Testosterone and Women

Testosterone has become the hottest hormone on social media, and it’s easy to see why: so many women feel dismissed when they bring up low libido, fatigue, or that nagging sense of “I don’t feel like myself.” 

Dr. Holly Thacker unpacks what female testosterone actually is, why the lack of an FDA-approved testosterone product for women creates confusion, and how to think clearly about benefits vs risks.

You will also hear her candid warnings about testosterone pellets, high-dose compounded hormones, and “anti-aging clinic” dosing that can push levels into the male range. We cover side effects women rarely get warned about, including acne, oily skin, unwanted hair growth, scalp hair loss, mood changes, and changes that may not fully reverse.

If you care about evidence-based menopause care, women’s sexual health, and safe hormone therapy, listen through and share this with someone who’s been tempted by the hype. Subscribe, leave a review, and tell us what topic you want discussed next.

Transcript

Testosterone Questions And FDA Context

Dr. \ 0:00

Welcome to the Speaking of Women's Health Podcast. I'm your host, Dr. Holly Thacker, and I am back in the Sunflower House for a new podcast. And this one's a spicy, hot topic, pun intended. It's all about testosterone, and I've had so many patients, my staff, nurses, uh, those who answer patient calls and messages on my chart say, Can you please put something out about testosterone? And I'm like, Well, sure, of course, I'll do it. So here I am doing it, and it's really um increased a lot of attention and steam because of the FDA hearings where many of my uh colleagues and friends uh presented information to the FDA, the Food and Drug Administration, back in July of 2025 under the FDA uh director, Dr. Marty Macari, Johns Hopkins physician, who uh thankfully, after 20 years of us lobbying this administration, current administration decided to look at the boxed warnings on hormone therapy. And in November of 2025, some of the boxed warnings were lifted, like off of vaginal estrogen and some of the warnings on systemic estrogen progestin therapy. But one of the things that caught attention and kind of went like wildfire on social media was the fact that there's no FDA-approved testosterone for women. Uh, there is for men, but not for women. So a lot of folks have said this is sexist, uh, this is terrible, we have to use male products at one-tenth the dose for females or compounded therapies. Um, and so there were a lot of excellent points that were made. And you know, this podcast and our nonprofit, speaking of women's health.com, exist uh because of the uh very appreciated donations by philanthropists, our donors, from listeners, subscribers, patients, um, everyday people who really are committed to empowering women at every age and every stage of their life. And I'm your host, the executive director of Speaking of Women's Health, and I also direct our Center for Specialized Women's Health, and for almost three decades I've run the fellowship for specialized women's health uh because I needed to train partners, and I do have several partners, thankfully. However, many of them have been guests on this podcast, and maybe some can do some guest hosting for me in the future. And many of them have gone on around the country to just really excellent opportunities, and they've all had training in menopausal hormone therapy, which for several decades was vilified terribly so because of the twisting and the misinterpretation and the not very scientific sound bites of a very scientific study, the Women's Health Initiative. So today I really want to delve into testosterone. We've had several podcasts where we've talked about standard metapausal hormone therapy, bioidentical metapausal hormone therapy, local vaginal therapy, uh, hormone therapy for women in special conditions like women over 65, hormone therapy for women that are breast cancer survivors, or women who have cardiovascular disease. And that's really important because the bulk of benefit in general, and what most women past the age of midlife have missed, is getting adequate hormone therapy, primarily estrogen, because that we know improves longevity and reduces disease burden and is the prime hormone to help regulate the thermostat in the brain and reduce the so-called vasomotor symptoms like hot flashes, hot flushes, trouble sleeping, skin crawling, mood, joint, vaginal dryness, those symptoms. In terms of testosterone, luckily uh or thankfully, most women make testosterone their whole lifespan, and most women don't need to take supplemental testosterone therapy. Um, and not every woman needs menopausal estrogen or progesterone therapy either, but it's much more common because it's so consistent that the ovaries lose eggs and don't make any more estrogen. But testosterone is made in the ovarian stroma, uh androstine diione, which is converted in the liver and body fat uh into estrogen and testosterone. The adrenal glands, which sit on top of the kidneys, make sex hormones and also make cortisol and stress hormones. And even