones got labeled as the sex hormones, right? So people don't like to talk about sex. We don't then we gender them. Even I Googled what testosterone is and Google tells me it's an androgen that is responsible for developing male sexual characteristics. That's what Google says. And I'm like, as long as we have number one the gender bias on it and number two even the sex label on it, because it does so much more than sex, people are going to be hesitant and not as open to this.

Our results suggest that testosterone in women may be safe maybe there's a protective role Against Breast Cancer.

Compared to match controls those with testosterone prescriptions had similar odds of major adverse cardiovascular events and Pulmonary embolism significantly lower odds of upper or lower emboli or DVT and breast neoplasm significantly lower rate of breast neoplasm by about 50 percent.

the challenges with testosterone not only just from it being a scheduled pharmaceutical but also from the horrific gendering that we did with hormones in saying that testosterone is not essential and if it is essential it's just to get you to sleep with people... isn't it kind of weird that the only acceptable reason that women can be on testosterone is to sleep with men... it's an outrage.

women will feel freaking fantastic on these pellets for a while because they're very high dose and hormones are steroids and so you kind of get the steroid rush is which is one way to think about it especially with the testosterone because you tend to be shot up to super therapeutic doses which um may not be the safest for people

after using vaginal estrogen for three months my testosterone skyrocketed. certainly that's not normal. especially if you're post menopausal your testosterone should be pretty low and not be skyrocketing. i think what else is going on it's probably not your vaginal estrogen.

less testosterone decreased desire, decreased orgasm intensity, decreased blood flow.

No, I need to get on progesterone. I needed some testosterone. My libido is in the trash can, but also sleeping three and a half hours. Get you sleeping.

We have the most data for testosterone and libido, but that doesn't mean it's only for libido.

libido is more than just wanting somebody's naked body on your body. It is a lot more than that. It doesn't exist in a bubble. What do you want in life? What do you want for the future? That's all that wanting, that desiring, that is a libido as well.

there's no testosterone and so the testosterone gets bound up by the shbg and you're left with very low levels of free active testosterone in your bloodstream and that can lead to a lot of problems sexually it can lead to issues with desire arousal orgasm it can lead to decreased lubrication and it can lead to pain hormonally mediated vestibulodynia and that tissue is very testosterone sensitive

A new placebo-controlled trial looked at transdermal testosterone in a 2 mg formulation in postmenopausal women compared to placebo, and the testosterone improved every domain of sexual function, desire, lubrication, pain, and orgasm. The placebo group didn't, except for the pain. So, testosterone outperformed the placebo on basically everything that matters in a woman's sex life.

In postmenopausal women with documented low desire, testosterone consistently outperforms placebo across 35 randomized controlled trials and the same in men.

Just being seen and being asked about desire, being given permission does something real because sex is biopsychosocial.

Testosterone is one lever in a complex system.

Just dismissing a hormone is not the answer, but just saying it's only a hormone is also not the answer.

We can't have a conversation about female sexual desire without acknowledging the huge important role that hormones play in all of this.

My message to any woman in midlife who is struggling with desire is yes, focus on those psychological factors... but also do this in conjunction with the hormone element of it because we all need to be having better sex and we can't do that if our hormones aren't balanced.

You can't talk about orgasms and just have an orgasm without talking about hormones. Estrogen, testosterone, blood flow, nerve sensitivity, those things matter.

Like I'm a sex med doc. Like I help people have better sex and I hate that testosterone's gotten stereotyped as libido. I think there's at least eight issues with that.

Can you take Atti in addition to testosterone? Yes, probably only additive effects. Hasn't been studied. I haven't seen a study doing atti and testosterone, but I would like to see a study because you're probably going to see an improvement from testosterone for libido and an improvement from atti and they work in different ways.

Testosterone kind of has this stereotype of like the desire hormone. And I would argue estrogen is a great desire hormone, too. But people think of desire as a forward pursuit of sex.

It's like a positive receptivity that testosterone... gets lost in the translation of like testosterone affects desire is like you think you're going to go out and ask a bunch of people on dates or something, but you're more just like I would say yes. I would say yes a lot more today than I would have said yes a month ago.

Testosterone kind of has this stereotype of like the desire hormone, and I would argue estrogen is a great desire hormone, too. But people think of desire as like a I love the word appetitive, but it's like a forward pursuit of sex. And I see, and this is way more subtle. I'll see if you see it, but I see in women who are on testosterone, it's not so much that they're like going to go pursue sex, but they're just a lot more open to receiving it. It's like a positive receptivity that testosterone and I think like that gets lost in the translation of like testosterone affects desire is like you think you're going to go out and ask a bunch of people on dates or something, but you're more just like I would say yes. I would say yes a lot more today than I would have said yes a month ago.

Testosterone helps every single domain of sexual function except for pain. So it helps decrease distress, it helps increase desire. It helps arousal. Helps orgasm, right?

If you're coming to me and we're trying to improve sexual function, clitoral blood flow, etc., etc., we're probably going to use more than just maintenance doses. That said, systemic testosterone does help clitoral blood flow.

It's complicated, right? Because you're trying to balance a woman's desire for help for smooth skin with the benefits of androgens, which is can be libido.

Not a lot of data looking at testosterone vaginally, but there are a couple of studies. They have found improvements in the orgasm domain.

Two things. Number one, libido is really complicated and testosterone doesn't help everybody with libido. So, check out my book, You Were Not Broken: Stop Shooting All Over Your Sex Life to learn more about the complexities of libido and the biopsychosocial nature of it. Number two, if and when testosterone does help with your libido, often times it's not going to kick in in six weeks. A lot of times it can take like four to six months. So be patient and remember that after your provider starts you on testosterone cream, you want to check a level in about 6 to 8 weeks to make sure that you're absorbing it properly.

The findings that mood and libido improved to a similar degree is not surprising... given that libido is a mood, an affective state or a pervasive and sustained feeling tone that is experienced internally that is a mood. Further, libido and mood are closely interlined. Women are more likely to feel in the mood for sex if they are energized and their mood is positive, whereas fatigue and negative mood symptoms, stress, irritability, low mood, anxiety have a deleterious effect on sexual desire.

Moods are in the brain, libido is in the brain. Hormones act in the brain to change moods. One of them is libido.

started reading about the role of hormones on desire and it's not just testosterone it's testosterone and estrogen and it's not the same for everybody

testosterone can work really great for libido

testosterone is important for sex drive

DHEA has mixed data I tried DHEA it gave me crazy sex dreams like super fun I didn't notice anything else

testosterone therapy only for low libido ... testosterone is useful for low libido

the other FDA approved non-hormonal drug for low desire is bremelanotide which is VII that is the on-demand injectable ... side effect is nausea

I gave her testosterone, her desire's not better.

It's not all, you know, one-to-one linear, just get to this testosterone level and everybody's going to have a, you know, raging libido. It doesn't work that way.

Yes, you can try testosterone.

I think we're oversimplifying when we say testosterone is the hormone for desire in humans.

I think this at this point now myth that testosterone is the hormone for desire.

you want to use the lowest effective dose because it can partially bind the Androgen receptor and low testosterone affecting libido

clinical pearl transdermal testosterone is recommended for postmenopausal women with hsdd not primarily related to modifiable factors or comorbidities

Addy which is FDA approved for hypoactive sexual desire disorder so basically low desire and distressed about it a very safe medication side effects are weight loss and being better well rested right so sleepiness is not really the right way to say it had better sleep is kind of a better way to say that side effect so those are good things especially if you're in the perimenopausal world of not sleeping well

testosterone multiple studies show improved libido improved desire in helping women with testosterone specifically post-menopausal

transdermal testosterone has been shown to improve sexual desire and reduces sexually associated personal distress in menopausal women diagnosed with hsdd with and without concurrent hormone therapy meaning estrogen and or progesterone

no testosterone serum level correlates with presence or absence of hsdd or its severity but there is a correlation between testosterone concentration during therapy and improvements in sexual dysfunction

for women who do not notice improvements in their hsdd after six months of use testosterone can be stopped and sometimes it does take that long I usually say at least three months so three to six months of use to see desire go up

can you put a vaginal estrogen cream in your in your vulva and vagina and increase your desire not technically but you can create thoughts about I'm caring for my pelvis my pelvis feels better my lubrication's better so therefore I want more desire that's how it works but putting a cream does not give you desire your thoughts about the cream give you desire

estrogen does increase sensation and having increased sensation can increase your desire right because now it feels good

progesterone for low sex drive i have not seen any data there are no guidelines saying progesterone is the hormone of choice for low desire typically it's testosterone right or typically it's estrogen and progesterone with testosterone but progesterone in and of itself for sex drive i have not seen these guidelines

local testosterone can actually help with sensitivity or lack of sensitivity and bringing in a good sensation and good function of the clitoris

the other thing i would think about is testosterone either local on the clitoris and vulva to get more sensation or to help with desire and libido

Testosterone is really the spontaneous desire hormone.

You don't get the testosterone sort of side effects, but you don't get the testosterone sort of desire.

Testosterone is the hormone of desire.

what happens in menopause is our hormones go down conflicting data on if supplemental estrogen progesterone or testosterone helps with desire we think it's probably testosterone as far as desire as far as supplementing our nation has a long way to go before supplementing testosterone in women becomes normal i'd say it's pretty low at this point

the only indication really is for sex drive low libido

usually a sex drive is like the quote-unquote legitimate thing you're going to get testosterone for

It is for low libido that people do this.

Vaginal estrogen also is good for blood flow. I put it on the clitoris. We want great blood flow, great nerve sensation for being sexually active.

I see women in their 80s on vaginal estrogen. Their vulvas look freaking fantastic and they're having sex, and they're enjoying sex. It is possible. It is not a myth that you stop having sex after a certain age, but you have to do something to maintain it.

Ask about vaginal estrogen. Ask about testosterone. Ask what the evidence says for someone in your situation.

You're practicing medicine if a doctor gives a prescription and then you don't give it when we've been giving women testosterone for like 80 years. Yes, we don't have an FDA-approved dose, but there's lots of things that we don't have FDA-approved doses for, and you guys aren't so obstructionist at the pharmacy.

around 86% of all of the comments were asking for women's testosterone. ... One of the more powerful quotes from women is, 'I feel like a criminal. I feel like a criminal the way we currently have to access testosterone.'

