Testosterone Is Not a Male Hormone: Levels, Dosing, and What It Does During Menopause

19:50Dr. Mary Claire Haver:So what does low testosterone really actually look like in a woman? Most commonly, sexual side effects are the most specific, right? So if a woman has low testosterone, she'll say I have low libido. They can typically have low arousal, orgasmic dysfunction as well. So sexual. But there's other symptoms that occur. She'll say that I have a depressed mood, change in my mood, decreased energy, right? Poor cognition has been seen as well. Decreased muscle mass, increased fat deposition, right? These are very similar to what we see also in women who go through menopause, right? And sometimes you say some of the menopausal symptoms are very similar to what someone's suffering from low testosterone.

20:29And there are many studies showing that if you place a woman with HRT and you put her on estrogen and progesterone and she still has symptoms, If you add the testosterone, you can mitigate those symptoms, right? Why? Because those symptoms were actually T-related, not so much E &P-related.

20:43Dr. Mary Claire Haver:We do see that in clinical practice. Yes. You know, we always – I do too, yes. You know, I'm a gynecologist. I'm a menopause specialist. So we start with estrogen and plus or minus progestin depending on, you know, uterus and sleep issues. And then, you know, testosterone definitely with HSDD. But we are seeing when we add it, suddenly they're getting better symptom control across the board. Across the board. And Louise Newsom just published that big study in her group. When she added the T, those patients saw greater improvements in menopausal symptoms than just estrogen and progesterone alone.

21:14Dr. Mary Claire Haver:How often clinically do you and your team, because you have residents. I mean, you're in a big academic practice. So walk me through what your practice looks like. I'm at Baylor College of Medicine, and I'm in the Division of Sexual Dysfunction and Fertility. And so we have three clinical fellows. We have 20 residents. We have an unbelievable amount of medical students. And every day it's a lot of fun. You're constantly teaching. You're educating. You're operating with them. I work at the VA every Monday, half day. So I'm working with the vets and I'm operating with the residents there. But it's busy.

21:43You know, it's about 150 to 160 patients a week. It's eight surgeries a week. But it's fun. And then we spend a lot of time. Friday afternoons is my research day. I started a basic science lab in 2007 and still running where it's called the Laboratory for Andrology Research, where we do a lot of research looking at testosterone for men and women in our lab. And so it's busy.

22:03Dr. Mary Claire Haver:That's awesome. Yeah. So how often in this clinical situation do you have a patient who's come in and she's been worked up for depression, fatigue, relationship problems who's never had her testosterone drawn? So common because getting her testosterone drawn is something that's last on most clinicians' minds, right? Yeah. So she comes in and she has these symptoms. It wasn't even on the checklist. It's not on the checklist. TSH is on the checklist. For sure. For sure. Clinical depression is on the checklist. And they may check for… We screen for everybody. Right. So depression, but the T is one of the last on the list.

22:36And what's unfortunate is that many women, I've seen this, will come in with those symptoms and they'll be given an SSRI. Say, I think you need an SSRI. You've got a lot of stress going on. You're a little bit depressed. I'm going to put you on an SSRI. And she's already telling the clinician that she suffers from low libido. What do you think that SSRI is doing to her libido? It's plummeting.

22:54Dr. Mary Claire Haver:It's plummeting. It's plummeting. So it made it worse, right? She doesn't need an SSRI. She needs to really look at her hormones, right? Evaluate her hormones. Look at her testosterone level. Start with the bioidenticals first, normalizer, and then see if you need something else, right? But not the reverse. So what does the blood draw look like? Like, what are you looking for? Are you doing free? Are you doing total? There's a lot of questions about that. What is the scientific validity of doing a free versus a total? So look, if you look at the global consensus position statement, the statement states that you should only look at total, right?

23:25And there's reasons for this because we know that as you get to T levels below 100, the asses – Like female levels. Yes, female levels. The assays become more inaccurate, right? So if you really want the most accurate testosterone level, then you want to get LC-MS, right? And you want to get something, but it's hard to get LC-MS and it's expensive. So we use amino assays as a surrogate model.

23:45Dr. Mary Claire Haver:And for our listeners, what is LC-MS? The good comatography mass spec. It's a specific type of way of measuring testosterone in women at low levels. It's the most accurate. And you can send it out. So LabCorp has it, Quest has it, but most clinicians just order testosterone. Okay, fine. And so it's not as accurate because of lower levels. And remember, women also have diurnal variation, particularly younger women. So just like men, we have the highest levels in the morning of testosterone. Oh, wow. So do women. So just remember that. We also know that. How much is that fluctuation? It's about 25 % from morning to evening on testosterone.

24:16But at younger ages. So as she gets older, she loses the diurnal variation just like men. But it's at 25. So she comes in and she's 45 years old. And you check a T in the morning and you check it in the afternoon. It can be a 25 % variance on the T level. Okay. That's why they recommend checking it in the morning. The second thing is we're getting into a world of fasting. So we do know that if you have a meal, testosterone levels can also be suppressed in men and women. So they recommend fasting in the morning. If she's premenopausal, I'll get the honor in the follicular phase, day three to seven roughly to check that.

24:48But if she's mostly postmenopausal, that's fine. So early morning fasting if you can. But we use LC-MS. Now, the guidelines say don't use free tea. And I don't completely agree with that. We do know in the male population, free tea is the best predictor of symptoms. It's been shown, EMAS study, and numbers are shown that your body doesn't care about the total.

25:10Dr. Mary Claire Haver:Right. It only cares about the free. It just needs the active. It only needs the active. And so it's not that different in women also. It's the active. In certain women, the SHBG can be very elevated. Okay, so walk me through SHBG for our listeners. Sex, hormone, binding, globulin. Think of it like something that's bad, not great. It's made by the liver, and it loves to bind to the testosterone. And if it binds to the testosterone, guess what? You don't have very much to use. So the higher the SHBG, the less free T I have, right? Well, what is notorious for causing elevated SHBG in women? Oral estrogen.

25:44Oral estrogen and birth control.

25:46Dr. Mary Claire Haver:Yeah. Ethnolestradi. Yeah, right. That is notorious. Erwin Goldstein did this amazing study out of Boston University several years ago. And he showed that if a woman took oral contraceptive pills greater than five years and then stopped, her SHBG may never normalize. It's permanently elevated, right? So that was an interesting – that really made a hit on me because I thought, okay, that's making her have long-term effects of negative sexual dysfunction because her free tea will be permanently low. So I see a woman. She's been – she said, look, I took birth control 20 years ago. Yeah, I took it 20 years ago, but I took it for 10 years.

26:19You look at the SHBG, it's still sky high, right? Because it can stay perfectly elevated. So you have to compensate by giving her high T levels as a workaround. Now, guidelines will say don't look at the SHBG, just look at the total T. But no, there's exceptions. If you have a woman who's in the normal range who has signs and symptoms of low T, check the SHBG. If it's elevated and the free T is low, I still think it's important to raise the T to see if she has improvement in symptoms.

26:44Dr. Mary Claire Haver:Are there ways outside of elevating testosterone? Like how can I get my SHBG down if it's elevated? Yeah, so people ask me that. Some patients are very clever. They said, look, you know what? Don't raise my T. Lower my SHBG. I said, look, SHBG is due to medical conditions. For example, hyperthyroidism will increase SHBG. Pregnancy will create SHBG. So conditions can do it. Cirrhosis decreases it. So if you fix the condition, you can change the SHBG. There are supplements, but I'm not a big believer, like boron. There's certain ones that can potentially drop the SHBG a little bit. The best way to drop SHBG, testosterone.

27:19Testosterone in itself lowers SHBG. So it feeds back to the liver somehow. And drops the SHBG level. So you're increasing total T and you're dropping SHBG. And that helps a lot.

27:32Dr. Mary Claire Haver:Welcome back to another MidiPause. I'm Dr. Mary Claire Haver, host of Unpaused. Let's talk about one of the most frustrating parts of perimenopause and menopause for so many women. Sleep. Why is it that the place we're supposed to feel most at peace can cause so much disruption? If you've ever found yourself wide awake, staring at the ceiling at 2 a.m., convinced something is fundamentally wrong with you, this is for you. Even women who never had trouble sleeping can suddenly find themselves waking up in the middle of the night, tossing and turning, are feeling exhausted no matter how many hours they're technically getting.

28:13Dr. Mary Claire Haver:And it's not just inconvenient. It can affect everything. Your mood, your focus, your energy, your stress levels, even your relationships. You are not alone. And this is not just in your head. Perimenopause and menopause changes the way our brains and bodies regulate sleep. Declining progesterone can affect how calm and sleepy we feel at night, while hot flashes, night sweats, and increased anxiety can make staying asleep feel nearly impossible. There are real solutions, and they're not one size fits all. For some women, improving sleep starts with lifestyle adjustments, reducing alcohol and caffeine, managing stress, creating a more consistent nighttime routine, or supporting blood sugar balance.

29:00Dr. Mary Claire Haver:For others, it may involve hormone therapy, targeted supplements, or addressing underlying issues like anxiety or sleep apnea. This is exactly why personalized care matters. MidiHealth helps women navigate menopause with a much more comprehensive approach, including sleep health. Midi connects women with clinicians who specialize in midlife and menopause care. So instead of feeling dismissed, you're actually getting support tailored to your symptoms and your lifestyle. What's great is that Mitty looks at the bigger picture. They help women identify why sleep is being disrupted, not just how to temporarily mask it.

29:41Dr. Mary Claire Haver:Whether that means exploring hormone therapy, creating a sleep support plan, or addressing related symptoms like anxiety or night sweats, the care is individualized. And because it's virtual, women can access expert support from home, which makes these conversations feel a lot more accessible and less intimidating. Because sleep isn't a luxury, it's foundational to your health. So if perimenopause or menopause has completely changed the way you sleep, know that you're not alone. And more importantly, you're not out of options. The right support can make a huge difference. Go to joinmidi.com, join m-i-d-i dot com, and connect with one of their clinicians today.

30:29Many women in perimenopause and menopause are focused on eating healthier, but they may still be missing key nutrients like protein and iron.

30:38Dr. Mary Claire Haver:When you're not tracking them consistently, it can be difficult to know if you're actually meeting your needs. That's why I recommend Chronometer. It gives you a detailed look at your nutrition, including protein intake, iron, fiber, omega-3s, and so much more. I like that it helps women move beyond simply counting calories and really understand nutrient density. What makes Chronometer different is the level of accuracy and detail. The platform is incredibly user-friendly, but also robust enough that I genuinely trust the data. During midlife, nutrition becomes even more important than ever, and having access to this kind of information can help support smarter daily habits.

31:27Dr. Mary Claire Haver:If you want a clearer picture of your nutrition and micronutrient intake, download Chronometer for free today at chronometer.com. This podcast is sponsored by MidiHealth. You've heard me talk about my menopause toolkit. It consists of nutrition, exercise, hormone therapy, and other medications, stress reduction, sleep quality, and community connection. When you put those pieces together, they don't just ease symptoms. they support your long-term health. That's why I recommend MidiHealth. They put your toolkit to work for you. Midi is a virtual clinic built by leaders in women's health with clinicians who understand the science of female aging and who take the time to understand you.

32:13Dr. Mary Claire Haver:Through one-on-one visits, they listen to your symptoms, your goals, and your concerns, then create a personalized care plan tailored specifically to you. And best of all, MIDI is covered by most major insurance plans, making expert, high-quality care accessible and affordable for every woman. All of which is why MIDI should be part of every woman's menopause toolkit. Book your virtual visit today at joinmidi.com. That's joinmidi.com. I'm getting my blood drawn. I'm doing it in the morning. I'm doing it fasting. Yes. And I'm postmenopausal, so time of the month does it. But if I'm peri, which a lot of our patients are, we have them try to come in, you know, molecular fast.

32:56Yeah.

32:57Dr. Mary Claire Haver:Because we're doing a bunch of other labs too. And okay, talk to me about levels. What do they mean? Yeah. So let's talk about levels. Guidelines will tell you that we should put them back into the premenopausal range. And what is that? So some will say 17 to 57. Most will agree that 20 to 80 is the premenopausal range. Some others will say, no, it should be higher, but most guidelines say 20 to 80. So this is where I disagree a little bit. And we look at the male literature as well. If she's 25, that's considered normal. But to me, that's not considered normal, right? They say, well, she's in the normal range.

33:34So normal ranges for thyroid, testosterone, and men, if they give you a range, patients tend to do better, I've seen, in the upper quartile normal. It varies.

33:43Dr. Mary Claire Haver:If they're symptomatic. Yeah. So I use that as a judgment. Just like you would treat a woman who needed estrogen and progesterone, the OBGYNs do it on symptoms. You don't check levels. I've never seen OBGYNs. Let me check your estrogen. Oh, you come in, she still has vasomotor symptoms. What do you do? Yeah, guidelines don't support checking estrogen. Right. So the fear is that you don't want to get super physiologic on giving her too much. many years ago. This is very important. In my lab, I started checking the blood in men and women, and I checked something called the CAG repeat. The CAG repeat is looking at the sensitivity of the androgen receptor, looking at her DNA.

34:20So I showed the DNA in the men and the women. I looked at the sensitivity of the testosterone receptor. We showed, for example, those men who have more sensitive receptors, they need less T. Those men who have very insensitive receptors, they need more tea. And we published also in Women a very similar paper. What does that mean? All of us are different. Levels don't matter. Well, to some degree, but all of us are different. And all of us have our own set point. So let's say on that range from 20 to 80, you feel great at 60. It doesn't mean that everyone has to feel great at 60. Maybe she feels great at 80 and she feels great at 40.

34:57Dr. Mary Claire Haver:What if she feels great at 100 or 120? Right. So that's where people will say you need to be careful. I have no problem in raising the levels higher, slightly higher, but I want to be very clear. I don't believe in keeping super physiologic levels at a sustained super physiologic level. If they're transient for a while, I agree. If the woman is in the upper quartile abnormal and she still has symptoms, that's your clue to say, what else is going on? So I would tell the residents, I say, look, we got this patient into the upper quartile abnormal. His or her testosterone level is right where it needs to be.

35:29Well, Dr. Carroll, let's raise it. Let's raise it to super physiologic levels. No. Let's first look and see what else could be causing her symptoms. And then we'll talk about it. Let's say, is she depressed? What about her relationship with her partner? What's about her overall health? And we'll talk about that. Health is important. First, look at everything else before you tell me you want to raise it to the superphysiologic level.

35:48Dr. Mary Claire Haver:Yeah, that makes sense. So testosterone has been used in women. We looked at the data since 1935 in some ways. Yes, some ways. And yet here we are, it's 2026, and there is no FDA-approved testosterone formulation for women. How is that possible? I want to talk about the history. It's so interesting. Okay. 1935, Boo Nanarussica actually invented or synthesized testosterone. Back then it was an oral testosterone in 1935. In 1939, a physician named Alfred Lozier, he was an OBGYN in London, was the first to start using it in women. And his first was a case report of a woman who had mastitis. He started noticing that women who are breastfeeding during their menstrual periods also have a lot of testosterone in the urine.

36:34So he started giving this woman with mastitis or testosterone and reported significant improvements. A year later, he wrote the first pellet study, 1940, giving 10 women testosterone pellets, and he reported significant improvements in sexual function. Greenblatt was an OBGYN in Canada. Yeah, and he was in 1941. same thing. He started giving women pellets, showing significant improvements. And over the course of many years, other studies have come out showing beneficial effects of testosterone in women. But what happened is the United States had three strikes. First strike we had in 1965, we had Estrotest.

37:11I don't know if you remember that.

37:11Dr. Mary Claire Haver:Yeah, I used to describe it. Estrotest basically was methylated testosterone and estrogen, and it was out in 1965 for women. And it was an oral. It was an oral. The FDA later on said, you know what, we know we gave you permission to put it out there, But we want you to give us a study showing how this would work with just estrogen alone versus estrogen plus testosterone. The company said, we're not going to spend the money. We're not going to do it. We're done. They took it off the market. Strike number two was Intrenza. I don't know if you remember Intrenza. It was a patch. And it was a patch that were women.

37:39It was by Procter & Gamble. And they were trying to get it for women through the FDA. And a lot of the studies were done at Baylor. And I was working with a guy named John Buster back then. He was doing the clinical trials. And it was a patch. It was 300 micrograms. And they almost made it to the FDA. They had great data. Like efficacy was fantastic. They had a large phase four cardiovascular study. It looked really good. And the year they tried to get it passed was right after the WHI came in. WHI. Right after. And the reason why it was turned down, if you read, was the theoretical potential adverse risk.

38:12Great data. So we have strike two. And LibbyGel was our third, I hope, the most recent.

38:17Dr. Mary Claire Haver:LibbyGel, yeah. Yeah, recently. And so LibbyGel tried to get it through. and they had the largest study on cardiovascular. It was a great study, good money, great well-designed study, but they missed their efficacy endpoint in terms of improving sexual function. So they took it off the market. So we lost all three, right? And so right now, if you and I went to Australia and we asked for testosterone for women, we could get Androfem. It's available. It's on the market. If you and I go to Walgreens down the street and say, could you please give us all the testosterone for men? 30 products will show up on the counter.

38:51Zero, zero for women. Not one FDA approved product for women, which is unfortunate, right? Now, it's not illegal to give a woman testosterone. No, it's off label. It's off label. But that's where the problem is. It gets unregulated. Levels get crazy. You have to do one tenth the dose and try to squeeze it out. Like, why do you have to do this? And if it's off label, it's going to cost her more money, right? Because she has to pay the compounded price. The men walk in and pay$10 copay, by the way. $10 copay, right? The women pay the 90 bucks for the compounded, or she pays the whack price for the commercially available and then has to spread it over time.

39:23So it's much easier for men. And so it's very – I have two daughters, so I tell them the story, and my daughters were very upset. They're like, Dad, that's unfair. Why do they get to do that? And I said, I agree. Right. Yeah.

39:35Dr. Mary Claire Haver:So what are women actually using? I mean, I know in the landscape we've got compounded versions. When I first started putting a toe in the water after long, heartfelt conversations with Kelly Casperson, and Rachel Rubin and Ishwish, you know, doing an Ishwish conference. I'm like, okay, I've got enough data in my mind to justify doing this, but I was scared of it. Sure. Right? I was taught to be scared of testosterone. It was a bad hormone. Right. For women. So I couldn't get my patients to be able to afford the, you know, using the men's versions at the time. Sure. We have a workaround for that now.

40:09Dr. Mary Claire Haver:So I was compounding at a local pharmacy. But then a lot of women were coming in who had already been given certain other forms like pellets and from a certain company. But they were coming in with, to me, astronomical levels of testosterone. And this was weeks out from their implants. So it is the Wild West out there right now. So walk me through how you try to give testosterone to your patients. Sure. So I think when you look at all the consensus statement guidelines, what is the main concern? The two main concerns are super physiologic dosing and compounded, meaning unregulated. So if you had something that wasn't super physiologic and wasn't compounded, you feel the safest, right?

40:50So I tell women, look, testosterone is a compound. It's a molecule. I don't care whether it's a pellet, an injection, a patch, a gel. It's the same drug. It's different ways to get it into your body. So let's talk about the different ways to get it into your body. Yes, we do use a lot of compounded creams. We do use sometimes commercially available gels, and we try to use one-tenth a dose. But quite frankly, my favorite is injectables. Now, if you look at the consensus statements, they say, well, injectables should be on the lowest. But not necessarily. The reality is that any drug that you use, any formulation you choose, as long as you do it appropriately with the right dose and the right monitoring, you win.

41:26Anything you do.

41:27Dr. Mary Claire Haver:Even a pellet. I mean, I have to say, I don't want to demonize pellets. It's a method of delivery. Right. But let's talk about this. I use a lot of pellets in women. And I use the commercially available one, Testapel. Right? It's commercially available. So it's not compounded. Yeah. It's commercially available. And it's a 75 milligram pellet. And let's say I decided tomorrow that I decided to cut the pellet in half, which I've done before, and put 33 milligrams or 32.5 milligrams in a woman. Okay. I don't think anyone would argue that 32 milligrams over three to four months and it's not compounded.

41:57What would be the harm of giving her 32 milligrams non-compounded over three to four months? Nothing. So you're telling me it's not that the pellet is the problem. It's the abuse of the pellet is the problem. It's not the pellet. Because a 32, I can't imagine anyone telling me, Kara, you're not allowed to use a FDA approved pellet for women at 32 milligrams every three months. No one's going to say that's a problem. Not a single person is going to tell me that. Right? But they say, yeah, if you put 200 milligrams every three months and don't check levels, which happens, that's a problem.

42:31Dr. Mary Claire Haver:Yeah. That's a big problem. And that's not a pellet problem. That's a method of, you know, that is. That's right. It's how you use it. So first, how you use it, the levels you're achieving, because many times these pellets are being reinserted at such high trough levels. The trough level is so high. And then she gets another 200 milligrams, right? And many times I ask when these patients come in, the levels are not being checked. Like there's not even checking levels, which makes me very uncomfortable, right? So I think you have to ask yourself, it's not so much the modality. it's the inappropriate dosing and the inappropriate monitoring.

43:07I love injectables. I found we have a paper coming out right now. You know, we have them, we compound it, but it's testosterone cypionate. And we have them inject 2.5 milligrams, which is 0.1 cc, is 25 milligrams per ml on Sunday and Thursday. We do the same for men. It works great.

43:23Dr. Mary Claire Haver:Different dosing. Different dosing, much different dosing, right? Much different dosing. In fact, it's 20x. So you do a biweekly or twice a week? Biweekly, because we showed many times if you microdose it, You don't get the spike and it decreases the rate of hertsuism, acne, facial hair, also decreases the rate of erythrocytosis in women as well. So if you just do it twice a week and typically it peaks in 24 hours. So Mondays when she's on, Friday when she's on, she likes those two days. It's very cheap. It's$30 a month, no insurance. And she simply has to just pinch the fat and do it twice a week.

43:53So they like it. They like it a lot. And then when we give women choices, I found that that's the one they choose the most. So I always give them choices. I don't say you have to do this. I say, these are all the things I can offer you. What would you like to do? And we give them choices. Some women say, there's no way I can inject. I can't put the gel on every day. I forget to do it. I travel all the time. Please let me use the pellet. Sure. As long as I'm doing it appropriately, I monitor you. I give you the right doses. No problem. Awesome. Right? But you get to choose. Just like I give the men, you get to choose.

44:22Right?

44:23Dr. Mary Claire Haver:The creams, injections, pellets, is dosing a lot different? Like there's different concentrations. Yes. Yes. So listen, I wrote this big paper in 2007 called The Switch Study. And what we showed was when you use a transdermal, like a topical, like a gel or a cream, don't get fooled by the milligrams. This is the formula. It's milligrams times percent penetrance. So if I give you a million milligrams of cream and you have zero percent penetrance, you get nothing. Nothing. You get nothing, right? So but you were fooled on the million milligrams. Like, oh, my God, I got a million milligrams. You got nothing.

44:58So in our paper, we showed, this was with androgel intestine back then, that 20 % of men who put the gel on got nothing. It didn't absorb, right? So each one of us, all of us, have a different percent penetrance. We all do.

45:10Dr. Mary Claire Haver:I mean, we just, Louise Newsom showed that with the estrogen patches. Right. Or the transdermal estrogen opsin, 20 % variance. Yes, and everyone has a different percentage. So that's why if you give a woman 4 milligrams of testosterone in a cream, some women need a higher level. How can I give her eight? Because she's not absorbing. She's a partial absorber. She's absorbing 30%. So if I give her higher levels, because remember, you multiply higher milligrams times the same percent penetrance, I get a better blood level, right? So it's okay to go higher in order to get the level you want because we're all different.

45:43So creams are very important. Gels are very important. I have not found it very useful to – look, even though the guidelines recommend we should not use compounded. We should use one-tenth of a man's dose commercially. That's not what the world does. The world uses compounded, right? That's what we do. So you have to be careful on the compounding pharmacy that you use, right? That's very important. How do you pick a compounding pharmacy for the clinicians listening? Really important. Let's look at the different grades. The top is a 503B. There's a 503 compounder. These are compounding pharmacies that make bulk, okay?

46:17And they're approved by the FDA. If there's a shortage of a medication, they will make the difference. They're regulated like you can't even believe just by the FDA. The majority of the compounders you see around here are called 503As. There's almost 6 ,000 of them in the United States, right? But there's different degrees of quality. There's 503As that are accredited. There's 503As that are not accredited. And if something is not allowed to be made by a 503A, because we can talk about peptides, it's actually very important. And if they're not allowed to be made by a 503A, they're made by what I call the underground.

46:50They'll come from China. They'll come from different places and be shipped in. So the 503As, you want to make sure they're accredited and they're licensed by their state, which are two basic things. Like are you accredited? Are you licensed by your state? That helps prevent a little bit of this concern that it's not of good quality.

47:07Dr. Mary Claire Haver:Amazing. What about oral formulations for testosterone? Yeah. So right now we don't have – now, look, the only thing I have against oral slightly is the increase. increase in SHBG. So they will, just like estrogen, the oral teas will increase the SHBG. But the new undecanoate orals don't. Undecanoate, but it's only in Australia, right? Well, not yet. It's coming. In the US, they're about to come. The oral undecanoates don't increase SHBG. In fact, they have a slight decrease in SHBG levels, which is nice, but they bypass the liver and they go into the lymphatic system. And I've tried using the orals that we have for men, for women, in the lowest dose, one of them is by Kaiser's Rex, it's 100 milligrams.

47:46It's just too high in women. It's just too high. And it's hard to cut it. But companies are looking at making a 50 milligram dose, which would be great. If we can get an oral that's lower in concentration, that would be fantastic. There's a belief that Androfem, which is available in Australia, may be coming to the United States. So that would be great also. This is a big year. We did a lot of work with the FDA also. And this administration is very pro-hormones and testosterone for men and women. Well, look what they did for the estrogen black box. Yeah, in November 10th. Yeah, and for us also on April 16th, they're lifting the indications for men for you.

48:21So they're really proactive. And I think that we will see a testosterone for women within the next two years. I do.

48:28Dr. Mary Claire Haver:Okay, I really hope so. I do too. For a dosing insurance standpoint, all of it would make life so much easier. But we also have to provide the education to the clinicians on how to properly dose and monitor. Let's talk about why do we worry about super physiologic dosing? What's the point? Well, so there's a couple of things. We have most of the data in men, but there's some in women, but super physiologic doses, you can get cardiotoxicity. You can actually get what we call remodeling of the heart. Remodeling of the heart means actually you get thickening of the ventricle and fibrosis, which is not reversible, right?

48:59You see in athletes who dope as well that you actually see increased cardiovascular events in young ages, right?

49:05Dr. Mary Claire Haver:There's a lot of, I think, misunderstanding, definitely misinformation on social media about some of the negative side effects of being super physiologic of testosterone. Every woman assumes she's going to grow hair where she doesn't want it or have a deepened voice. Walk me through what the data actually says about side effects. The most important thing to realize is side effects are related to dose. That's very important. If I give you a high dose, you're more likely to get side effects. If I give you a low dose, you're less likely to get side effects. And every woman will have side effects at a different level.

49:35So you always start low and go slow. The most common side effects are acne, facial hair, oily skin. Those are reversible. Right? It's reversible. And if you started low and went slow, you would notice if you started developing them. And I asked the woman, I noticed you're starting to get some – she says, I'm starting to get facial hair. She said, I am, but I love the testosterone so much I will deal with it. Great. That's fantastic. Right? But you are – it's like a partnership. You're going through this together, but you have to warn them what's going to happen. At very high levels of testosterone, you start seeing things like clitomegaly, enlargement of the clitoris.

50:10You start seeing deepening of the voice, right? You can actually see you start seeing something about hair loss as well. The deepening of the voice is not reversible. So let's just be very clear. It's not reversible. So you have to be very careful. Enlargement of the clitoris is partially reversible. It can reduce, but it's not in most cases completely reversible. And hair loss in some cases cannot be reversible, right? So you have to be very careful understanding, also in men, it's dose-related. So if you don't want her to have bad side effects, start low, go slow. And if she starts getting these side effects, back off.

50:45You can use other medication. We use spironolactone, other medications to help combat those symptoms. But it's very important to realize it's dose-related.

50:52Dr. Mary Claire Haver:Is this all theoretical or do we have any data? When we look at frailty in our female population, where does testosterone play in that? I've looked at the data when they, I think there were three, when they looked at NHANES and WHI, and they were looking at endogenous testosterone levels. And the women in the highest quartile had much, well, they had, you know, it was dependent, you know, the higher your testosterone, the lower your risk of frailty. Yes. Do we have any studies looking at exogenous testosterone, giving, you know, therapeutically giving someone testosterone? And will that potentially decrease her risk of frailty?

51:24Dr. Mary Claire Haver:Yeah. Through sarcopenia or osteoporosis, you know, as she ages. Yeah, I love that question. So let's look at feral T in terms of bone mineral density. That's an easy one, right? So there are studies looking at a woman's testosterone level, the higher her testosterone level, the increased bone mineral density she has. That's good. Okay. So higher T levels, higher bone mineral density. There are studies looking at giving testosterone to women. And what it can do is in certain studies, not all, it can increase bone mineral density. That's great. And most of those studies, actually, some of them are actually showing that T plus E is better than each one alone.

51:57So we're fixated on giving estrogen for bone mineral density. But the studies show that the combination is better than the independent combination. And that's been shown as well. Now, the third question is, if I give testosterone to her, can I decrease bone fracture? That's never been shown. So we're not there yet. Same with men. Identical story. Give testosterone, increase the bone mineral density. If I give a man testosterone, can I decrease the risk of bone fracture? We're not there yet. Now, it doesn't mean it can't. We just haven't shown it. We haven't shown it. We haven't looked at it. Yeah, but it is interesting.

52:28I would assume that if I'm going to increase for bone mineral density, I'm probably going to decrease the risk for fracture. But that's where we are. But there's no question that testosterone also increases muscle mass, right? Even if you look at the 2019 global consensus statement, the last statement said, we only approve this for HSDD. But for muscle mass and cognition, we just don't have enough patients. We don't. But look at what happens to women who take large doses of testosterone. If they're bodybuilders, they get significant increases in muscle mass. It's the testosterone that helps. They're also lifting.

53:00They're lifting. So that's a great point. They're taking in protein and they're lifting and they're taking testosterone. So that's very important. So I remember the plane going up. If you want the plane to go up, you want as much muscle mass as you got, as much bone mineral density. So when you take the hit, it's not going to be that hard. And so I think that older patients, men and women, need testosterone more because you want to protect them from sarcopenia and bone fractures.

53:24Dr. Mary Claire Haver:Okay. I mean, we counsel around the triad, right? testosterone, lifting, and protein. You have to have the substrate, the stimulus, and then the hormones to make it all. Yes, very important. To stack the cards in your favor. Each one works a little bit on its own, but when you combine, we see magic. Because we do body composition scanning here in the clinic. We do too. And if someone says, I'm going to take that testosterone and improve my muscle mass, I say not if you're not lifting weights and eating protein. There's something I've learned about getting dressed. You don't need more options. You need a few things that just work.

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57:42Dr. Mary Claire Haver:Some clinics are marketing testosterone, and it's through pellets usually, as breast cancer preventative. What are your thoughts around this? I've seen a couple of papers. I've seen a couple of papers, and I know the authors have done it. And I say you cannot make that claim at this point. Okay. Right? I think it's too premature. Yes, there are studies showing that. There are studies also showing that higher levels of T increase the risk for breast cancer. Now, let me be careful. Converting. Yeah. Well, there's a difference between endogenous testosterone and exogenous testosterone. So the UK Biobank is a big study out of the UK just came out.

58:16They showed that women who have higher levels of T had higher levels of breast cancer, just high levels. But when you look at studies giving testosterone, the Tri-Next study came out just showing that there's a reduction in breast cancer. Others have shown the same thing. So giving is very different than just what's floating around, right? And so in the floating around, I just want to be fair. So there's some controversy, but to be honest with you, I think most of it will lean towards no risk for breast cancer. If you look at all the guidelines, the position statements, they say that no increased risk for breast cancer if it's physiologic range and patch is what they say.

58:51And that's level one grade A evidence, no increased risk. In fact, those guidelines will even say if a woman has a history of hormone receptor positive breast cancer, use with caution. Unless you're still able to use it. So I don't think that testosterone increases the risk for breast cancer. But it is too premature to say it is a cure for breast cancer. Okay.

59:12Dr. Mary Claire Haver:What is proper monitoring for a patient on testosterone? So we get a baseline when they hit the door. So say we start. Like how often are you monitoring these patients? So typically I tell women it takes at least three months to see benefit. Let's start there. She says, look, I want to come back in a month and check my levels. And I say, I always like to check your levels. And it depends on what formulation you're on, right? If you're an injectable, you're gel, all different answers, right? But it depends on what you're on. But we first like to check everyone in four weeks just to see how things are going.

59:41Do I need to titrate? Do I need to change anything? And then we will see them if they're on a gel or cream, we'll see them every six months for life. every six months for life and make sure their levels are good. I think waiting one year is a little too long, right? If they're on a pellet, we'd see them every four to five months. If they're on an injectable, then it's really gonna be every six months for life. So it really depends. Now, I prefer to know the trough. I wanna know how low is your low, right? If your high is too high, your body will tell me, acne, facial hair. In some women, they get erythocytosis, polycythemia.

1:00:17We don't see it more in men. We don't see it that much in women, but they do. And women can also get hypertension with testosterone. It's really important to know that. You should check the blood pressure.

1:00:26Dr. Mary Claire Haver:Okay. But at the end of the day, we typically like to check those levels at the trough. Because if her low is really low, it's no point living great for three months and lousy for one month. Just how bad is the low? I do the same for men as well. How bad is the low? Okay. What constitutes a red flag to you? Like, you know, not everyone has access to you or us or whoever, but they are interested in testosterone. First of all, how would they find someone who would be willing to prescribe it? And what are red flags to look for when they're looking for a practitioner? Yeah. I think Ishwish is a great society that has find a provider on there.

1:01:00So is the SMSNA, two great menopause society as well. Great societies to help find providers. Red flags, I think, are sometimes false claims like anti-aging, cardioprotective, not going to make you have a heart attack. