Testosterone Therapy For Women: Addressing Systemic Health Beyond Libido - Episode Hero Image

Testosterone Therapy For Women: Addressing Systemic Health Beyond Libido

BETTER! Muscle, Mobility, Metabolism & (Peri) Menopause with Dr. Stephanie · · Listen to Original Episode →
Original Title:

TL;DR

  • Testosterone therapy for women, currently off-label in North America, is crucial for addressing systemic health beyond libido, impacting cognitive function, muscle mass, and energy levels.
  • Misconceptions about testosterone's cardiovascular and prostate risks are being debunked by recent studies, indicating potential benefits and a need for updated clinical understanding.
  • The development of an FDA-approved oral testosterone for women, expected by 2027, aims to fill a significant unmet need, offering a safe and effective treatment option.
  • Testosterone plays a vital role across multiple organs, not just reproductive health, influencing brain function, bone health, and cellular energy production through androgen receptors.
  • Accurate diagnosis and monitoring of testosterone levels, focusing on free testosterone and SHBG, are essential for personalized treatment, especially considering the wide variability in optimal ranges.
  • Testosterone therapy, when dosed physiologically, offers a clean safety profile, contrasting with super-physiologic doses that can lead to side effects like virilization in women.
  • Addressing hormonal imbalances in both partners within a couple is critical for relationship health, as mismatched hormone levels can exacerbate issues like sexual dysfunction.

Deep Dive

Testosterone therapy, while readily available for men, remains largely unexplored and underserved for women, despite substantial evidence of its systemic benefits beyond sexual health. This disparity creates a significant unmet need, as declining testosterone levels in women contribute to a range of debilitating symptoms from brain fog and muscle loss to sleep disturbances and stubborn weight gain, impacting overall well-being and quality of life.

The fundamental misunderstanding surrounding testosterone's role in women stems from its historical categorization as solely a "male" hormone, obscuring its crucial functions in every organ system, including the brain, heart, bones, and muscles. This neglect is compounded by a healthcare system that often dismisses these symptoms as mere "aging," while simultaneously offering men a broad spectrum of therapeutic options. The consequences are profound, leading to mismatches in partnered relationships and contributing to midlife dissatisfaction and divorce. Furthermore, the current limited access for women typically restricts treatment to hyposexual desire disorder, ignoring testosterone's broader physiological impacts.

The implications of this neglect are far-reaching. For men, established therapies, though often focused on sexual health or muscle building, can also improve energy, cognitive function, and metabolic health. However, even for men, the "normal" testosterone ranges have been steadily declining, leading to a situation where many individuals may not be technically "low" by outdated standards but are experiencing suboptimal levels and symptoms. This underscores the need for a shift towards optimizing levels for individual well-being rather than adhering to increasingly broad and potentially inaccurate reference ranges. The advent of novel delivery systems, like the orally administered Kazatrx which mimics natural diurnal rhythms and avoids liver toxicity, offers promise for more accessible and effective treatment. While this product is currently approved for men, its development and ongoing clinical trials for a female-specific product, projected for completion in 2027, signal a crucial step toward addressing this critical deficit. The broader availability of such therapies, coupled with increased education for both patients and providers, is essential to empower women to age with vitality and address the systemic effects of hormonal decline.

Action Items

  • Audit testosterone testing protocols: Include free testosterone and SHBG for all patients experiencing relevant symptoms.
  • Create physician education materials: Detail the systemic benefits of testosterone beyond libido for both sexes.
  • Draft clinical guidelines: Outline safe, off-label testosterone dosing strategies for women based on symptomology.
  • Track patient outcomes: Monitor cardiovascular health and prostate status in men on testosterone therapy.
  • Design patient-facing resources: Explain the role of testosterone in energy, cognition, and body composition for women.

Related Episodes

Key Quotes

"Your husband can get testosterone therapy by sneezing in his doctor's general direction, but you're told it's 'just aging' and here's an SSRI. Shalin Shah is here to blow up every myth about testosterone and women's health--because spoiler alert: that brain fog, disappearing muscle, and stubborn belly fat might not be a 'you' problem, it's a hormone problem."

This quote highlights the perceived disparity in how testosterone therapy is approached for men versus women. Dr. Stephanie Estima points out that men may have easier access to testosterone treatment, while women experiencing similar symptoms are often dismissed with explanations of "just aging" or prescribed antidepressants. The speaker, Shalin Shah, is presented as someone who aims to debunk these myths and reframe common midlife health issues as potentially hormone-related.

"On the male side it's often pigeonholed into terms of muscle building because of all the history around steroids and sports or it's really sexual health right that this is going to make guys sort of you know just just drive to crazy levels of sexual activity or something like that which is which is far from the case but what's really the misunderstood or not understood at all is that there's an androgen receptor or a testosterone receptor on every organ in the body so this does affect your brain your cardiovascular system your bone health your muscle health yes your libido and even all the way down to the cellular level mitochondria..."

Shalin Shah explains that testosterone's role is often narrowly defined in popular understanding, focusing on muscle mass and sexual function. He emphasizes that this view is incomplete, as testosterone receptors are present throughout the body, influencing a wide range of physiological processes from cognitive function and cardiovascular health to cellular energy production. This underscores the systemic impact of testosterone beyond its commonly perceived functions.

"The easy easy place to start is on the male side because you know folks barely even consider it a female hormone today even though it absolutely is right testosterone is a male and female hormone just like estrogen is a female and male hormone same thing."

Dr. Stephanie Estima asserts that testosterone is fundamentally a hormone present in both males and females, challenging the common perception that it is exclusively a male hormone. She draws a parallel with estrogen, which is also present in both sexes, to illustrate that hormonal roles are not strictly gender-specific. This statement aims to reframe the understanding of testosterone as a vital hormone for women as well.

"So some of the first things that show up on the male side which unfortunately still get dismissed as general aging often but it is it is around energy feeling that afternoon drag is certainly one of the main ones that show up on in the male side and you also see things like sexual dysfunction that loss of libido that does happen the inability to put on muscle mass right so all the positive aspects of the therapy often do manifest as the symptoms the inability to burn fat so these things are pretty common on the male side but they're equally common on the female side too right..."

Shalin Shah details common symptoms of low testosterone in men, such as fatigue, decreased libido, and difficulty building muscle or burning fat, noting that these are often mistakenly attributed to aging. He then states that these same symptoms are equally prevalent in women, suggesting a shared hormonal basis for these midlife changes. This comparison aims to validate women's experiences of these symptoms as potentially linked to testosterone levels.

"The traverse trial and that read out in june of 2023 simple conclusion testosterone therapy does not increase the risk of cardiovascular events period and actually in the data there were there were less cv events in the testosterone arm than the placebo arm right so i think actually where the conversation is going to go is how understanding testosterone's role in in cardiovascular health because if you actually look at endothelial function improves on testosterone therapy so that's where i think it's going but again firmly that that myth still perpetuates today despite that study it's going to take usually they say it takes 10 years for these things to be fixed..."

Shalin Shah addresses the persistent myth that testosterone therapy increases cardiovascular risk, citing the results of the large-scale TRAVERSE trial. He explains that the study concluded there was no increased cardiovascular risk and, in fact, observed fewer events in the testosterone group compared to the placebo. Shah suggests that the future understanding of testosterone's role in cardiovascular health may reveal beneficial effects, such as improved endothelial function, while acknowledging that outdated myths continue to influence perceptions.

"So on the male side there's a there's a black box for transference to to others right so it just doesn't exist because there's no female product they have nowhere to put that that warning the compounders compounding creams don't have to put that but yeah no it's an absolute issue i've again i've seen it firsthand and and it's you know between especially if you talk about your audience right like we're on the go you don't have like you put this cream on you gotta wait 30 minutes for it to to dry or you're putting your clothes on top of it or what not like it just it doesn't fit into routines but then also you just have variable absorption so you don't know what you're going to get versus again yes an injection you're going to get pretty much a steady blood level likely go super physiologic on kaizetrex we've we see if if you're taking it appropriately you're going to see a more consistent daily level..."

This quote discusses the challenges and risks associated with different testosterone delivery methods, particularly topical creams. Shalin Shah points out the lack of a black box warning for transference to others with female-specific products, unlike male products, but emphasizes that transference is still a significant issue. He also notes the inconvenience and variable absorption associated with creams, contrasting them with the more consistent daily levels achieved with oral or injectable forms like Kazatrx.

Resources

External Resources

Books

  • "The Women's Health Initiative (WHI)" - Mentioned as a study that led to the denial of hormone therapy for women for approximately 20 years.

Articles & Papers

  • "Traverse trial" (FDA mandated study) - Discussed as the largest randomized placebo-controlled study on cardiovascular risk and testosterone therapy, concluding that testosterone therapy does not increase cardiovascular events.
  • "Alzheimer's data" - Referenced in relation to tau protein accumulation and its correlation with low testosterone levels.

People

  • Shalin Shah - Chief Executive Officer at Merys Pharmaceuticals, guest on the podcast.
  • Dr. Stephanie Estima - Host of the podcast "Better with Dr. Stephanie".
  • Shauna Swan - Mentioned for her research on a significant annual decline in testosterone levels in men.

Organizations & Institutions

  • Merys Pharmaceuticals - Pharmaceutical company where Shalin Shah is CEO, involved in the development and FDA approval of oral testosterone.
  • FDA (Food and Drug Administration) - Regulatory body involved in drug approval processes.
  • Health Canada - Canadian regulatory body for health products.

Websites & Online Resources

  • kizer tracks.com - Website for Kizer Tracks, offering provider information and access to therapy.
  • qualia life.com/better - Website for Qualia Senolytic, offering a discount code.
  • bond charge.com/better - Website for Bond Charge red light therapy panels, offering a discount code.
  • drink element.com/doctorestima - Website for Element electrolytes, offering a special bundle.
  • equipfoods.com/better - Website for Equip Foods' Clean Coffee, offering a discount code.

Other Resources

  • Kazatrux - First oral testosterone therapy for men with low testosterone due to medical conditions.
  • Testosterone Replacement Therapy (TRT) - Discussed as a treatment for low testosterone in men and off-label for women.
  • Hormone Therapy (HT / MHT / HRT) - General term for hormone replacement, often discussed in relation to estrogen and progesterone.
  • Urolithin A - Ingredient in MyTure gummies that supports cellular energy.
  • Senescent cells (Zombie cells) - Cells linked to inflammation and declining energy, targeted by Qualia Senolytic.
  • Red light therapy - Therapy using red and near-infrared light to enhance cellular energy production and healing.
  • Cytochrome c oxidase - Protein enhanced by red light therapy for energy production.
  • GLP-1s - Medications discussed in relation to energy, drive, and muscle preservation.
  • Myostatin inhibitors - Investigated for muscle preservation.
  • Sarcopenia - Age-related loss of muscle mass.
  • Frailty - Condition associated with aging and muscle loss.
  • Hip fractures - Potential consequence of frailty.
  • Physiologic doses - Recommended dosage levels for testosterone therapy.
  • Super physiologic levels - Doses significantly higher than natural body levels.
  • Pellet therapy - A method of testosterone delivery, often discussed with potential side effects.
  • Oral testosterone - A mode of testosterone delivery, with Kizer Tracks highlighted as a specific example.
  • Injections - A common mode of testosterone delivery for men.
  • Gels - A mode of testosterone delivery, noted for transference risks.
  • Creams - A mode of testosterone delivery, also noted for transference risks.
  • Circadian rhythm - The daily cycle of hormone levels, particularly testosterone in men.
  • Infradian rhythm - Hormonal cycles related to the menstrual cycle in women.
  • Hyposexual desire disorder - The only on-label indication for testosterone therapy in women in North America as of the recording.
  • Androgen receptor - Receptors on cells that respond to androgens like testosterone.
  • Mitochondrial biogenesis - The process of creating new mitochondria, the energy powerhouses of cells.
  • Oxidative stress - Cellular damage caused by free radicals, linked to aging.
  • Inflammaging - Chronic, low-grade inflammation associated with aging.
  • Hirsutism - Excessive hair growth in women in a male-like pattern.
  • Mandible - The jawbone, mentioned in relation to potential changes from high androgen levels.
  • Clitoral enlargement - A potential side effect of high androgen levels in women.
  • Hematocrit - A measure of red blood cell volume, monitored for men on testosterone therapy.
  • LH (Luteinizing Hormone) and FSH (Follicle-Stimulating Hormone) - Hormones monitored in relation to testosterone therapy.
  • PSA (Prostate-Specific Antigen) - A marker monitored for men in relation to prostate health.
  • Virilization - The development of male physical characteristics in females.
  • Mycotoxins - Toxins produced by fungi, tested for in Clean Coffee.
  • Pesticides - Chemicals used in agriculture, tested for in Clean Coffee.
  • Herbicides (e.g., glyphosate) - Chemicals used to kill weeds, tested for in Clean Coffee.
  • Regenerative farming - Farming practices that improve soil health and sustainability.
  • Mycotoxin-free coffee - Coffee tested and confirmed free of harmful fungal toxins.
  • Cardiovascular risk - Potential risks to the heart and blood vessels.
  • Prostate cancer - A type of cancer affecting the prostate gland in men.
  • Colorectal cancer - Cancer of the colon or rectum.
  • Breast cancer - Cancer of the breast tissue.
  • Endothelial function - The ability of the inner lining of blood vessels to function properly.
  • Diurnal rhythm - The daily cycle of hormone levels.
  • Pituitary gland - An endocrine gland that produces hormones, including LH and FSH.
  • Negative feedback loop - A biological control mechanism where the output of a system reduces the input.
  • Menstrual cycle - The monthly cycle of hormonal changes in women.
  • Progesterone - A female sex hormone.
  • Luteal phase - The phase of the menstrual cycle after ovulation.
  • Compliance - The degree to which a patient follows a treatment plan.
  • Consistency - The act of maintaining a regular pattern or behavior.
  • Ritualization - The process of establishing a routine or ritual.
  • Telehealth - Healthcare services delivered remotely via telecommunications technology.
  • Functional medicine - A system of medicine that focuses on identifying and addressing the root causes of disease.
  • Concierge medicine - A type of healthcare service where patients pay a recurring fee for enhanced access to their physician.
  • PBMs (Pharmacy Benefit Managers) - Companies that manage prescription drug benefits.
  • Payers - Entities that pay for healthcare services, such as insurance companies.
  • Cash basis - A payment model where services are paid for directly by the patient.
  • Efficacy - The ability to produce a desired or intended result.
  • Safety profile - The potential risks and side effects associated with a medication or treatment.
  • Unmet need - A medical condition or problem for which there is no adequate treatment.
  • Andropause - The decline in testosterone levels in men as they age.
  • Perimenopause - The transitional phase before menopause.
  • Menopause - The cessation of menstruation.
  • Vaginal - Relating to the vagina.
  • Libido - Sexual desire.
  • Heart - The organ responsible for circulating blood.
  • Brain - The central organ of the nervous system.
  • Lungs - The organs responsible for respiration.
  • Muscle - Body tissue that can contract to produce movement.
  • Hormone replacement therapy (HRT) - Treatment to replace hormones that the body is no longer producing in sufficient amounts.
  • Primary healthcare provider - A doctor who provides general medical care.
  • Doctor-patient relationship - The professional relationship between a doctor and a patient.
  • Diagnosis - The identification of the nature of an illness or other problem by examination of the symptoms.
  • Treatment - Medical care given to a patient for an illness or injury.
  • Medical disclaimer - A statement that limits liability for medical information provided.
  • Legal disclaimer - A statement that limits legal liability.
  • Apple or Spotify - Platforms where podcast comments can be left.
  • Show notes - Supplementary material accompanying a podcast episode.
  • Primary care provider (PCP) - A doctor who provides general medical care.
  • Urologist - A doctor specializing in the urinary tract and male reproductive system.
  • Endocrinologist - A doctor specializing in hormones and glands.
  • Hepatotoxic - Harmful to the liver.
  • Lymphatic absorption - Absorption through the lymphatic system.
  • Small intestine - The part of the digestive system where most nutrient absorption occurs.
  • Fat content meal - A meal containing fat.
  • Soft gel - A type of capsule containing liquid or semi-solid medication.
  • Fish oil capsule - A capsule containing fish oil.
  • Transference risk - The risk of transferring a substance from one person or surface to another.
  • Absorption issues - Problems with the body's ability to absorb a substance.
  • Variable absorption - Absorption that varies from person to person or from dose to dose.
  • Steady blood level - Consistent levels of a substance in the bloodstream.
  • Daily capsule - A capsule taken once a day.
  • Dosing schemes - Different methods or schedules for administering medication.
  • Physiologic perspective - A viewpoint based on the normal functioning of the body.
  • Real world clinical life - The practical application of medical knowledge in patient care.
  • Delta - A difference or change.
  • Electrolytes - Minerals that carry an electric charge when dissolved in body fluids.
  • Rehydrate - To restore lost fluids and electrolytes.
  • Ritual - A sequence of activities involving gestures, words, actions, or objects, performed in a sequestered place and in a prescribed order.
  • Renaissance - A revival of or renewed interest in something.
  • WHI - Women's Health Initiative.
  • Roadblocks - Obstacles or impediments.
  • Personalization - The tailoring of something to a specific individual.
  • Free T - Free testosterone.
  • Traditional medicine - Conventional Western medicine.
  • Bureaucracy - A system of government or administration characterized by complex rules and procedures.
  • Liability risk - The potential for legal responsibility for harm or damages.
  • Biphasic - Having two phases.
  • Pulsatile - Occurring in pulses or bursts.
  • Temporary - Lasting for only a limited period of time.
  • Super physiologic - Significantly above normal physiological levels.
  • Extended period of time - A long duration.
  • Pellets - Small, solid dosage forms inserted under the skin.
  • Female advisory board - A group of women providing advice on product development.
  • Clinical trials - Research studies performed on human subjects to evaluate medical interventions.
  • **

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