The other crazy thing about testosterone is it kind of stereotype is like, oh, urologists handle that blah blah blah. We're comfortable with that blah blah. But actually a lot of urologists don't do testosterone, let alone female testosterone.

in all fairness, men do have what, 12 approximately, depending upon what's available at the pharmacy, 12 testosterone products for something where they have maybe a 20% population deficiency when you can argue women 100% will have testosterone deficiency. We have zero products.

How do I know I need testosterone? And I'm like, well, technically nobody needs you can castrate a man, right? Like nobody needs it in the life-threatening sort of thing, but man, it's a

The whole gender part's actually the silly thing. We just need different doses.

Age is not your driver's license is not an indicator of overall health, vitality, wellness, or risk. And I see that with women get that a lot more than men do. We aren't like, 'Well, you're 65, no testosterone and Viagra for you.' Like we never do that with a man, but with women we're like, 'You're too old. You're too young.' And it's like, I don't think age is as important as people think it is.

I always say age is not your driver's license is not an indicator of overall health, vitality, wellness, or risk. I see that with women get that a lot more than men do. We are like, 'Well, you're 65, no testosterone or Viagra for you.' Like we never do that with a man, but with women we're like, 'You're too old. You're too young.' I don't think age is as important as people think it is.

I need a quantitative study on women's opinions about taking testosterone because they want to talk and nobody's listened and done a Brene Brown on that. Can you do a Brene Brown on women's experiences taking testosterone because there's lots of fascinating things going on there.

We need a female dose testosterone. It is ridiculous that we're micro dosing and we're pelleting and we're compounding.

To the best of the experts knowledge, there's as many women in America on testosterone as men are on testosterone, but we do not have receipts on that.

I can tell you how many men are on a testosterone prescription, but I can't tell you how many women are on a testosterone prescription. And that's a disservice to the women because they're hard to count.

women's testosterone is normalized. Like you don't have to explain yourself.

I think we're going to deregulate testosterone so it's not a scheduled two or three medication to make access easier and to correct the stigma on how safe it actually is and the proper regulations to reflect its actual safety when used in normal physiologic doses.

who's training the pharmacists with all of the new data on safety of hormones and the fact that you can use vaginal estrogen and systemic estrogen at the same time and that women produce testosterone and testosterone is normal in women, but women get huge roadblocks at the pharmacy.

When doctors look at your labs and the reference range is normal just like I know you know this. They go and get their testosterone checked and you're like well, technically it's normal even though you know, your free testosterone is like 0.4. Technically that's still in the reference range and so I don't think it's flagging doctors

There's no FDA approved female testosterone, but the testosterone product that she got said this is the indication is for deficiency of a substance that promotes masculineization. That's like water is only for drinking and it doesn't like help plants grow or let boats float on it or like all the other things that testosterone does. So, that's a really narrow-minded thing, and yes, that's what it's indicated for in men, but that's why we need one of 12 reasons why we need a female dose, proper dose, insurance coverage, an adequate reason for a woman to take it, which is for low testosterone at female doses. It does not promote masculineization.

Using it thoughtfully and appropriately isn't vanity. See also progesterone and testosterone. It's medicine.

we need testosterone deregulated so it doesn't require a DEA prescription that is why TelMed can't just have all states because every provider needs a DEA license in every single state. Massively prohibitive. DEA meds are under threat for telehealth anyways. So all the testosterone experts by and large I'm grossly stereotyping as I tend to do. Please see previous comments about pharmacists. But most testosterone experts want deregulation because it was the doping scandals of in sport that basically caused this massive limitation for average Americans. And most people aren't going to try to become gold medal pole jumpers. And if you are going to try to become a gold medal pull jumper, don't dope. But if you're going to dope, you're going to be taking lots of other things besides physiologically dosed testosterone. So it makes no sense that this thing is irregulated at this point.

It is not illegal to give women testosterone. It's not FDA approved, which means it's often not covered by insurance. But it is not illegal to give women female dose testosterone. It's not illegal to give a male dose testosterone. Stop saying it's illegal.

So certainly vaginal estrogen, low hanging fruit, vaginal estradiol creams, the cheapest. I think some women do a lot better with DHEA, especially if we're talking like profound GSM

Vaginal DHEA is a FDA approved option. The brand name is Intrarosa and interesting in my experience with medical oncologists, they actually are more comfortable with DHEA because it doesn't say the word estrogen in it. Even though the way it works is that it within the cells gets converted to estrogen and to testosterone

I think my big recent bugaboo on informed consent is anti-depressants. ... Most people aren't told about that. And then they're like, I have low libido. I have And it's like, well, how long have you been on this SSRI? 20 years. And I'm like, did you have a plan to ever want to try to get off of that? Like like it's anti-depressants are like so underinformed consent in my world and I get it.

I just think I want to be on these for the rest of my life. I just like just be on my estrogen, my progesterone and testosterone when I'm in the coffin. They'll have my little testo my little estrogen patch on.

International guidelines say check a baseline T. So you get a baseline, do a trial, recheck it in six to eight weeks, check symptoms.

My compounding pharmacy is very reasonably dosed compounded testosterone. It's like 60 bucks for three months or something. Also, when you micro dose the male testimum, it's really cheap because that's like $200 for a 30-day supply. I'm excited to get an FDA approved female dose because insurance will cover that because remember insurance doesn't cover compounded things.

What we're going to want to talk about today is I met a woman whose husband is young, right? He's like in his 50s, and he got his testosterone checked, and it was normal at like normal for men is like 300 to 900, right? So, it was normal, but it was like literally like 302, 303, something like that. ... So, 303, 302, that's the lowest 2% within the normal range. So, this man is in the lowest 2% of testosterone, has symptoms, and his doctor said he can't have any testosterone cuz he's normal, right? And insurance won't pay for it because he's normal. So, she's like, 'What do I do?' So, I'm like, 'You need to find the data that shows age-adjusted normal, and you'll see that a man a man in his early 50s that 302 is not actually normal for that, and most testosterone experts will treat that.'

I'm livid that my insurance will not cover my testosterone dose for females but will pay for my husband to have it. You should be pissed about that. ... And they're only picking one of those as a reason to not cover it. And I think that is absolute

In addition, we will in America get a female dose testosterone product probably within three years. Unless I'm wrong or the sky falls or something.

Best sources to share with my doctor on testosterone? I would do the international guidelines for testosterone with low sexual desire for women. That's 2019, free online. It's excellent. But transdermal testosterone doesn't get metabolized through the liver. If you went to med school, you should know how liver metabolism works.

I have a course on there for sexual health and testosterone which people are loving. It's like 12 CMEs just for testosterone and sexual health basically like by the end of my course I'm like I'm going to teach you the data so people can stop saying there's no data and I'm going to teach you not to be afraid of this.

When most people think about HRT, they think about estrogen. They don't think about testosterone. And so PET is actually very very inclusive to the people and the types and to really stop having your last period be meaningful whatsoever.

They should have access to their labs. I just had an insurance company not cover it was like vitamin D, testosterone and like hemoglobin A1C or something like not crazy. These are not crazy ridiculous labs.

I asked that we need female dose testosterone because women are already on testosterone. Many many women are already on testosterone and are doing much higher doses, supraphysiologic doses. Very expensive, very invasive, super physiologic.

I asked that we need female dose testosterone because women are already on testosterone. Many many women are already on testosterone and are doing much higher doses, supra physiologic doses. Very expensive, very invasive, super physiologic. Lots of interesting stuff there. The other thing I asked for is when we get a female dose testosterone to have it FDA approved for hypogonadism to not have low libido or hypoactive sexual desire disorder be the indication because for two reasons. Number one, insurance often has exclusionary riders on sexual health, which is fine if your Viagra costs $2, but it's not fine if your testosterone formulations hundreds of dollars. So don't make it for sex. How do you objectively measure low libido? How do you objectively measure that the testosterone is being successful with low libido? You can't. So have it be for hypogonadism.

I think the risk for cheating and doping is so low that to put a DEA restriction on it, which limits telehealth access, DEA licensing requirements on top of medical licensing requirements, that it's prohibitive to half of the population, which is female, to make it DEA restricted. And plus, listen, the DEA's got a hard job to do with the opioid crisis, etc. We don't need to be putting physiologic dose testosterone on something else that they're doing.

In my clinic, I prescribe testosterone, an FDA approved, naturally occurring hormone covered by insurance. But all of those prescriptions, they're for men. ... The FDA is failing women by denying access to a hormone their bodies naturally produce. The FDA has rejected two attempts at female dose testosterone, not because the products didn't work, but because they cited insufficient safety data, a legacy of the WHI backlash. But testosterone has been used in women since the 1940s and trans men received 10 times the dose. That is not a lack of evidence.

We can't dismiss this as a lifestyle drug for women who know the secret handshake.

Testosterone for a woman. We deserve it.

We desperately need it in America and we need to help out the Australian women so that we decrease the stigma to testosterone. You don't need to be partnered to get a prescription for testosterone. It's insane.

Testosterone's like the super special sidekick that some people know about and are fine with, right? Like that's your postmenopause hormone diorama.

You can start with progesterone. You can start with testosterone even for some people. And again, it's this is not lab test based because you can test labs.

Some might argue everybody on oral birth control should be on supplemental testosterone because of how much it messes with your testosterone. Well, I think we're just starting to pull the layers of the onion back on that one and start to really admit and recognize the impact that oral contraceptives have on women's sexual function.

Number one, ovaries make testosterone declines naturally with age and there are very safe options to try replacing.

Start with the lowest dose, the cheapest option for the patient, and then you can get fancier if you need to. So why is it that in the United States of America we don't have an FDA approved female testosterone product and women are often started on the highest dose most expensive product which is pellets. Make it make sense.

A lot of women are on birth control off label for acne because it blocks your androgens. They also have low libido because your androgens are blocked. So, I don't think that's a common informed consent that people get like, 'Hey, you want if you had a choice between clear skin and libido, what would you pick?'

So GSM is genital urinary syndrome of menopause previously known as vaginal atrophy... So the summary of this genital urinary syndrome of menopause or GSM describes the spectrum of symptoms and physical changes resulting from declining estrogen and androgens concentrations in the genital urinary tract during the menopausal transition.

When people say like, I still have pain with sex and I've been on vaginal estrogen, then I usually think, is it muscles? Do we need to see pelvic floor PT or do you also need androgens or a testosterone?

Clinicians should offer the option of vaginal DHEA. DHEA converts to testosterone and estrogen. That's why it's beautiful. It's the chef's kiss for a beautiful beautiful vulva.

Clinicians should offer vaginal DHEA. Which is great. We've got more and more studies on vaginal DHEA.

I love both of them. I think vaginal DHEA in my opinion makes better tissue, but it's way more expensive. So, I like to start with vaginal estradiol. And if it's not working, then kick it over to vaginal DHEA.

It's important to educate patients that documentation of hormone levels is neither necessary nor helpful for the treatment of GSM.

Vaginal testosterone cream may improve sexual function, but the panel cannot recommend this treatment at this time. There's just not enough studies.

In patients with GSM who are on systemic estrogen therapy, clinicians should offer the option of local low-dose vaginal estrogen or DHEA.

To say a woman can't take testosterone because the effects are placebo effect is a completely insane thing to say because all medications have placebo effects.

Meanwhile, back at the ranch. Can't get access to FDA approved testosterone? Try homeopathic testosterone. There's nothing in this bottle. There's homeopathic doses. Is female homeopathic testosterone dose one-tenth the male homeopathic dose? Ask him for a friend.

I think a big reason that people seek care for me is my expertise in testosterone.

100% of women will have low testosterone in their life. And if they choose to replace it, they have zero FDA approved products.

It is not illegal to give testosterone to women. And actually there is there it's hard to measure because again we have to micro dose but some current experts think that about as many men and as women get testosterone in our country. There's actually a lot of women who are on testosterone.

We have no FDA approved dose. And it's usually not covered by insurance again because we don't have an FDA approved dose.

Dosing matters, and that's why pellets are great for some people, but they're really high dose. And as an introduction to testosterone, I wouldn't recommend that being your first go-to.

Number guideline statement number 11. In patients with GSM who are on systemic estrogen therapy, clinicians should offer the option of low-dose vaginal estrogen or DHEA. Now you have a guideline to print out and bring in.

The impact of testosterone on mood and cognition was assessed in 510 women, which is more than the number of women treated with testosterone in all the randomized control trials combined, which was 45. That's insane.

Absence of evidence is not evidence of absence. Because we haven't done the data and the studies doesn't mean that testosterone doesn't work.

Pellets are the most expensive and give you a scar. If you plan on living 40 years postmenopause, do you want 40 years of a scar in your butt? And you have to remortgage your house to pay for 40 years of pellets.

You should be allowed to take estrogen progesterone testosterone your body your choice pro-choice on what you want to do with your body that mean certainly if you drink alcohol after cancer that's a known carcinogen so like let the woman do the other things that we know have no significant risk of recurrence

birth control pills ... have testosterone blockade

both of these medications are not FDA approved for postmenopause that doesn't mean they don't work they work

I would suggest seeing somebody that doesn't just offer pellets. If all your doctor does is offer pellets, they're not a comprehensive hormone doctor because the comprehensive people know that a pellet is the highest dose on the menu.

I, like most people in the world, understood testosterone to be a male hormone until I went through that fellowship, right? And learned about the importance of testosterone in female bodies, right?

women have four times the amount of testosterone than estrogen when they're cycling and having periods. That for me was like the what the [ __ ] is happening?

When testosterone became a controlled substance in the way that we think of it now, I was like, 'Wait, that happened in my lifetime? What do you mean?'

The FDA and the DEA didn't want to regulate testosterone. Congress did it. And so, it's like, dude, the people who regulate didn't even didn't think testosterone was dangerous enough to be regulated. It just got and it's the only naturally occurring hormone on the list.

I think one of the big frustrations for women is how many FDA approved testosterone doses for men do we have how many decades have be we we have tons of safety data on testosterone but the hurdle to get an actually appropriately dose testosterone for women it's generic you can't charge a lot for it if you do get a product where you're going to charge a lot for it we'll still just use the male dose and and buy the cheaper stuff right like it's a hard ask to actually get a female dose testosterone in this country for a couple of reasons

Pellets are malpractice is my opinion.

Bring in the testosterone guidelines. International Society for the Study of Women's Sexual Health. ... It's free online. Uh international guidelines for testosterone for low desire. Bring them in.

I'm a urologist. When a man comes in and says he wants help with his erections and his low libido, we don't ask him if he's suffering enough.

Yeah. I mean, you've got over the counter vaginal estrogen, you have and so it's appropriately dosed testosterone. You have pretty cheap medications when you do get them, you know.

if there's some reason that you can't be on estrogen or progesterone... you can be on all of them for most people but for let's say a woman she's got a reason that she can't be on estrogen most likely she can still be on testosterone

we don't diagnose low libido by a testosterone level we don't check a testosterone level and say now it's time to start like that's not how it works we're not cookie cutters

at 40 your testosterone levels are 50% what they were when they were 20 there are many studies looking at the multitude of benefits of testosterone in women at women physiologic doses

at the end of the day this is my belief women are smart humans are smart they might not have gone to medical school they might not know how to navigate the medical system Lord knows it's hard enough for you and me to navigate the complex medical system but they are smart you give them the information they can make decisions and that's like that's my whole platform is like I'm going to give you the info you decide if you want to try hormones or not I'm here to support you

I just sent this article from Mayo Clinic showing that only 6% of gynecologists feel comfortable treating menopausal women.

This is the turducken of medical care because it's just a whole bunch of crap put together calling it healthcare.

the price needs to go down access needs to get better

Some people love the convenience of the pellets because it's like every once every four to six months but pellets are going to come with higher risk of side effects because they're physiologically much higher dosing and then they're very expensive insurance doesn't cover pellets.

clinicians should provide and obtain informed consent including a comprehensive discussion of off-label use as well as benefits and risks compounded pellets cannot be recommended because of lack of efficacy and safety data

testosterone's like a little bit of the butter on top of like yeah it's really nice but like we've had so much bread we just have to get out there.

gynecologists do not know what they're doing with testosterone God bless the ones that do but I would say the majority of them are either afraid of testosterone so don't touch it with a 10-foot pole or they don't know what they're doing so they just give you pellets and don't think that there's another option

I think it's exciting for me to be on this end of things like where I got trained in the Urology Avenue right and so just to catch people up on like where I see breast cancer and hormones going and then we'll back off a second is I got trained that testosterone caused prostate cancer if you got diagnosed with prostate cancer never ever could you be on testosterone again and now then it goes to okay well once you've been treated and you're cured and it's been five years you can give on testosterone if your testosterone is low now in 2023 you come to me on testosterone we diagnose you with prostate cancer and a lot of again mild prostate cancer in men we don't even treat we watch it we keep you on your testosterone and we don't even treat your prostate cancer now I want to be clear and say prostate cancer is not breast cancer but the Paradigm of hormones causing these cancers has changed in prostate cancer to the point where these people can be on their testosterone and I think it's coming with breast cancer

I have a friend who's an OB gyne and her theory is this fear of breast cancer like yeah but breast cancer like you are just your breasts you're not a human otherwise with other body parts or competing interests for death and you know discomfort in her opinion on it because I'm like why are we so obsessed with breast cancer when we know we cure it really well and they end up dying of heart disease which we're completely ignoring why are we so obsessed her opinion is it's the patriarchy keeping us silent by scaring us with breasts is that too far-fetched because once we understand this like it gets a little ridiculous of like why are we scaring women so much about breast cancer

I come from the prostate cancer world we used to take out your testicles radiate you remove your prostate and put you on Lupron and now we're like let's just watch some of this and here's some testosterone like it's like what we've done in changing that in the last 10 years is crazy and I'm like breast cancer needs that also if only we can get away from this like kill every breast cancer cell for as long as humanly possible and don't care about the human suffering that happens the law of diminishing returns at some point I think is where we're headed with this

off label testosterone dosed for a female can be wonderful for some people it's a hormone mediated drop in desire very simple to do there are guidelines on dosing testosterone for low desire you can bring that into your physician you can get it very very cheap you do not need to use pellets a lot of people who use pellets get a super therapeutic dosing so they're going to get a lot of side effects if you dose it at just the physiologic female dose you should have very minimal chance of those side effects happening but that's going to be with a daily gel instead of an implantable pellet

I see how we treat men and I see how we treat women and I see how we treat them differently. We don't take a guy and be like 'I'm sorry that your testosterone is declining have you tried just like having a glass of wine and realizing you're getting old' like we don't talk to guys that way and for women like we're so dismissive.

the majority of them are either afraid of testosterone so don't touch it with a 10-foot Pole or they don't know what they're doing so they just give you pellets and don't think that there's another option

Do we have an FDA approved female testosterone product in this country? No we do not. Is that a problem? Yes. But if we did I guarantee you would be effing expensive and no insurance would cover it. So we could do a cheap option. We can use a male dose gel usually and dose it to women which is one tenth the dose. It's actually pretty easy. Australia is the only country that has a female physiologic dosing option.

testosterone is available FDA approved Dirt Cheap in a cream sorry in a gel you can get from your regular doctor as long as your doctor knows how to prescribe it and that it's safe and that it's indicated for low libido

since there are no testosterone formulations for women approved by U.S national drug regulating authorities off-label use of approved formulations for men are used for women at approximately a tenth of the standard dose for men

two recent position statements provide guidance to clinicians regarding the use of testosterone for the treatment of hsdd if you go on my Instagram and you go on my link tree or if you're in my membership I have links to both to those to those guidelines the ishwish clinical practice guidelines so these guidelines both provide practical clinical

I like the fda approved products dosed for females there's a ish wish has a position paper on it it's dirt cheap because it's one tenth the dose don't expect insurance to cover it but it's a heck of a lot cheaper and safer than pellets and injections

Is there an FDA approved product for women for testosterone in America? No. But there is dirt cheap topical testosterone that's formulated for a man that you can get prescribed to you by just a regular doctor.

I'm comfortable doing testosterone, but only I'm pretty much like you have to have seen a sex therapist to figure out your desire reasons aren't for anything else.

the issue is there's no fda approved indication for testosterone in america so people are using it post-menopausally for low desire

Why not in pre-menopausal women because your ovaries are still making testosterone.

I think vaginal estrogen should be like sunscreen. I think it should be like seat belts. It's like we just do it because it's how we take care of our bodies and I want to prevent disease from happening.

Women are only getting the placebo effect with testosterone. It's not testosterone that's working. It's just placebo effect. Are they saying that to the men who are getting testosterone and it's working?

We've been safely prescribing testosterone to both men and women for over 80 years.

It blew my mind when I was talking to male testosterone researcher and he was like yeah, yeah, 300 which is the lowest part of normal in a male testosterone. That's the lowest 2% of all men.

Most medications don't have box warnings and a lot of medications have box warnings that you don't even know about. Like do you know that your SSRI anti-depressant has a box warning that says death by suicide? Like some box warnings are on there and people completely ignore them and then some box warnings are incorrect and people freak out and don't give women hormones.

I love it. No, I think because testosterone is not going to hurt you. As long as you're making sure you don't get into, you know, 7,000s, it's worth ... a testosterone of 7,000 is bad ... for any any gender, right? If you're watching it and not giving people these superficiological doses, like try it.

It's the same with the testosterone gel. It's like, why did you take this simple little molecule and add all this crap chemical junk to it and now expect that I'm going to rub this all over my skin?

the too long didn't read is for transdermal estradiol, testosterone, vaginal estrogen, and oral micronized progesterone. risk of starting late is very very small and there's usually a benefit to people.

Sometimes doctors need to be reminded of the things that they were taught. I know you were taught that in medical school that transdermal testosterone does not impact the liver.

Listen, you're probably using a female dose testosterone, so you can't give a guy any because they have 10 times the dose. So, that's not a problem. Wash your hands before you touch small animals and small humans. That's where I put most of my testosterone just lateral thigh and then wash your hands. The worry is overblown. Women have been using testosterone for 80 years. We're going to be okay.

It's incredibly safe and should not be DEA restricted.

About 20% of men are poor absorbers for testosterone. So, it's not like women are weird.

I like things that are well tested and well studied, are cheap, and have a great margin of safety. That would be estrogen, progesterone, and testosterone.

Hormones in female bodies include androgens, which were just called androgens because we decided to make up that term and call them male. But all bodies have them.

Is DHEA safe? Yeah, absolutely.

High levels of testosterone can cause basically an inhibitory or blockade in the vagina looking like atrophy. Trans men will have more urinary tract infections, more burning with urination, more urinary urgency, frequency, pain with intimacy.

Spironolactone is a testosterone blocker. Basically, that's why your skin gets nice because you're blocking your androgens.

Also as per the guidelines, DHEA doesn't increase the risk of breast cancer.

If testosterone caused everybody to be bald, wouldn't all the men be bald? So, testosterone does not cause all people to be bald. And it's no longer called male pattern baldness. ... Looks like testosterone is not the culprit for everybody. There might be a correlation with somebody's free androgen index. So, women who are more susceptible to it. We have to do a lot more study. We do not have a lot of data on women and testosterone in the first place. Let alone things that let's say scientists don't care that much about which is hair. But female dose testosterone onetenth the male dose not high pellet doses right tend to not increase hair loss. And remember hair loss without any hormones just hair loss 50% of post-menopausal women. So sometimes I think it's correlation and not causation, but certainly the hair follicle gets shocked by drastic changes. So zero testosterone to a pellet level testosterone. I see a lot more complaints of hair loss than people who are doing the transdermal appropriately dosed female dosing.

So, if you're in early menopause, you have low hormones and putting calcium and vitamin D in your body, although can be helpful if they are low, do not replace the hormones. They are not estrogen, progesterone, and testosterone. Nowhere ever do we ever say that they are equivalent.

Testosterone is like the stereotypical male hormone. It's actually DEA regulated in the United States of America. So, it has this stereotype as being dangerous, but all bodies make testosterone.

And using the data that we do have to say, let's do it safely.

This is in response to testosterone. Testosterone is bad for women's liver. Do you think we'd let women take 10 times the dose because they want to live as transmen?

All bodies have testosterone. All bodies have estrogen. And our ovaries actually make estrogen via conversion from testosterone. So myth number one is that it's only for male bodies.

When we dose testosterone, we dose for female physiologic doses. The only way we're going to turn you into a man is if we give you male doses.

We actually can learn a lot about safety for testosterone because we give 10 times the dose to trans men. And turns out they do just as great.

I have many premenopausal women who are using testosterone and it does not negatively impact your fertility.

Physiologic testosterone's very safe. You have something that people can try. There's like no harm in trying it. Worst case scenario it doesn't work. Second worst case scenario you give somebody too high of a dose and then they have too high of a dose testosterone side effects, which some people call risks, but I'm like that's not a bug, it's a feature.

It's easiest to get too much testosterone when you have pellets, but it's a lot harder to get too much testosterone in your body when you're using the compounded cream or Testim, which is a male product dose.

You have to earn your pellet. You have to earn a supraphysiologic level of testosterone. Going from a testosterone of zero to a testosterone of 300 gives many people side effects. Going from a testosterone of zero to a testosterone of 60 gives you less side effects and may be just as efficacious.

Testosterone is in everybody. Everybody, everybody's body. Women make four times the amount of testosterone than estrogen. So their bodies aren't even converting it all to estrogen. When we give transmen testosterone, they don't convert to estrogen. We've got multiple papers where we give women testosterone and then we check their estrogen level before and after, we have that published data, their estrogen does not go up and they're not on blockers.

Estrogen doesn't cause cancer. Hormones are food, they help our bodies thrive. They can feed cancer, cancers are hungry little shits and they love the hormones because they're like 'this is what I need to be to build.' But food doesn't cause the hormones being the food doesn't cause. My analogy for this in my next book is oxygen feeds fire but oxygen doesn't cause fire. So food, the hormones, are oxygen. You got to take the oxygen away when you're fighting cancer but it doesn't cause the cancer.

There's actually multiple studies looking at testosterone being breast protective, progesterone being breast protective. Women in the Women's Health Initiative who are on estrogen only had a 20 to 30% decreased risk of breast cancer. Hormones are breast protective.

I think and I know all the research that testosterone's incredibly safe

we have a 50-year study it's on Brits and we have a 30-year study no increase in mortality so don't tell me this stuff is unsafe especially at female doses

really with female physiologic dose testosterone we don't see hair loss as a significant issue

when you play with hormones you get side effects but dosing matters

if you give male doses but don't give male doses give female doses female doses don't do those things

People are like, 'Just giving women testosterone is dangerous. Giving women testosterone is illegal.' Like all the things people say, I'm like, 'Four times the amount of estrogen than estrogen.'

Testosterone will not make you as you know, I got after I talked to people, I'm like, testosterone will not make you win a gold medal.

Google says testosterone is the male sex hormone. Sentence is wrong on Google.

I was astounded by I think it quote if it's wrong correct me I think it was the British menopause society and they said we shouldn't be promoting testosterone I'm going to generalize the quote but we shouldn't be giving testosterone because it doesn't work in everybody and we also shouldn't be giving testosterone because there's a placebo effect and I'm like uh that's all medications like anti depressants don't work in everybody high blood pressure medications don't work in everybody that means we still give them to some people and there's a placebo effect certainly for the ssris and lots of medications that doesn't mean we don't try them so like the statement was so stupid

I think it really gets this bad wrap because of abuse of synthetic anabolic steroids that happens in sport but that's not what most people take this for.

I love the safety issue. I think for me is very very clearcut: we have excellent 12-month data that shows that testosterone in appropriate levels is safe and I have no reason to think it's not safe long term.

The data I've seen on female dose testosterone is that it's anti-proliferative to the endometrial lining.

It's not a safe way to give testosterone. People get sky-high levels and you can't control it.

Do not borrow your husband's testosterone because men require 10 times the dose of women. It will not end well.

What are the side effects of too much testosterone? Uh, acne, hair growth, hair loss, voice deepening, clitoreral enlargement.

testosterone will not give you a penis but if you take testosterone at male doses which is 10 times a female dose things change in your body but women it's really on Tenth the dose to get us kind of where we were functioning before menopause per menopause

testosterone promotes hair growth it doesn't mean you're going to turn into a man but there the my saying is when you play with hormones sometimes there's side effects... some people get a little bit a little bit they'll notice a little more acne than normal but it tends to be pretty subtle

people are like how do we know that testosterone is safe in women and I'm like because we've been giving 10 times the dose to the women who want to be live as men for Trans care and they're not dying... physiologic dosing at one tenth that dose is very safe

You've been giving drugs that block testosterone your entire career and you think testosterone's too scary.

A woman goes to a doctor and asks about taking testosterone and the doctor said, 'Well, are you okay with this if you're going to be dead from this from the testosterone within 5 years?'

Testosterone therapy in females is not associated with increased cardiovascular risk a U.S claims database analysis.

compounded pellets cannot be recommended because of lack of efficacy and safety data

when testosterone levels are maintained in the premenopause range androgenic adverse events are rare

I think one of the most damaging things that we did was we told women that something their body naturally produces gives them cancer and tries to kill them like the myth of estrogen causing breast cancer like let's break it down for a second why is most breast cancer diagnosed when women are post-menopausal when they have no estrogen in their body and number two you're a really really high estrogen is when you're pregnant right and you don't have a higher risk of breast cancer when you're pregnant and we let breast cancer survivors get pregnant so we're putting them up at a high estrogen all of these things point to me it like pokes holes in this myth that estrogen causes cancer

just saw a woman her testosterone was like 380. I'm like men would like a testosterone of 380 some of them ... don't have a testosterone 400 unless you want to transition like that's fine but maybe you don't want acne a permanently deep in voice and an enlarged clitoris

it's going to be a billion dollars to get a testosterone for women and you can't patent testosterone because it's natural so no pharmaceutical company is going to go through a 1 billion FDA study for the safety and efficacy of testosterone in women Australia does have a testosterone in women for women again women's testosterone one on average one-tenth the dose of male testosterone we have a good short-term safety data we don't have long-term safety data because again we gendered testosterone and so we didn't study it in women

no serious Adverse Events has been seen with physiological testosterone use but there is lack of data showing long-term safety potential side effects of supraphysiological testosterone includes hair growth acne voice deepening and alopecia I would add enlarged clitoris that doesn't get back to normal size

oral preparations are not recommended because of possible adverse lipid effects such as reduction in HDL cholesterol and increase in LDL cholesterol

It's a double-edged sword. You don't just get one edge of your testosterone sword.

when you give testosterone the male label you make it not important for the woman

Evidence is lacking for testosterone as an overall wellness supplementation.

Too much testosterone is dangerous. We think there might be an increased risk of stroke or heart disease.

Side effects with testosterone: male pattern balding, acne, hair growth.

Testosterone is not recommended for overall general health maintenance.

If you get pregnant it's not good to give that fetus testosterone.

Vaginal estrogen does not cause cancer. I repeat, vaginal estrogen does not cause cancer.

There's tons of data now that says vaginal estrogen does not cause cancer.

Vaginal estrogen is not systemically absorbed. It does not matter if you have a history of blood clots, it does not matter if you have a history of migraines, it does not matter if you have a history of family of breast cancer. Vaginal estrogen is so low.

DHEA is amazing. DHEA is written nowhere on the box. I don't know why. But prasterone is a made-up term for DHEA. DHEA converts to both testosterone and estrogen. That's why it's chef's kiss for vulva in America.

Estrogen and testosterone are separated by one carbon atom. That's it. They have the exact same foundation, a 17-carbon atom, four interlocking rings made from cholesterol, both bind to similar receptors. In fact, your body literally converts testosterone to estrogen. Not all of it, but some of it.

if you look at most of the testosterone studies and even in the sexual health ones these people weren't walking around with testosterones of 40 they were walking around with testosterones of 120. We need to have these conversations are vital because we still have clinicians that are prescribing so conservatively just based off of this is where the reference range should be. reference range in on Quest Labs is based off of two papers that are ancient and I mean to me I'm like I know all of this so much like I can dispute all of it.

So Susan Davis came out with a paper 2025 that did about 1,800 Australian women normals right and converted to American values once you're at a testosterone of eight you're in the lowest 10%. Well our normal values go down to two for Quest Labs.

It includes testing testosterone to get a baseline, not to chase a perfect number because how you feel on it matters.

Troches are a little bit of first pass metabolism, which we don't like testosterone going through first pass metabolism, and they're also very short-acting. So, they tend to have high peaks, low troughs. So, interesting data for on-demand for sexual function, specifically with testosterone, but as a sustained long-term hormone support product, least studied, least long-acting, definitely nobody's favorite go-to who knows things about metabolism and absorption and safety. So, I would say if actually troches with combo is a no.

Like the tissues needed estrogen. They also need androgens and testosterone and we can get into DHEA. But it helps flexibility of the tissue like stretching, elasticity, blood flow, which is arousal in the in the sex word.

It doesn't work in the DHEA receptors. It the testosterone and estrogen receptors.

I love testosterone. I put the testosterone directly on my clitoreral structures.

Don't shock the hair follicles. That's the big reason why I say you got to earn your testosterone pellet because I don't want you going from zero to 350. I want you to go to 40 first and then maybe live at 80.

I'm keeping her usually below 150 because I think 150 is really where I start seeing side effects kick in. Androgenic side effects, acne, mood changes, hair loss. One woman's happy at 40, one woman's happy at 60, one woman's happy at 120, they don't have side effects, great. There isn't a woman at two or three who would not benefit from a trial of testosterone. Just because the labs are normal doesn't mean she can't have a trial of testosterone because our labs in America go down. Their normal goes down so low.

if you take systemic hormones and it raises your blood serum levels to X, right? And then you use vulva, estradiol, DHEA, whatever you want to use, local down in your vulva, that raises your serum estradiol, your hormone levels zero.

Birth control pills are much higher dose hormone than PET therapy or progesterone, estrogen, testosterone, hormone therapy. So, why would you want to take that if you don't need it to not have the pregnancy thing?

I've got some hormones in my vagina. I've got testosterone. I've got an estrogen patch that I don't wear when I have higher estrogen.

My skin wasn't absorbing any of the anything. So, the my topical uh testosterone and my um patch, I wasn't my numbers weren't there.

Your labia and your clitoris and your bladder and your vagina became the functioning adults that they became because of estrogen and androgens. And then you decided to live past the lifespan of your ovaries and not replace what your ovary function is.

Oral DHEA does not seem to help like vaginal DHEA is.

DHEA is a precursor to both androgens and estrogens that is transformed into estradiol and testosterone within the vaginal cells.

Both androgens and estrogens are critical physiologic modulators for development and maintenance of genital tissue structure and function. Androgens are necessary precursors for biosynthesis of estrogens.

Women have about four to five times the amount of testosterone in their bodies compared to estrogen when they're premenopausal and cycling.

Cholesterol goes to through several steps goes to testosterone goes to estrogen.

About 50% are made in the adrenal glands and ovaries and then 50% is made in peripheral conversion of our tissues from other androgens.

Women have physiologic dose testosterone. Female bodies have about 10 to 20 times less the amount of testosterone than men. So, set another way, men have about 10 to 20 times the amount of testosterone than women do.

Testosterone decreases starting from the in your 20s. You have about half the amount of testosterone in your body in your 40s. It kind of goes down linearly. And again, from your 40s to your 60s, again, you lose about half.

Testosterone can increase hair where there's testosterone responsive receptors. It can also decrease hair if you're super sensitive up here. What matters is how sensitive you are, which we don't have a great test for yet. And what also matters is the level or dose of your testosterone. The more you push your dose higher, the more likely you're going to see those what we call androgenic side effects, which can be more hair where you don't want it, less hair where you do want it.

We make women make four times the amount of testosterone than estrogen in your psyche life. Testosterone starts to slowly decline in a linear fashion we don't know why after about your 20s. So when people say nothing significant happens to your testosterone level with menopause, they are correct. What they're not saying is your testosterone's low at age 50 compared to when you were 30.

Transdermal testosterone products are meant for daily absorption. They aren't long-acting. Your body is very sensitive to changes and fluctuations in hormones. If you dose your testosterone not every day, you're getting a high level going back down to low, high level going back down to low. You're not giving yourself a steady state.

There's no difference between men's and women's testosterone. It's a human hormone, just different doses. Kind of like insulin and estrogen and thyroid and vitamin D, all hormones.

ovaries make more testosterone than estrogen

testosterone goes down first then progesterone

female dose of testosterone is oneth the male dose on average you can start lower or you can go hot you can start higher I like on10th the male dose so if the male dose is 50 milligrams a day trans dermal female dose is 5 milligrams a day

does it matter what time of day testosterone is applied not really if you're at like a steady state not really but transdermal kicks in pretty quick

yes you can watch out for systemic levels though because the vagina and the vulva suck that stuff up like a mother. It's pretty unorthodox, not unheard of, but common menopausal experts aren't giving you testosterone for the vagina. There are some papers, but you're going to get systemic levels a lot of times on that.

I always see them back 6 weeks later and I tell them, 'Listen, I'm not writing you a prescription and going to see you in a year.' Right? Like there may be dose adjustment that we have to do. We want to make sure that like our goals for your testosterone level are also correlating with symptom improvement, right?

I like to say physiologic dosing... the guidelines say how do you feel right do you feel like it's benefiting you without having side effects.

I just do a total testosterone mass spectrometry for the female because it's more accurate at the lower levels.

I always like to jump to pellets after you're good on transermal because I don't like zero to 300 where you can get super high dose and it's it's irreversible. So I wouldn't I never say go zero to testosterone pellet. I think we should go zero to testosterone gel or cream and then a pellet if you're somebody who thrives at a higher dose and doesn't want the like daily application.

testosterone starts going down well before your periods start... testosterone does like a linear decline starting way over here so certainly in your 30s you're going to start to see a low testosterone and you you can still have periods and have low hormones

can we increase testosterone naturally... in the per menopause right when you're when you still have ovarian function regular sleep a Clean Diet get rid of alcohol marijuana any drugs that are toxic to hormon producing organs smoking is horrible for the ovaries... weightlifting and and getting your body mass trying to get your body mass to more lean body mass than fat tissue because fat tissue will convert your testosterone to estrogen so you want more lean body mass so yeah you can to a point and then your ovaries are done and then it just you know still still do all of those things but it's time for supplementation

testosterone pellets are very high dose... pellets take people from zero to Everest Base Camp fast... that's why I like the creams and the gels because it's like I want to get you physiologic

hormones are messengers... they're not magical they're Messengers to cells to help cells function well

testosterone is a little bit of its own Beast meaning it has its kind of own timeline but for the majority of women that is also declined to a level where they're symptomatic from it well before they need estradiol support

I don't think we actually... do we actually know what a normal female testosterone is? I would beg to say we do not have enough research.

off-label testosterone dosed for a female can be wonderful for some people. It's a hormone mediated drop in desire. Very simple to do. There are guidelines on dosing testosterone for low desire. You can bring that into your physician. You can get it very very cheap. You do not need to use pellets. A lot of people who use pellets get a super therapeutic dosing so they're going to get a lot of side effects. If you dose it at just the physiologic female dose you should have very minimal chance of those side effects happening. But that's going to be with a daily gel instead of an implantable pellet.

transdermal therapy provides the most physiologic form of replacement intramuscular injections and subcutaneous implants AKA pellets should be avoided because they result in Supra physiologic levels

the starting dose for women should be one-tenth of a one percent testosterone tuber packet approved for daily use in men which typically equates to three tubes or packets per month

we can use a male dose gel usually and dose it to women which is one-tenth the dose it's actually pretty easy

women make have more testosterone in their bodies than estrogen in their 20s and I actually recently learned from avramblooming that testosterone turns into estrogen in your body... so in a way when you're taking testosterone therapy you're almost giving yourself a little bit extra estrogen... when I practice I tend to be like get you back on the estrogen first then add the difference.

women typically note an improvement in their sexual function six to eight weeks after initiating treatment although it may occur as early as four weeks with maximal effects on sexual desire and satisfactory sexual events typically occurring at about 12 weeks reduction in sexually associated personal distress occurs at about four weeks with a continued downward trend over six months

I treat people with testosterone systemically... with a topical gel... stable doses... instead of implanted that gives really high doses goes down to zero... dangerous.

the most physiological form of replacement therapy is transdermal; intramuscular injections and subcutaneous implants should be avoided since they result in supraphysiologic levels

dosing should aim to achieve testosterone concentrations in a physiological premenopause range

if you have side effects just go way down on the dose so you can tolerate it on the estrogen

what I don't like about this question is the pellets. They're going to put you on very high doses. Some wellness people will put people on such high doses they actually get their period. The legit menopause people, that's not advocated. My concern is the pellets and what dose you're on. I think you should get off pellets. I think everybody should get off pellets.

intrarosa is prasterone which is also known as intravaginal dhea it's a precursor hormone that can convert to both estrogen and testosterone within the tissues where it's localized

You just get a cream, you put it on your leg, and you dose it at one-tenth the male dose to get the female dose.

we have testosterone receptors everywhere in our bones in our heart everywhere

we have one tenth the amount of male testosterone so women certainly have less but that amount is still more than the estrogen we have

We make more testosterone than estrogen throughout our whole life.

When you're 30 years old you have more testosterone in your body than estrogen.

Our ovaries make testosterone and our adrenal glands make testosterone.

There is plenty of data for post-menopausal testosterone supplementation at female doses of about 1/10 to 1/13 that of male doses.

Intrarosa: DHEA converts to testosterone and to estrogen. This converts into both testosterone and estrogen. Can be very soothing in women, especially women who aren't having the best time with estrogen. This is kind of a precursor to estrogen and testosterone.

What if some women are dealing with hormone deficiency, inflammation, pelvic floor dysfunction, or all of them combined?

Our bodies make four times the amount of testosterone and estrogen, my friends. Four times the amount.

And your labia and your clitoris and your bladder and your vagina became the functioning adults that they became because of estrogen and androgens.

Testosterone's bioidentical. All bioidentical means is that it's what your body makes.

Between 41 and 66% of women reported no change in individual symptom scores during the study period, mainly because the majority of women without a particular symptom at baseline didn't develop the symptom during the study interval.

I have an estrogen cream bias but also we can add some testosterone I've seen dramatic improvements specifically of the labia and the clitoris with addition of testosterone cream to your estrogen cream in the vulva dry applied directly

Vaginal estrogen basically restores the tissue integrity to the vulva that is lost with decrease in estrogen.

Keeping a healthy vulva and vagina decreases risk of urinary tract infections, it decreases bothersome vaginal dryness, it decreases pain with intercourse.

Bladder loves having good estrogen in the vagina. You definitely get an increase in overactive bladder, frequency, urgency, and burning with urination when you have a low estrogen state.

Vaginal estrogen decreases the pH which is bacteria fighting and lactobacillus which is the good healthy bacteria in our vagina love an acidic vagina. So estrogen acidifies the vagina so that's how it prevents UTIs.

One of the number one treatments for recurrent urinary tract infections in menopausal women, perimenopausal, menopausal is vaginal estrogen.

Vaginal estrogen cream use actually decreases your risk of vaginal yeast infection. Vaginal yeast loves living at a high pH. Vaginal estrogen again lowers the pH.

I see a lot of people come in to my clinic, usually for hormone issues and sexual health issues, and they're on an SSRI, and I say, 'Why are you on this?' And they don't know why they've been on it. Like, they can't tell me why I'm on this, and they can't tell me how long.

To tell somebody like, 'Hey, this thing you've been taking for two decades might be contributing to your anorgasmia, your low desire, your inability to lose weight, your X, Y, and Z.' It's not crossing their mind because it's just so normalized.

Why are we waiting for bone loss before we try to replace bone? Why are we waiting for depression and anxiety? Why are we waiting for diabetes to happen?

And so when I'm looking at the whole person, that allows me to say, okay, this isn't just mental health. This is actually hormones as well.

You'll always get sleep benefits. You'll always get, for people that helps moods, you'll always get mood benefits. So don't let anybody say that there's no benefit, but you likely won't get the preventative health benefit on heart and brain like you do when you start early.

Depression and anxiety skyrocket in perimenopause.

Women in the run-up group to menopause, a period known as perimenopause, are another group that may be missing out. Menopause experienced serious mental health problems. They looked at a UK Biobank of 130,000 women who'd gone through menopause and had no history of psychiatric disorders. During perimenopause, the risk of major depression and bipolar disorder increased by 30% and 112% respectively compared with the risk of developing the illnesses during their younger reproductive years. So mental health and hormones are a thing.

It meaning it's happening because of hormones. Depression and mood issues in pmenopause are because of hormones by and large, especially in people who don't have a past history of that.

Depression and mood issues in perry menopause are because of hormones by and large, especially in people who don't have a past history of that.

it's helping my bones it's helping my mood it's helping my sleep it's helping everything else

you will always get metabolic benefits, bone protective benefits, mood benefits, all the things, no matter what age you're on

I wanted to have a goodbye for it. And I realized that I had a really pretty big intersection with my mental health of I was so excited to be free of the symptoms of the fibroid.

I certainly have felt an increase of depression and an increase of irritation that I didn't have before.

My emotional regulation is very different now than it was before the surgery.

I start talking about mental health um immediately and um and then talking about how to have the appointments differently too.

You know, one of the common things in ADHD is a lack of focus. Well, you know what else has a lack of focus? Going through perimenopause. You know what else has a lack of focus? Depression. It's actually one of the symptoms. Anxiety can cause a lack of focusing. Trauma can cause that.

I think that the time is ripe because the data currently says that 25% of midlife women are on anti-depressants... I think there's something else and there's a different way.

Approximately two-thirds of women report subjective cognitive impairment, brain fog, with wide-ranging symptoms including fatigue, difficulty concentrating, poor memory, reduced verbal fluency, and reduced ability to multitask and plan. That's a lot of people, two-thirds of women in the perimenopausal menopausal transition. Why aren't we trying to help them? Do we not care about them? Do we not want to help them? Is brain fog not bad enough?

The risk of major depressive episodes is increased two- to fourfold in the perimenopause menopause transition. Suicidal thoughts are up to eight times more prevalent in perimenopausal women, which may contribute to a higher suicide rate in women age 45 to 64 years.

There is no clear evidence of benefit for selective serotonin reuptake inhibitors when used to treat low mood in perimenopausal women without a formal diagnosis of clinical depression. That's NICE guidelines 2019. So if you are perimenopausal and you go in with low mood, brain fog, and you've never had a history of depression before, hormones are first-line therapy, not just starting people on SSRIs.

We know 25% of midlife women are on SSRIs and about 3% are on hormones. Way more people are on SSRIs, but there's no clear evidence of benefit for selective serotonin reuptake inhibitors when used to treat low mood in perimenopausal women without a formal diagnosis of clinical depression.

Progesterone receptors are all over our body it's great for the mood for anxiety it's great for sleep

Progesterone helps bones in high enough doses, it helps hot flashes, certainly helps the brain. A lot of people say it helps with their anxiety, really helps with sleep.

Exercise is the best medicine. There is not a drug, pill, supplement, anything that is as good as exercise. In bone health, muscle health, metabolic health, brain health, moods, sleep. The list makes you look sexy as hell.

if you feel shitty and you're not sleeping and you have night sweats and your mood's crazy because of your hormone number one fluctuating or number two being zero

I can get your hormones dialed in so you're not having night sweats anger issues all that stuff

oral micronized progesterone is number one very cheap very safe incredibly safe and really helps people with sleep and mood

it probably decreases risk of dementia and all neurologic disorders by about 30% if you're on hormone therapy

progesterone is great it works in the brain it's great for mood it's wonderful for Sleep

the highest risk of depression or mood changes with oral birth control pill is age less than 19 so the developing brain needs these hormones

I recently saw a woman who was 52 years old and she had no classic symptoms of menopause but on a bone scan about four years ago she had osteopenia which is not normal go from normal osteopenia osteoporosis and had a mom with significant bone issues and she had a low desire and she had significant atrophy right but she thought she just sailed through menopause no big deal. Here's my take: a lot of women don't know the changes that happened to their bodies with menopause and if you're just sitting on osteopenia taking a calcium gummy which doesn't work and increases your risk for kidney stones by the way, you're probably undertreating the low hormone diseases that are happening in your body. I know it's a radical way to think but perhaps preventative medicine will help us age well so we don't have to suffer more when we're older. What do you think?

I think you've got some data backing you up on that it should really be hormone therapy should be first line.

there are so many things there can be chance of anxiety depression sleep disturbance and then a really big one that I see a lot is body image concerns and that is huge because that really is not at all a question of vanity when I'm talking about body image with the patient I often hear them say I'm not really vain but drop that thinking that has nothing to do with vanity it is your body your skin how you feel about yourself and how you think about yourself hugely impacts the way you feel emotionally and it impacts how you interact with your partner and it impacts your libido so it's a really important thing and I just want to stress that if people are having concerns with it it is something that can improve with counseling or other methods like that

she's like you fixed my rage... I have my old self back I feel like myself my marriage is better I'm a better parent thank you for fixing my rage and I'm like I fix rage this is like literally the best job in the world.

if you're having hot flashes night sweats poor sleep mood changes joint aches and pains um all the stuff you're probably less likely to be interested in sex dry vagina ... treating those symptoms usually with estrogen as menopause hormone therapy will help those symptoms and therefore your sex life

people on menopause hormone therapy have decreased cardiovascular risk they have decreased colon cancer they have less anxiety and memory issues

anxiety so with anxiety we're living in the future right we're not living in the moment with anxiety you have to be in the moment to be an open receptive sexual being

So, hot flashes, poor sleep, night sweats, managing your menopause symptoms. Turns out you're sleeping better, your anxiety's less. Your sex drive gets to go up a little bit.

Listen you guys education is never a bad idea learn about it see if it's for you you can even try it you can stop it you can do all those things education's good I think education really helps with anxiety too because I think so much anxiety is the fear of the unknown and educating yourself about that just really really helps.

One thing that really bothers me is when people say testosterone is only indicated for libido. That makes it sound like it doesn’t do anything else. But the way medicine works, there are four countries with FDA-approved female testosterone, Australia, New Zealand, South Africa, and the UK. Their indication, because they have a regulatory process like ours, is for “proactive sexual desire disorder,” which is the medical term for low libido. But that’s a problem because doctors aren’t good at talking about sex. I have a lot of Australian patients who’ve been denied testosterone because they’re single. That’s a horrific patriarchal bias. At the FDA hearing last month, one of my requests was to get a female-specific testosterone dose approved, not just for low libido, but for low hormones. Because insurance won’t cover something prescribed for libido, and doctors aren’t great at talking about it anyway. It’s just another barrier for women trying to get proper care.

When I put my testosterone on in the morning, I get so much done. I’m productive, my brain is clear, I’m focused and energized. It makes such a difference in how I feel in my body. I feel so much more motivated.

That’s a new thing. That’s advanced. There was just a study and published paper on testosterone drops for dry eyes. We have testosterone receptors all over our bodies. I think we’re in this amazing time where we can go back to useful, safe, simple solutions that are affordable, instead of always creating expensive new drugs.

And for years, doctors have been saying that progesterone actually works really well to help women sleep. Testosterone is interesting when it comes to sleep. Some women will sleep eight or more hours and tell me that testosterone is what helped them. I have a patient who was taking a huge dose of Ambien, then started on testosterone. She was already on estrogen, and her sleep improved drastically. But for some people, testosterone is too stimulating. It’s interesting. I don’t think we have enough data yet on the relationship between sleep and testosterone.

But I see women like you, you’re a great example, who know when they feel better. When you’re feeling better and more like yourself, of course your libido is going to improve. Another thing about libido and testosterone is that a lot of women’s libido gets better with estrogen. But nobody ever says, “Oh, estrogen is only for libido.” That stereotype only exists for testosterone. I have plenty of patients who put on their estrogen patch and say, “I’m good. My sex life is great. Thank you very much.” So libido isn’t just about one hormone. And it doesn’t live in some tiny square inch of your brain that testosterone acts on. That’s not how libido works. It’s incredibly complicated. But in general, if you’re sleeping better, your energy is up, your self-confidence is higher, and you’re feeling better in your body, libido naturally follows. When you’re feeling terrible, you’re not going to want to have sex.

There are so many barriers. Testosterone got labeled as a DEA Schedule II drug in New York and Schedule III everywhere else because of the Olympic doping scandals in the 1980s. That makes telehealth and prescribing across state lines really difficult.

In my book, I call it the forgotten quarterback. When you’re talking to anyone about female testosterone, you always have to take a couple of steps back. If you don’t educate people, they don’t realize that testosterone is made in the ovaries and adrenal glands. Women make four times more testosterone than estrogen. We have testosterone receptors all over our bodies. Another big myth is that it only converts to estrogen. That’s not true. We have four times more testosterone than estrogen, which means 75% of it stays as testosterone and doesn’t convert. It’s acting on testosterone receptors. It’s not just there to make estrogen. Another thing women don’t know is that you can’t have estrogen in your body without testosterone. That’s the cholesterol pathway.

Without that education, people think you’re trying to turn someone into a man. They don’t understand the gender bias that’s been attached to testosterone and estrogen, as if male bodies have one and female bodies have the other. That’s just not true. We’ve been giving testosterone to women since the 1940s. The more you learn about it, the more ridiculous it seems that we don’t have an FDA-approved version.

The other very interesting thing is Parkinson's disease. Right, so testosterone and estrogen help the dopamine pathway. Parkinson's is a profound lowering of dopamine in a certain portion of the brain. Looking at testosterone in helping Parkinson's and possible prevention. Right, and we know in men, because we have the studies, low testosterone's correlated with depression and dementia. These are all brain things, going back to the role of testosterone in the brain, right. If brain cells work the same, I think the same is true for women. It's just very hard to do a long-term testosterone study for dementia prevention, but like biochemically and extrapolating the male data, it makes sense. And my other question is, when dementia affects two times, two to three times the amount of women than men.

Glial cells are the support cells for the neurons. They help the myelin sheath of the neurons, like testosterone's everywhere in the body, but a lot of people start the conversation too high of like, what's it good for, what's it indicated for, it's like, understand what it does first. Then we can talk about what makes sense of what it's good for.

The big studies say they probably don't work much more than placebo. And 25% of American women are on an SSRI. So that dismissing testosterone because it's a placebo effect makes no logical sense when we've got 25% of American women on something that doesn't work much better than placebo and we don't blink an eye. We also don't have much long-term studies on SSRIs.

I think the other thing is because testosterone is so integral, it's myelin sheath, glial cells, mitochondria. It's not specific like for a shoulder problem. And the problem with that is when you give women and men testosterone, they say, I feel more like myself, I have more motivation. The things they say because that's an integral part of your being and your functioning, those things are almost too soft for medicine.

Sometimes I wonder why I love testosterone advocacy so much, because there's so many barriers to it. So like, I'm just, I like, I'm picking the most like forlorn hormone to try to advocate for, because it has so many barriers against women getting its use.

Neurologists, why aren't neurologists curious about testosterone levels? I get cynical sometimes of like, because you can't make money off testosterone because it's generic, because it's cheap, because you can't patent a hormone.

Watch out for the patch shortages and the progesterone shortages because the women are coming, wanting to try things to help them feel better. And female dose testosterone. We don't have that in America.

Not to dismiss female sexual dysfunction at all. No, but to require a woman to have nothing else in her life going on to affect her desire before she can try testosterone. We don't say that with Viagra and we don't say that with male testosterone. Distressed, yeah. I mean, nobody wants to admit to that.

And so an act of Congress, truly an act Congress passed the anti-doping act of 1991. And that's why testosterone is on because of doping swimmers in the Olympics and there's a lot of doping in sport. Nobody wants that. ... And that's where the reputation of this is dangerous, because why else would it be on this list, it's on the list because of sport doping. And Lord knows I always joke, I can't make you an Olympic gold metal pole jumper on female dose testosterone. There's going to be other anabolics in there, right, and so there, and there was with the Olympics, lots of anabolics, but this one natural hormone got thrown on the list.

There's a bias, there's a bias in what hormone you're allowed to replace. To my understanding, no natural testosterone has showed increased risk in breast and in fact, Rebecca Glaser's work shows decreased risk of breast cancer. So whenever people say, it was just like estrogen, right, are you talking about oral synthetics or are you talking about, you know, natural transdermal because they're very different mechanisms.

The other problem with testosterone is we've said only one gender has it, right. We've made it binary.

The ophthalmologists who use testosterone for dry eyes? What? I'm sorry, what? The eye doctors know that tear ducts have testosterone receptors and so they give people drops of testosterone to help with tear duct production? That's off label. That's not libido, right? And so this stereotype of this narrow window for testosterone falls apart so quickly.

All of this. And we have to just keep drowning out the naysayers who say it's only for libido. And even that is not that important.

Perfect. I want a randomized placebo-controlled trial looking at dementia prevention with testosterone. I'm putting together the puzzle pieces. ... We've got all these pieces. Testosterone might be dementia prevention. It might be. ... But until we get that study that I want the billion-dollar trial. And until we value women's cognition as they age. Yes. ... We have to use the data we have now to make the best decisions we have now. And if testosterone is moving the needle even a little bit on breast cancer and dementia, why aren't we pounding down the doors studying this? Why aren't we?

What do we know about men? Men with low testosterone have higher risk of depression, have higher risk of dementia. Also correlated, we think with Parkinson's. ... Higher risk of diabetes. So why is it that we can research all these things in men and apply them to women, but we completely ignore the role of testosterone outside of sex in men. And we're like, we don't know when women haven't studied it. But testosterone helps the brain. It helps neurons. ... It's absolutely insane to me.

Like, we know that. And there's also, there's cadaver data, because I can't cut open your brain and look at testosterone in it, right? And your serum testosterone doesn't correlate with your brain levels. So that's a problem too, to study it. But we have cadaver studies. Cadavers with a higher level of testosterone in their brain had less dementia. So it's like, we got to put together all the pieces to say, we've got this study.

Testosterone helps nerves. It helps the myelin sheaths. Glial cells are the supporting cells of the neurons. Testosterone plays a role in supporting glial cells. Testosterone works in the brain.

The genitals have a much higher density of testosterone receptors. ... if you take a systemic dose testosterone and you put it on your genitals, check your levels. You might have a much higher systemic level.

She comes to see me. She's like, let's try testosterone. Okay. Try testosterone. And so we do a telemed follow-up and she turns her laptop and she's like, I want you to see what's out this window. ... What's that? That's my testosterone deck. Your testosterone deck? Tell me about your testosterone deck. And she's like, I have been planning on a deck for years. Started on testosterone. I have motivation to finish a product. That's the energy. That's the drive towards. So yes, it does help libido because that's a motivation towards something. It also helps you get your job done and do things.

So we've established that testosterone helps with blood flow. So it helps with arousal. ... You must pass through the vestibule. It helps with desire, which is in the brain. It helps with dry eyes. Great studies in postmenopausal women showing it helps with dry eyes. My patients say it helps with energy, but man, do we get pushed back when we talk about this.

So where does energy come from? Metabolic function, mitochondria, right? ... Guess what helps mitochondria? Testosterone and estrogen, right? Dopamine. The pursuit of something. Testosterone helps drive the dopamine pathway. So do we have a physiologic reason that hormones help energy? Yes.

We must get them feeling better in order to get them out doing things. So when they poo poo testosterone and they're like, we don't have any data to say it helps energy or motivation. I'm like, first of all, we have a physiologic, biologic plausible reason that it happens.

Why does it help libido? Because it helps the dopamine pathway, right? And people say it only helps libido. Oh, is there a libido corner to your brain? That one square centimeter on the left that the testosterone goes to? You put testosterone in a woman, put her in an fMRI, her whole brain lights up. There are receptors everywhere for this.

Louise Newsom's group showed that getting women on estrogen, some of them were able to get off their antidepressants. You add testosterone, much bigger amount were able to get off their... On the combination. Estrogen and testosterone. Why? ... That's the theory, right?

DHEA makes vulvas beautiful again. DHEA is a precursor hormone that converts into both testosterone and estrogen. The reason why we say it makes the vulvas beautiful again is because it gives you a little bit of the estrogen and the androgen.

What else about testosterone? So there's some really interesting data, and this is pellet data. ... Rebecca Glaser's work. So what she did is she has many, many people on testosterone pellets and she compared their rate of breast cancer with the rate of breast cancer in the SEER database or the general population. And it looks as if there's about 30% decreased risk of breast cancer in women taking the testosterone. Now, the critics will say this is not a randomized placebo-controlled trial. ... When we get a medication that decreases our risk of breast cancer by 5%, it will have a Super Bowl ad, because 5% is meaningful. Her data suggests testosterone might be more than that. More than that. And we know, again, is it physiologically plausible? Yes, testosterone appears to be breast protective.

In addition, the oncology community is looking at terms, testosterone receptor modulators, terms for estrogen, turles for testosterone. They're looking at terms, so they're actually creating medications to sit in the testosterone receptors that seem to help breast cancer. In fact, before we had modern breast cancer treatment, we gave women testosterone. So for me, when people say, when they dismiss this data, to me, I'm like, why aren't we profoundly curious with how afraid we are of breast cancer and how miraculous something would be that decreased our risk?

We actually have pretty decent data saying testosterone doesn't cause more hair loss than placebo. I believe that data. I also believe women who say, I tried testosterone and I lost hair. I believe them. It shocks the hair. So it's not so much the testosterone as the drastic change.

What happens? Blocks your testosterone. It increases your sex hormone binding globulin through the liver and so then the testosterone is not as free to go do its job. ... It's profoundly important to your sense of who you are. And these medications can blunt orgasm, decrease desire.

And the amount of people that come to me actually did a very informal social media poll. I'm like, hey, any woman who started a business since starting on testosterone, just let me know. I'm up to like eight now. I haven't asked in a while. Motivation to do something.

So I think of testosterone not as so much a libido drug, which what is libido? Libido is the pursuit of, it's the motivation of something. Testosterone is not just a libido medication, it's a motivation medication. Libido being one part of motivation.

So you answer your question of how do you counsel a woman when they're like, I'm not feeling like myself. Should I try testosterone or not? I say, okay, what are the things I need to think about to answer that question?

Testosterone exists in female bodies. We should consider using this for health span, longevity.

Private company. Compounded testosterone, can't measure it. Individualized. To the best data. And this is like chasing paper references, like the best of our knowledge, as many women in America are on testosterone as men. Wow. ... Billions. 100% of women will have low testosterone. Does that mean everybody's going to be helped by taking testosterone? No.

I got a message today on Instagram. I asked my doctor for testosterone and they said, what do you want to grow whiskers? And what do you want to grow whiskers? If that's the response your doctor gives you to that question, when ovaries make testosterone, we have a big learning gap. Big learning gap in the medical community.

Saw a patient, she had surgical menopause, struggled for years, finally got on estrogen. ... It would be malpractice to not do it. If there was a urologist who removed testicles, who didn't talk about testosterone replacement, that's malpractice until proven otherwise.

We got pellets. Men's testosterone pellets are FDA approved. What does that mean? ... That's huge, right? So 20% of men will have low testosterone, about 12 products. 100% of women will have low testosterone, zero products. Like to me, I'm like, make it make sense.

Oh, men just need more therapy. Like we know, Addie or testosterone, we're like recent menopause conference for sexual health. So we said women don't need testosterone. They need better body image.

Keep in mind, men's testosterone got FDA approved with six months safety data. Intrinsa Patch had years of safety data.

So right now in America, there are zero FDA approved testosterone products for females. Let's just know why.

We have four times the amount of testosterone than estrogen. It's not all converting to estrogen. And so for people to be like, 'Oh, well, testosterone just made you feel better because it all converted to estrogen.' No, that's not how it works, even in healthy, young, normally cycling people.

I do fasting insulin now in everybody, complete metabolic profile. I do estrogen, testosterone, sex hormone binding, globulin, FSS. Ferritin.

Where are there testosterone receptors in the body? Everywhere. Brain, bone, muscle, clitoris, vulva, vagina, eye, tear ducts.

What does the evidence say clearly testosterone, giving a woman testosterone can be helpful for? Every single domain of sexual health. And I will say that because again, the stereotype is just libido, desire, decreasing distress about sex, blood flow, so arousal helps with orgasm. The only domain of female sexual health that it doesn't help with is in the domain of pain.

What does testosterone not fix? I'd say relationship problems. ... I'm like, okay. This conversation needs to go a different direction because offering you testosterone or Addy or Vylysee is not going to fix a relationship issue.

It helps people orgasm more, helps arousal, decreases people's distress over their sexual health. None of that's libido, right?

No idea. One possible idea is because they're worried that testosterone is teratogenic. And can you be trusted to take testosterone and not get pregnant because you're a woman and can you be trusted to do that? So that's one theory of like, why do we draw a line in the sand with menopause if testosterone doesn't fall off a cliff with menopause? Teratogenic. ... But okay, fair. Testosterone's category, pregnancy category X. And it should be. ... We're a female fetus. But we're just replacing your testosterone to how it was in your 20s when you would have gotten pregnant anyways.

We have a 30 year paper and a 50 year paper. No increased risk of death, cancer, breast cancer, anything because of testosterone. And like what other drug do you study at 10 times the dose for 50 years? And then tell women, sorry, you can't have your dose because it might be unsafe.

The focus of this study was to assess the impact of testosterone on neuropsychological symptoms. Consequently, only data pertaining to cognition, which was feeling tired or lacking in energy, memory problems and difficulty in concentrating and mood, which was feeling tense or nervous, irritability, attacks of anxiety or panic, feeling unhappy or depressed, loss of interest in most things, crying spells and loss of interest in sex.

In this pilot study, use of a transdermal body identical testosterone for four months was associated with significant improvements in cognition and mood in a real-world cohort of perimenopausal and post-menopausal women. This supports the notion that testosterone has neuropsychological benefits beyond libido and signals the need for further research.

So the aim of this study was to assess the effect of transdermal testosterone on cognitive and negative mood symptoms in perimenopausal and postmenopausal women with persistent symptoms despite standard HRT, estrogen with or without progesterone.

The prevalence of moderate to severe cognitive symptoms decreased by thirty one percent versus moderate to severe mood symptoms decreasing by thirty seven percent versus moderate to severe loss of interest in sex decreased by forty two percent.

In 1988, a small randomized control trial demonstrated a decrease in cognitive symptom scores following bilateral oophorectomy that was prevented in women treated with estrogen, testosterone or a combination of both hormones.

In men, testosterone deficiency is associated with fatigue, depressed move and cognitive impairment. If you have low testosterone and you don't get it treated, your risk of dementia is higher in men.

More recent randomized controlled trials have demonstrated a beneficial effect of transdermal testosterone on learning and memory, both in women using and not using concurrent estrogen.

I'm like with all the female testosterone research I've done, I'm like, you guys, this is a brain protective drug. Prove me wrong. It absolutely is.

39 percent of women with cognitive symptoms reported improvements versus 47 percent of women with mood symptoms reported improvements.

Memory problems were the least likely to improve and that was at thirty four percent of women reporting an improvement.

Cognitive symptoms were more frequently reported than mood symptoms at baseline.

Do I think testosterone has a role in dementia prevention? Yes, I think that.

All nine cognitive and mood symptoms significantly improved across the study period. Mood improved more than cognition, which is 47% of women reported an improvement in mood versus 39% reported an improvement in cognition. They had a 34% versus a 22% decrease in mean symptom score respectively for mood and cognition. Regarding libido, 52% of women reported an improvement mean symptom score decreased by 33%.

In 2006, a 24 week double blind randomized control trial assessed the effect of adding a synthetic testosterone... with or without HRT to venlafaxine, which is an antidepressant, in 72 women with post-menopausal depression. A trend towards increased remission rates was observed in each treatment group relative to venlafaxine plus placebo. That means hormones did better than venlafaxine alone.

Overall mood improved more than cognition. Forty seven percent of women reported an improvement in mood versus thirty nine percent of women reported an improvement in cognition.

The three symptoms most likely to improve were lost of interest in most things at 56 percent of women reporting an improvement, crying spells and loss of interest in sex.

Libido is a mood. Testosterone improves mood in many people, many different domains of mood and cognition, improves mood more than cognition, doesn't help everybody.

Only women in the venlafaxine plus methyl testosterone group were significantly more likely to basically get rid of their depression.

The findings that mood and libido improved to a similar degree is not surprising.

Our results suggest that testosterone therapy also benefits mood and cognition and may be useful adjunct to estrogen and progesterone therapy for peri and post menopausal women with neuropsychiatric symptoms. Further, testosterone therapy may obviate the need for higher estrogen doses in women with persistent menopausal symptoms after initiating HRT.

The present study has several strengths. The impact of testosterone on mood and cognition was assessed in 510 women, which is more than the number of women treated with testosterone in all the randomized controlled trials combined, which is 415.

It can take up to six months to see a clinical response to testosterone therapy. So assuming levels are in the physiologic range, benefit is therefore likely to have been underestimated because outcomes were assessed only after four months.

Testosterone improves libido and vulvovaginal health has anti-inflammatory, cardioprotective, bone protective and neuroprotective effects.

Transdermal testosterone therapy for four months was associated with significant improvements in all mood and cognitive symptoms.

All ten symptoms significantly improved four months after initiating testosterone therapy.

In 1985, a double blind randomized control trial found that surgically menopausal women randomized to testosterone alone or testosterone combined with estrogen had more energy, improved wellbeing and greater improvements in somatic and psychological symptom scores compared with women treated with estrogen alone or a placebo. Don't tell me there's no data on testosterone and mood.

I think it's easier to dose. It's relatively cheap and you don't get shit at the pharmacy from the pharmacist for trying to get the male testosterone.

Print out the international guidelines, bring them in and do not bring them in my Instagram rants about testosterone.

Approximately two thirds of women report subjective cognitive impairment, brain fog, with wide ranging symptoms, including fatigue, difficulty, concentrating, poor memory, reduced verbal fluency, and reduced ability to multitask and plan.

Given that all women received a standard testosterone dose, it's unlikely that therapeutic levels were achieved across the whole cohort because again, we absorb at different rates because we all have different skin.

Women make four times the amount of testosterone than estrogen in your cycling life. And then testosterone starts to slowly decline in a linear fashion.

One size for testosterone does not fit all. Some people do better and respond better at higher physiologic doses.

Transdermal testosterone products are meant for daily absorption. They aren't long acting.

What's a common milligram to start for testosterone cream for women? Five milligrams.

I love to say that libido is a mood. An effective state or a pervasive and sustained feeling tone that is experienced internally. That is a mood.

I support a woman's interest in trying testosterone, but it won't help everybody with libido.

The risk of major depressive episodes is increased two to four fold in the perimenopause menopause transition. Suicidal thoughts are up to eight times more prevalent in perimenopausal women, which may contribute to a higher suicide rate in women aged 45 to 64 years.

Women are more likely to feel in the mood for sex if they are energized and their mood is positive. Whereas fatigue and negative mood symptoms stress, irritability, low mood anxiety have a deleterious effect on sexual desire.

There is no clear evidence of benefit for selective serotonin reuptake inhibitors or SSRIs when used to treat low mood in perimenopausal women without a formal diagnosis of clinical depression.

Because testosterone has a placebo effect in the placebo trials is not a reason to not give people testosterone. Just like the fact that SSRIs have a placebo effect that's freaking high is not a reason not to give somebody SSRI when medically appropriate.

People will say that any benefit that a woman gets from using testosterone is from the placebo effect. First of all, there's a placebo effect in everything.

There's no difference between men's and women's testosterone. It's a human hormone, just different doses.

Physiologic testosterone is very safe. I think you have something that people can try.

I will not let you do something dangerous.