women who have their ovaries removed, not all of them need testosterone. And some women are suffering with too much testosterone their whole adult lives. And I see women well into menopause who still are suffering with oily skin and acne and chin whiskers and uh hair thinning, the so-called androgenic hair thinning, which is made worse even from just natural endogenous testosterone. So I want to cover uh that for some women they do need testosterone therapy, and if done correctly, can be safe and effective, even though it's still not FDA approved. We came really, really close. It was not long after I opened our Center for Specialized Women's Health, um, and um it was a little bit before the time that I took over the nonprofit, speaking of women's health, that Professor and Gamble was bringing a testosterone patch to the market. And they primarily were an organization that uh did household products, not really pharmaceuticals. They had done residrinate, which is an osteoporosis medicine uh that we still use, that's very effective at reducing uh spine and nonvertebral fractures, and they did research into the testosterone patch, which because of all the misinformation and hullablue over the women's health initiative, which the initial results were released in July of 2002. So in the early or the late 2000s before the teens, the 2018s, uh there's still a lot of hysteria about oh hormones increase heart disease and cancer and death, which actually is not true, and that's why the boxed warnings have been lifted. Um certainly if you wait several years, more than a decade or more past the age of menopause, and you acetylate or methylate the estrogen receptors, and you already have existing heart disease or you have existing brain disease, and then you throw in oral estrogen, there can be a slight increased risk of clot, maybe an increased risk of dementia. Um but in terms of the huge benefits that preventatively you get, if you start with a woman closer to the age of menopause and/or under age 65 who doesn't have a diseased artery or significantly diseased brain, you help these organ systems as well as the genitor urinary system as well as the bones. And we've really gone into that quite a bit in depth in prior podcasts. So we have a lot more information for on that. So the testosterone patch, the intrinsic patch, um was not approved for fear of cardiovascular disease. And it's really a shame because it did show improvements in hypoactive sexual desire disorder, and it did not produce too high of levels, and it was a patch designed to boost into the high normal female range testosterone, not the male level, which is what pellets do. And pellets are all the rage, they're not FDA approved. We've talked about them in prior podcasts and given warnings, and uh the women I see who get pellets, ooh, they feel great at first, like they can take on the world, and they have a boost in their sex drive and energy. Um, but it's a super physiologic level, it's it's it's sometimes as high or even higher than a man's level. Um, usually these people doing pellets don't give adequate estrogen and don't protect the uterus. There's what's called tachyphylaxis, the levels go up and then they go down, and they're expensive. Yeah, they people charge several hundred dollars to do them, they're implanted in the butt or under the skin, and it's really not an appropriate practice. Uh, but because the field of doing appropriate menopausal hormone therapy is not particularly lucrative, um, people who get into this field who are trying to make money many times pull several things over on women that are needing help, who have symptoms, who have estrogen deficiency, who maybe have been rebuffed by their physicians and nurse practitioners and want treatment. Um so you always need to beware, and especially, I mean, sometimes cash-based practice, if it's concierge care, if it's direct primary care, I mean, there's definitely a role to pay a healthcare clinician to be able to spend more time for you, not be beholden to your insurance company or some employer or some hospital. So I'm certainly not denigrating people making money, but when you go to these fly-by-night anti-aging clinics, these spas that are doing cosmetic therapies when they're not dermatologists or plastic surgeons, and then they're trying to throw in a pellet or uh compounded hormones, uh you really have to be uh concerned because hormones are very potent, and uh when done correctly and safely and monitored can be a very effective therapy. So we're gonna dive into what does testosterone do in women? Why in some women do levels decline? And in some women, actually, after age 70, the levels can increase. Who are the people that can benefit from therapy? What are the risks? And how can you find a qualified prescribing clinician, physician, or APP who can prescribe it safely? So let's get started. Most people think of testosterone as the so-called male hormone, but women actually produce it in the ovaries and also the adrenal glands. And actually, we women produce more testosterone on a gram per gram basis than we do estrogen. Estrogen is the sex hormone primarily responsible for our feminine female characteristics as well as bone health in both males and females. And in fact, males that make testosterone but cannot aromatize it to estrogen, they keep growing, they never close their epiphyses, so they're like really super tall, seven and a half foot people, and they have very soft bones and osteoporosis. Some of these people are in the NBA because they're so tall. Um, and many of them have osteoporosis, and we actually give them estrogen to close their epiphyses so they stop growing indefinitely and to mineralize their bone. Testosterone levels fluctuate over time, they can decline with age, but then they can get boosted later in life, and we don't understand why in some women over 70 the levels go up. Now, testosterone does get converted to estrogen, and that's why men who are older than women who are in menopause and have no estrogen, those men have more estrogen than the women do because the testosterone gets converted to estradiol. So testosterone plays a role in sexual desire and arousal, and in fact, the only really studied indications that testosterone is beneficial for is in women with hypoactive sexual desire disorder. Now, in some women that truly are androgen deficient because maybe their ovaries have been removed, they've had some insults to their adrenal glands, or they have other medical conditions that have affected their testosterone production, there can be energy and motivation issues, um, some focus and mental clarity perhaps, as well as testosterone does affect muscle mass. So males have 70% of the muscle upper body muscle strength than women. They have much larger musculatures. It's one reason they tend to run higher creatinine levels, which is a kidney function blood test, because they have more muscle mass than women. Um men, because they're bigger and have more muscles, tend to have uh more bone density and more muscle mass as well. But we women actually have several times more testosterone than we have estrogen. It's just that we generally, in the reproductive age, have more estrogen than men do. So what happens is when estrogen levels go to nothing, when you run out of your last egg, that makes estradiol, and the testosterone levels are the same, they don't go up, but relatively it's a more masculine level. And that's why so many women at midlife notice hair thinning, androgenic hair thinning, chin whiskers, maybe even a deepening of the voice slightly. And if you're an opera singer, that's a big deal. That can be your livelihood. Um certainly with age, the adrenal production of dihydroandosterone, which can get converted in the liver to estrogen and testosterone, that declines in both males and females with age. Um if the ovaries are both taken out for surgical reasons, um, that can cause a woman to lose 30 to 40 percent of her total uh female testosterone. Now, for some women, that's a huge benefit. They were plagued with too much testosterone and oily skin and acne, polycystic uh ovarian condition, a female hyperandrogenism. Um and there can be ovarian tumors that produce testosterone. I see women who are in their 60s, 70s, and 80s, maybe, and all of a sudden they start growing a beard and developing a little bit more musculature. Um and someone like a dermatologist might get some hormone levels and find out that their testosterone levels are high, and we find out they have an ovarian tumor or an adrenal tumor. Certain medications, like long-term glucocorticoids like predazone or steroids, uh certain um estrogenic oral hormonal contraceptives, um, or any hormonal contraceptive, even by patch or by vaginal ring, that's at a contraceptive dose can lower testosterone. That's one reason why hormonal contraceptives are so great for acne and abnormal hair growth or androgenic hair thinning, because it tames and reduces the woman's natural testosterone levels. Other medications, antidepressants, could do it. There's various adrenal disorders that can lower testosterone levels. If there's something wrong with the hypothalamus or the pituitary gland in the brain, the master gland, that can affect it. Poor nutritional status can do it. Eating disorders like anorexia, nervosa, and bulimia can do it. Women that have low testosterone can describe low libido, uh, no interest in sexual activity when they previously had a good relationship with their partner. Sometimes poor sleep quality and fatigue that just doesn't improve with rest. Anytime there's hormonal uh fluctuations or deficiencies that can affect the mood, uh, the vitality. Um certainly hormonal loss and deficiencies can make pre-existing psychiatric problems like anxiety, depression, worse. Um brain fog primarily is described by women low in estrogen. Estrogen helps with acetylcholine transmission in the brain and neuronal growth, but some people low in testosterone complain of brain fog and reduce stamina and difficulty maintaining muscle mass. Um and so these symptoms do overlap with lack of estrogen, other conditions too, like thyroid disorders. If you didn't hear our podcast with Dr. Ula, a bed on thyroid disorders, as well as the one on polycystic ovary condition, which is associated with too much testosterone, those are good ones to go back to. Um, life stressors can mimic some of these symptoms, and I mean lots of women at midlife are pretty stressed. They're the sandwich generation, they have aging relatives, teenage children, work issues, um, community, family issues, relationship issues. So it's it's really good to be able to see someone who could help sort this out. And it's really best to start with your primary care physician to get a general workup, make sure you don't have sleep apnea, vitamin deficiencies, um lifestyle concerns, or other undiagnosed medical problems. Um, it's good to see your uh gynecologist or your women's health clinician for an exam. Uh, what does the vagina look like? Uh, what's your hormonal status? What are some of your basic blood work? Uh, what's the status of your bone density if you haven't had a bone density? And you've been listening to the Speaking of Women's Health podcast. I'm Dr. Thacker, your host. I'm in the Sunflower House, and we're talking all things testosterone and everything that is really in the news. I haven't had so many women flood into my office asking me about testosterone at any point ever in my career. So, why do some women uh benefit from testosterone? Well, if you have any kind of hormonal deficiency, if you restore it to a normal female level, uh research shows that women can have improved libido and sexual satisfaction. But I can tell you if your testosterone levels are normal and you have relationship issues or other issues that are affecting sexual function, and you just think throwing more testosterone into the mix is going to make things better, it very well may not. And you might be punished with uh pimples, uh oily skin, even more irritability or weight gain. And oh, so many women, that is the number one concern in all surveys and clinical experience weight gain and body composition changes. And taking hormones above the female range is not going to make it easier to lose weight, that is for sure. And we have several podcasts on weight loss, on nutrition, on exercise, on intermittent fasting, um, also on prescription medications, some interviews uh with former graduates like Dr. Tara Eyer, who also is boarded in obesity medicine. I did a good podcast with her on uh weight loss medications, and some of these really popular um GLP uh inhibitors and GIP antagonists, like the popular uh terzepatide, Manjaro for diabetes, or ZEP bound is for weight loss and sleep apnea, or just the GLP agents like Ozempic or the diabetic agents, um those can sometimes be associated with significant muscle mass loss and lean body mass uh loss, and that that has been talked about in our podcast in terms of uh focusing on body composition. And when you lose muscle mass, you can lose testosterone as well. Just like if you go and do some weightlifting and build some of your muscles up, you can boost naturally your testosterone. Uh and trace minerals like boron uh play a role. Having the adequate uh building blocks with amino acids also are very important. And so, certainly, if you have adequate hormonal levels uh, and assuming you don't have other medical problems, some women will note sharper cognition and better musculoskeletal health. And I do hear women say, oh, I feel like myself again, finally. But what I see from a lot of women who get super physiologic levels because they go and get high doses of compounded testosterone, uh, or they get the testosterone pellets, which once you get them, they're in your body for several months. They get way higher levels than anything normal or expected. And they may get that steroid rush. Now, they might get steroid rage, too, and irritability and lots of problems with their skin and hair. But if they're not necessarily wired to initially have those skin and hair problems, it can take a while for those side effects to manifest. In fact, when a male goes into puberty, it's four years of high testosterone levels before you start to see the masculinizing effects. And once you start growing that beard and getting that muscular jawline and brow line and deeper voice and bigger muscles, those physical manifestations, even if you stop the testosterone, don't go away. They're permanent. So for a lot of women who feel great and they don't mind spending a few hundred dollars and getting a pellet and they finally feel like they're getting hormones. When I check their levels, a lot of them hardly have any estrogen. And they have much too much testosterone. And if you have a uterus or an endometrium, testosterone eventually gets somewhat converted into estrogen. And unopposed estrogen and testosterone can increase uterine cancer risk, just like high testosterone states with tumors, ovarian adrenal tumors, or even just polystytic ovarian condition, of which there's two types, and it can affect 10 plus percent of all women, it's associated with a higher risk of endometrial cancer and diabetes and heart disease. So getting into the nuts and bolts about how is testosterone prescribed for women. So as I mentioned at the beginning of this podcast, there are no current in 2026 FDA-approved products in female levels of testosterone. However, there is one product that's meth which is a sterified plant-based estrogen in kind of a standard menopausal dose, 0.625, and then there's one that's twice that amount, 1.25, which would be used for a younger woman who maybe has premature menopause or surgical menopause. And it has methyl testosterone. And this drug used to be called the brand name was Estratest, which it's not made anymore. There was a generic named Covarix, HS or full strength covarix. That one's not made. So it's just E E M T H S. Esterified estrogens with methyl testosterone. Usually the HS half strength is the appropriate dose for the vast majority of women. So that's not FDA approved because that drug hit the market before the FDA was even around. So some women's insurance won't cover it because uh it's not FDA approved. Well, the company, you know, and the people that make it don't go and get an FDA approval for something that's already on the market. So FDA approval is important in some respects and reflects a certain amount of scrutiny and research data. Um and I have been prescribing the esterophyll estrogen and methyl testosterone for over three decades. The concern was, well, if it's oral testosterone, it goes through the stomach and liver, it might irritate the liver. And we do have an epidemic of diabetes, fatty liver, which can go into cirrhosis. You know, if you've got any trouble with your liver functions or fatty liver, please go back and listen to the podcast that I've done on fatty liver and metabolic problems. But for most women, taking those doses does not irritate the liver. Um, and that's a really nice, easy, standardized way for me to give back testosterone as well as estrogen, particularly for a woman who has had her uterus and ovaries out. But even in women who don't have their ovaries, I only find about one in six even need the half-strength daily dose. So I have a lot of women who only take half a pill like every other day. Uh because if they take the full standard dose, even for someone without an ovary, it's just too much and causes side effects. Now we have been forced to use male products of gels like androgel or testim and use one-tenth the dose because that's the female replacement. Um and I just saw a woman in my office the other day, and she got the androgel one, which for a man would last about a month or so, and for her it lasts for 10 months. So it's kind of a bargain. And she doesn't have to go to a special compounding pharmacy. Now we're fortunate at the Cleveland Clinic, we have a great um compounding uh pharmacy that's overseen by uh farm Ds, doctorates in pharmacology, and they do strict quality control, which in general, if something's compounded, there's no oversight, there's no standardization. I kind of describe it like you know, I I go and get US grade meat. I don't just go to someone who's just butchered a cow and no one knows how they're handling the meat, and I just buy the meat from them. But if I couldn't go to a store and buy US grade A meat, then I would probably have to do that because how else would I, you know, get that food? So that's how I describe it. Compounded medicines aren't better, they're just less regulated. But a lot of women are so excited because they go to the pharmacy, they pick them up or have them mailed to them, and they don't get that long list of all the informed consent and potential warnings. And some of the problems with the warnings that come in FDA-approved products is not that they're riskier, but they're trying to do full disclosure to the point that it's over-disclosure in that it includes ever every single potential side effect, you know, high, low, exaggerated doses ever seen in any research on both males and females, and they kind of lump it all together. And I think that's something that this FDA is trying to be transparent and make sure that side effects from biologic agents, drugs, vaccines, etc., are appropriately tracked and reported and followed, uh, but yet be more specific to the product, meaning that it's ridiculous to have all these systemic boxed warnings on vaginal estrogen when it's a low dose and only used locally for the vagina, and does not have systemic effects that taking a patch or a pill, you know, or an injection or a high-dose product, maybe that's vaginal, that's at a therapeutic level or at a hormonal contraceptive level. So there's lots of differences and nuances. So the testosterone patch, the intrinsic, which we really should have gotten on the market um 15, 20 plus years ago, which we don't have, did make it to the market in Europe for hypoactive sexual desire disorder. And there's reports of actually improved cardiac function in some of these people. And testosterone does affect skeletal muscle and the myocardium. Um so what are the risk and side effects? Because that's really basically what I think isn't focused on enough. I think what's focused on is oh, you feel great and you feel more energetic, and your sex life is back to how it was before. And I always caution women when you're 50, when you're 60, when you're 70, when you're 80, we can't make you back to 20 or 30 or even 40. And so we are all for improving your health span and your lifespan and reducing chronic disease. Um, but you do have to realize that your body is different, and as much advances as we've made in reducing the aging process, you know, there's a reason you have children in your 20s and 30s and not your 50s and 60s. You do have less energy, you do have less reserve, you know, kidney function goes down, um, balance goes down. Now there's wide ranges in how people age. I see that every day. So there's a lot in your power that you can do. But I do think that women need to be realistic and not so hard on themselves because I think that they're more likely to be swept up into, oh, I saw this on Instagram, or I saw this, or you know, my friends are doing this. Um, and I can understand how it feels when you haven't been listened to, when your symptoms have been ignored, when you haven't been given standard, appropriate, well-studied, safe, and efficacious hormone therapy. So this void that we've had for so long and all the misinformation that a lot of times the media has perpetuated has certainly contributed to all these problems. So, what happens when testosterone levels are too high in women? It's not pretty. And it doesn't always happen to everyone. So if you don't have the genetic predisposition to having sensitive scalp hair follicles to dihydrotestosterone, you're not going to start having hair shedding. But boy, if you do, you you may permanently lose some hair. And in my experience, women do not like that. Um, the natural causes of high testosterone, as I mentioned, polycystic ovarian syndrome, PCOS, is very common. Less common, uh, but sometimes overlooked is congenital adrenal hyperplasia, and that can be treated and needs to be diagnosed. Any kind of androgen secreting tumors of the ovaries or adrenal glands need to be diagnosed and treated. Acne and oily skin, particularly if your skin is geared that way. Um, excessive hair growth in a masculine pattern, like on the face or the body, um, hair thinning, scalp loss, even overt alopecia. If you're perimetapausal or premenopausal, too much testosterone can make your periods irregular. It can contribute to infertility, insulin resistance, uh, clitoral enlargement. I've seen women who um have a clitoris enlargement a couple times the normal size. Also, loss of uh breast tissue can happen. And these symptoms can be distressing, um, and they're obviously very different than the signs of low testosterone. So, how do we manage excessively high testosterone levels? And I see this from women who've been prescribed inappropriate doses and pellets. So, management might include um, depending on the age and the medical history, hormonal contraceptives because that can uh reduce and block some of the endogenous testosterone production. We use sperno lactone, which is a um diuretic that is very helpful for skin and hair. When used alone without any menstrual cycle control, it can cause abnormal bleeding, though. We like to use medications that help address insulin resistance as well as all the lifestyle issues, exercise and taking out carbs from the diet. Um, exercise weight management improves insulin sensitivity and can help regulate menstrual cycles. Uh, you know, we've talked about the roles of alpha lipoic acid and chromium and trace minerals in prior podcast on glucose control. Obviously, targeted cosmetic skin and hair treatments like laser hair removal, electrolysis, um, various acne therapies that we've discussed in prior podcasts, prescription creams, um, seeing an endocrinologist, someone who's expert in congenital adrenal hyperplasia, if you're diagnosed with that. Um, and it's a completely different approach than how we approach low testosterone. And women should never self-treat or just assume their symptoms are hormonal. It could be another condition, it could be undiagnosed sleep apnea, vitamin problems, uh undiagnosed untreated depression. So, who should prescribe testosterone if if you do truly have low testosterone? There's very few labs that do accurate levels, um, and so I think it's important to get accurate levels. This Dutch testing uh may not harm you directly, it might harm your wallet, but is certainly a waste of money. And I see a lot of women spend hundreds of dollars getting testing that we can't even interpret. So I think to see a uh physician that specializes in menopause andor hormone disorders, um, not all gynecologists, but some gynecologists have hormone therapy expertise. Some endocrinologists, but not all endocrinologists, uh, can have expertise in female androgen deficiency or low testosterone as well as high testosterone. Um, a lot of functional and integrative medicine uh clinicians um uh present themselves as being experienced in hormonal care, but in my experience, they're better with the gut microbiome, the diet, heavy metal exposure, mold exposure, and a lot less in the hormonal realm. I I think any physician who's not comfortable being able to do a pelvic exam, work up abnormal bleeding, get an endometrial sampling is probably not going to have your best interest at heart in terms of protecting your uterus. And that is a risk. Uterine cancer, uterine hyperplasia. I've seen women have to get hysterectomies that they might not have needed had their hormones been managed correctly. I also see a lot of these online pharmacies and these functional medicine doctors, and I have women come in and say, Oh, all my friends are on an estrogen patch and separate progesterone. Well, natural progesterone is not very well absorbed, and some people get heartburn or dizziness with it. It's mixed in peanut oil, so if you're peanut allergic, that's an issue. And it's only FDA approved in a cycled regimen. Um, and a lot of women don't want to cycle. And so there's ways that we can get around that with a continuous combined program. But I've just seen over the years a lot of women find out that estrogen makes them feel good, and progesterone somewhat downregulates estrogen's uh stimulatory and mood elevating effects on the brain, and then they just don't take it, and then they get into problems with the uterus. Uh, and there is a role for oral therapy in terms of it's better on mood and skin and hair, it's less expensive, there's more options and therapies. Uh, and so there are some benefits of transdermal, particularly in those who have high triglycerides or who have had blood clots or at risk for blood clots. So one size does not fit all, but what I find troubling is people wanting to get the therapy that they think is popular or that they see Instagram clips on, um, when there can be serious problems with just experimenting with hormones. Now, as I tell my patients, you're an adult, and if you want to experiment with yourself and do that, you know, be my guest. But don't, you know, be expecting my practice to manage and prescribe things that we think are not helpful and or potentially harmful, and that you want to come to the practice uh so that we you just dictate your care, and then we have to be responsible and manage the problems. So I had to have that kind of conversation with someone today. I mean, we want to do shared decision making, it's your body, we want to empower you. But this whole popularization, just like I had to deal with for years, the urban myth that hormones increased death rate and cancer and were terrible, when that's not what the research showed, and I saw so many women suffering that I knew could be beneficial, but they were so plagued by the propaganda, basically, that they were being fed by the culture that they wouldn't listen to me. And I now kind of see the flip side that women want high doses of hormones, unregulated hormones, they want to do it like they think their friend's doing it, or that they heard or read about by someone who's self-proclaimed as a hormone expert, who's actually potentially a grifter or someone just trying to sell you vitamin supplements or enrich themselves or sell their books. So, you know, I've just seen so much harm over the years from the lack of treatment as well as inappropriate or excessive treatment. So that's why it's great you're here and you're listening to get some good information. And if I'm prescribing hormone therapy or you're taking it as a patient, it's about restoring it to the natural female level, not exceeding it. We're not trying to transform you into a male. And um, as I tell women, women don't at post-reproductive age don't have nearly as robust a sex drive. We're looking for you to be responsive, to not have pain, uh, to get pleasure, to uh have normal sensation and lubrication, uh, but not uh, you know, uh feel like you're 20 years old again. And so you deserve to be heard and taken seriously. And it's important that you get educated and that you come armed uh with your questions and concerns and not just throw it in at the end of a visit or uh after you're done your annual, you know, your annual exam. It's important for you to make an appointment, come in with your labs, and come in prepared and be willing, you know, to assume the risk. And even though we don't have FDA-approved options, I mean we do have the one uh product I mentioned that's an oral estrogen testosterone product that can be very effective for women. Um currently we have to use male products at a fraction of the dose or compounded products. That can be done, and we certainly uh we certainly do that. Um so thank you so much for tuning in to speaking of women's health. Uh, give us a five-star rating. You can share this uh with friends if this was helpful, if you're experiencing fatigue and low libido or not feeling like yourself. Talk to someone who has expertise in this. And realizing that testosterone may be helpful to you, but you may be like the majority of women who don't have to take testosterone. Always remember that you can come to speakingwomen's health.com to get trusted information, expert guidance, and resources to help you. Remember, be strong, be healthy, and be in charge.