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The 'Pause
The menopause podcast with unfiltered conversations about the symptoms you hate, the changes you didn’t see coming, and the hilarious moments midlife can bring. You've got questions and we've got the experts to answer them.
The 'Pause
Unmasking Menopause Fatigue: Is Testosterone Your Missing Link?
Discover why testosterone might be the missing piece in your menopause treatment plan and how this misunderstood "male hormone" could help restore your energy, focus, and vitality.
• Women naturally have 4-5 times more testosterone than estrogen throughout their reproductive lives
• Testosterone is not FDA-approved for women despite being used regularly in other countries
• Proper testosterone therapy involves using about one-tenth the dose prescribed for men
• Benefits extend beyond libido to include improved energy, mental clarity, muscle tone, and mood
• Potential side effects like unwanted hair growth are rare when appropriate dosing is used
• Testosterone works best as part of a comprehensive approach including diet, exercise, and stress management
• The "hormone trifecta" (estrogen, progesterone, testosterone) more closely mimics pre-menopause hormonal balance
• Monitoring levels with healthcare providers helps ensure proper dosing and effectiveness
Stay curious, stay empowered, and don't pause your power.
Welcome to the Pause, the menopause podcast, with unfiltered conversations about the symptoms you hate, the changes you didn't see coming and the hilarious moments midlife can bring. I'm your host, val Leggo, and I've been a dedicated health reporter for 25 years and I wanted to normalize something that every woman goes through menopause. So together we're going to talk about it the Perry, the Menno and the Post. Welcome to the Pause. I'm your host, val Lago. So tell me if this sounds familiar. You've tried hormone replacement therapy or maybe a natural alternative. Maybe you've changed your diet to eat clean, maybe you've started working out or at least started walking more All the things that your provider recommends. And at first it is great. You feel like a teenager again. You're like, oh, I have finally, finally gotten over the hump. But then, all of a sudden, it's like, meh, I'm not motivated. I don't feel like myself. That's exactly where I'm at right now. I just don't have motivation to do anything. So, being a curious health reporter, I turned to my best friend, google, and I asked why do I still feel blah? And it turns out there's actually a term for it, and it's called menopause fatigue. Are you feeling it? Because I sure am. As I started sifting through all the articles about menopause fatigue, there was one key theme they all seem to center around testosterone. So it turns out, as strange as it might sound, testosterone just might be the missing piece to get you feeling like yourself again Now.
Speaker 1:We've long associated testosterone with men, but here's the twist More and more women are discovering that testosterone plays a critical role in their health, especially during menopause. So in this episode of the Pause, I'm in search of the answers to these questions why is testosterone suddenly trending for perimenopause and menopause? What do the studies say? And, most importantly, is it safe? To help answer these questions, I'm joined once again by certified menopause practitioner, nisha McKenzie, and we are talking about this growing movement and what it might mean for you and what it might mean for you. So women do produce testosterone and we need it for our toned arms, our energy, our mood and yes, nisha's favorite topic our sex drive. But by the time we hit perimenopause, testosterone levels can start to plummet, and sometimes they can plummet even lower than estrogen levels, which, as we know, can get pretty low. So if it's essential, why haven't we heard more about it, nisha?
Speaker 2:What we don't understand and what's not widely spread out there is that as women through our entire from the start we get, from the time we get our first period until the time we get our last period we have more testosterone in our systems than estrogen. And everybody thinks estrogen is the female hormone because women are here's my scare quotes supposed to be dainty and feminine and slight and all these things that are more associated with estrogen. But even those dainty, feminine, slight women have four to five times more testosterone through their entire life than they have estrogen. Why?
Speaker 1:is this the first time I'm hearing this?
Speaker 2:Because men have claimed testosterone. They stake their claim, they put their flag on it.
Speaker 1:They put their flag on it. We own the testosterone.
Speaker 2:They peed on the testosterone tree and they're like this is ours. So and you know I think I may have said this to you before At this point in my life my husband has more estrogen than I do. He doesn't love to hear that either. Men have estrogen, women have testosterone. Men just have 10 times more testosterone than women. But then we take that level and we go okay, we still have four to five times more testosterone than we do estrogen. So it's vitally important for us to keep testosterone oh my gosh.
Speaker 1:This is one of the interesting things that I found, though. Important for us to keep testosterone oh my gosh. This is one of the interesting things that I found, though, is that, unlike estrogen and progesterone, testosterone therapy for women is not FDA approved.
Speaker 2:Yeah, because men peed on the testosterone tree. I mean we almost had it About 10 years ago. There were two different drug trials that were working through FDA process of getting approval, spent billions of dollars and it was stopped for a number of reasons, but in part because of the fear of the WHI. We've talked about the WHI. There weren't proven adverse effects problems happening. There was no scientific data there. It's just that the investigators, the FDA, said no, we're not going to let this keep going because of what the FDA I'm sorry, because of what the WHI said. So I don't think there's probably going to be too many companies trying to spend that much money again. We do have testosterone approved in other countries.
Speaker 1:Right, that's what I was just going to say. A lot of other countries use this regularly to help with perimenopause and menopause symptoms. I just want to back up a little bit. The WHI is the Women's Health Initiative. That's that study that we've talked about many times in previous podcasts about the association between hormone replacement therapy and breast cancer and how that's now been debunked, and so that did way more than just stop hormone replacement therapy for 20 years for women.
Speaker 2:It stopped any kind of progress like testosterone therapy, right which we know that hormones aren't very good at treating chronic disease, but they can help prevent and even the WHI helped show that in multiple studies since then, helped show that in multiple studies since then. So we've stopped preventing because of the misinterpretation and the misinformation that we got from the WHI.
Speaker 1:Okay, so back to the testosterone. If it's not approved by the FDA, how can we use it as a provider?
Speaker 2:what can you do? Yeah, so, especially in women's health. So much of what we do is off-label. What we call is not FDA-approved. Birth control pills, for example, are not FDA-approved for acne. They're also not FDA-approved for heavy menstrual bleeding, and we use it for that too. We use it for birth control as well. So we use things off-label all the time, and that's what we'd have to do here. That's what we do with testosterone Like it was amazing. And now I really am in that math where I'm like I really got to get.
Speaker 1:I have to find the mojo again, and so when women come in, do you ask them specific like symptoms they're feeling and then suggest the testosterone or where do you go with that?
Speaker 2:Yeah, like how to decide if someone's a good candidate for testosterone? Certainly some. Some of it's going to be based on symptoms, and I will always have the conversation about lifestyle as well. We put a lot of pressure on hormones and I always tell people estrogen is not a weight loss drug. Testosterone is not going to fill your bank account. These hormones are not going to necessarily change everything in your life. We do have to move our bodies, we have to eat clean, we have to hydrate, we have to sleep well, we have to get the protein. We're not going to get the muscle mass from that testosterone can help with if we're not lifting the weights and eating right and sleeping well right. So it's not just in those things. And sometimes people either can't or don't change their lifestyles and they kind of recount on the hormones to do it all.
Speaker 1:And the women who do change their lifestyles. Though they say, those benefits are real.
Speaker 2:They really are. Yeah, yeah, they can feel it, but then there's also real benefits that we can't feel. Some of the heart benefits and brain benefits. Testosterone works in our brains just like all the other hormones estrogen and progesterone those three, the trifecta estrogen, progesterone, testosterone. I always say they all do similar things. They can all help with hot flashes and night sweats and moods and cognition, and they're all somewhat notorious for one thing Testosterone. I would say most people will know that they want to use it for libido, sex drive.
Speaker 1:Let's just call it what it is.
Speaker 2:Let's go in there. Yeah, there are people who don't. What's that word, libido?
Speaker 1:Libo, libdo. Yeah, and I think that's what most people feel Like. Is that what's going to? You know, is that the only thing I'm going for? But what are the? So? The benefits, though, is that it does sort of like pull you out of that meh a little bit if you're doing everything right and you just need that extra boost.
Speaker 2:It can. It can give you more energy. It can help with weight distribution. Again, it's not weight loss medication, but it can help with weight distribution, gain muscle mass. It's a brain hormone. There's testosterone receptors everywhere in our body, but also in our brain. So people will sometimes feel a little sharper, a little more focused, Like it can do all those things for people. So how?
Speaker 1:would you prescribe it? Is it going to be a cream? Is it going to be yet another pill?
Speaker 2:We don't have this in a pill. We will use this generally. I would say the most responsible way to use it would be through the skin, like a cream or a gel or something like that.
Speaker 1:Like all over the body, or just like on your elbow Everywhere.
Speaker 2:One of the potential risks with using it is you could get a little hair growth in the places you put it. So you know, like maybe just don't rub it on your cheek because you'll get a little patch of hair there, or you might. So often I'll tell women, put it in a place that you either don't care that you grow hair or that you're already shaved.
Speaker 1:Oh, like my hoo-ha, I put it there.
Speaker 2:I don't care if it grows hair there. I mean, could we say that word too? Could we just go vagina, yes, yes, or vulva, right, but no. I mean, I would tell people generally, maybe avoid the clitoris if depending on the dose you're using, because it could cause your clitoris to grow, which in some aspects that's not a terrible thing. I think we all, as women, know that bigger isn't better. The clitoris has enough nerve endings. It can be really small and still have the same amount of nerve. In fact it's smaller than the penis and has more nerve endings, so we don't necessarily need it to grow unless it's atrophied. But I'll tell people put it on your inner thigh, the back of your calf, some people put it in their armpits. Pick a place. You can alternate sides, like right and left, but don't necessarily alternate locations. Don't put it on the back of your thigh one day and then the top of your buttock the next day and then your inner thigh the next day, because it can vary a little bit in how it absorbs in different locations, all right.
Speaker 1:Now, are there serious complications? We talked a little bit about, you know, the hair growth. That's a very unsightly one and some people would consider that to be a very serious side effect. But are there other ones that we need to be concerned about when it comes to our health?
Speaker 2:The more common side effects are going to be the things that you would associate with testosterone, like hair growth, acne, deepening of your voice, enlarging of your musculature, enlarging of your clitoris, those types of things. Those are really rare and they said they're more common but they're the more common of the side effects, but overall they're really rare. That doesn't happen unless we use too much of a dose and we use one-tenth of the dose that we would replace for men. As long as we stay there, we really don't see too many of those side effects. If we get higher doses.
Speaker 2:We don't have a ton of data in higher doses in cisgender women, meaning that if you were born and the doctors in the room said mom and dad, this is a girl, and they looked at your genitals and said it's a girl, and then you grew up going yes, I'm a girl, that's a cisgender person. We do have data, longer term data, in transgender folks who have been on testosterone for a couple of decades, and we don't see cardiovascular risks or cancer risks. So we do have data that is longer term and, no, we don't see those risks. Some of the bigger concerns people if they get really high, they could get what you might term as roid rage. They just get really agitated and angry and moody, so it can negatively affect mood if it gets too high. But again, those are like in the 10 time the normal doses.
Speaker 1:Right, this is not a DIY situation Like don't use your husband's testosterone.
Speaker 2:First of all, he's going to be mad because he's going to run out early and you're going to probably grow some hair, lose some head hair, grow hair in places you don't want to hair. Yeah, no, it's not DIY. You definitely have to find someone who's trained and knows how to dose a woman in the perimenopausal and menopausal Yep and give it some time, Just like when you initially get on hormone replacement therapy.
Speaker 1:it takes about a month for you to figure out whether or not it's working and how much it's working, and so forth, and then six months later you know like, okay, I really need to dial things in. So unfortunately, it's not like taking aspirin. You have to like sort of just go with the flow and see what's working for you. So when people come in and talk about this, you know we should give them some questions that they need to ask their provider, Like are they having low energy? Are they having a low sex drive? You know, are they like losing their motivation even though they're on HRT? But also, have you had your testosterone level checked, and why is that important?
Speaker 2:Partially because we don't have FDA approval for this and so we want to monitor a little bit more closely so we know what we're doing. We're kind of gaining data as we go, but partially also because we just don't want to go too high. You'll very seldom I like to say never, but I'm in medicine, so I'm not supposed to say never, always right. But you'll very seldom I like to say never, but I'm in medicine, so I'm not supposed to say never, always right. But you'll very seldom hear me say that your testosterone level should be in this range. What we generally try to go for is physiologic range, so where a lab might say that a woman should be.
Speaker 2:I don't really like any of those terms, but we don't want to get too high, because then if we get too high, then we know we're probably going to grow a beard. So that's the only reason we check levels. We'll check at a baseline, make sure that we're not already too high. To start, there are some androgenic conditions that some women will have that already have them at a higher level of testosterone, and then we check it in six weeks. We might check it again in another six weeks. It starts to space out, as we know that people are stabilizing at a level, but we're not checking a level to get to a certain level. We're checking a level to make sure I'm not over supplementing or that you're not absorbing more of it than I thought you would, or something like that.
Speaker 1:So once you get on testosterone therapy, then do you have to continue to be monitored, so you know you're good.
Speaker 2:Eventually, what I do with my patients is I'll monitor them once a year at their annual exam.
Speaker 1:Okay, that's a good benchmark. Then you know where they're at.
Speaker 1:Yeah, if they're having questions, then you can say all right, maybe an adjustment, Absolutely Well, you know. What's great, Nisha, is that we have this wonderful Facebook group called the Pause Diaries and we now have over 500 women. Thank you all for joining. We love you. It's a great, great group. If you haven't joined it yet, I highly recommend that you do, and they've got a few questions for you about testosterone therapy. So here we go. Sabrina wants to know if low sex drive is the only reason to use testosterone. We addressed this a little bit A little bit.
Speaker 2:We're going to upload a global position statement on testosterone into the Facebook. And what is that, dr? Dr Nisha going to upload a global position statement on testosterone into the Facebook diaries and what is that, dr Nisha?
Speaker 2:This is a Many organizations that are hormone experts came together and decided how should we use testosterone in perimenopausal, postmenopausal women, what's the most responsible and appropriate way? So this kind of gives a guideline to that. So we'll upload that into the Facebook group so people can kind of look it over. It is a medical document but you can kind of skim it over and get an idea and with that it says yes, the indication within that is libido, but we can use it for so many other things. We don't have an FDA approval for it, again, right. So we can use it for whatever people feel like is appropriate for them. It's really up to your practitioner and your expert. Who needs it. Why do they need it? What are the risks and benefits?
Speaker 2:It's not a blanket statement we can give. One thing I will say is for men, testosterone is FDA approved for a diagnosis of hypogonadism. Hypo means low Gonads, are their testicles, or so it's low function of their gonads. If we were to have equality between the sexes, we would have hypogonadism as a diagnosis for women, which, like surprise, is menopause, yes, right. And then we would say we could use these hormones for this, but we don't have an FDA approval for it. We have a global position statement that says we can use it for libido, so, in other words, we can just use this hormone to have sex with another person. What happened to our own health? Right, right, we need, we need to be able to use this more broadly. It's not there yet, but we should.
Speaker 1:So short answer. Sabrina, it sounds like yes.
Speaker 2:Short answers I'm not good at.
Speaker 1:No, she's not. But we always get so much more information and I love it, so I'm fine with it. But the short answer is like it's going to most likely get you out of the meh, you know, give you some more energy, a little bit more focus.
Speaker 2:If we have more energy and more focus, we might want to have more sex, right?
Speaker 1:All right, so, lisa, asked is it a guarantee that you'll grow chin hair if you use testosterone?
Speaker 2:It's not Generally, if we use too high doses. But we can always back off on the dose, and sometimes people will notice that they're growing chin hair, face hair, anterior like front of their neck hair as they go through menopause, even without hormones, and a lot of times that's because your testosterone was already low, but now your estrogen is lowering and so the ratio of testosterone to estrogen is narrowing, so your body almost feels like it's got a little bit more testosterone, and so then we can see that. But no, it's not a guarantee.
Speaker 1:Okay, all right, that makes so much sense because I know we've talked about this before on previous podcasts that my mother was never on HRT. She did pass away because of dementia and when I went to visit her in her last years, you know she had a mustache. So I was like what is going on here? How is she growing facial hair? So that's the answer. Then Her estrogen was dipping so low that her testosterone was a little higher. It made it look a little higher to the body. Yeah, yeah, wow, fascinating, fascinating. All right, so here's one for me. So you can use estrogen, progesterone if you still have your uterus which we verified on the last podcast that I do and testosterone altogether. It seems like a lot. It does seem like a lot.
Speaker 2:I do call it the trifecta.
Speaker 1:Okay.
Speaker 2:All right, you have to use progesterone if you have a uterus. You can use progesterone if you don't have a uterus. So you could be on all three. And it does seem like a lot, but again, I've said it before, I'll say it again we just outlive our ovaries. It's the a lot that we used to have in order to function, and it's not even fully those amounts. It's a sprinkle of those amounts, just enough to help prevent some chronic diseases, help us feel more like ourselves and like we can get through our day. All right, so you can use all three.
Speaker 1:You can use all three. I think I'm probably going to dip my toe in the testosterone pool and see what happens, because I feel like if it's out there, you know, try it. That's the way I look at it.
Speaker 2:Try it and see if it works, but that's the way I look at it. Try itchman will say you need a husbandectomy, right. So it's not going to fix everybody's libido, it's not going to fix a relationship, right, but it can be helpful for many people.
Speaker 1:And that brings up my next point. I mean, some women who start using testosterone say, oh my gosh, in two months I felt like somebody just flipped the lights back on and I was a teenager again. But that's not going to be everybody's experience, and testosterone therapy it's not a miracle fix, you know, but it is something to definitely try if you're interested in it. Yeah, that's a good thing to know. So part of the bigger picture here is that hormone therapy is just part of the equation You've talked about. You need nutrition, you need sleep, you need to manage your stress. They all work together to really help that perimenopause and menopause journey just a little bit more tolerable.
Speaker 2:Yeah, we got to do it all. There's a lot I get really excited about testosterone too. I mean, I also get really excited about a lot of things All the hormones and all the sex. We'll talk about all of it.
Speaker 1:So is testosterone the missing link for women in menopause? It may be, it may be not, but it's definitely worth a conversation, especially with a trusted provider. So stay curious, stay empowered and don't pause your power. Also, remember, while Nisha is a menopause practitioner, she's not your medical provider in this setting. So the information shared on this podcast is for educational and informational purposes only and is not a substitute for medical advice, diagnosis or treatment. So please consult your own healthcare provider for personalized medical guidance. Until next time, join our Facebook group, the Pause Diaries. You'll love bonding with the women there who are so supportive and also going on the same journey that you are. Remember this is not the end of anything. It is the beginning of the rest of your life and we're going to talk about it.
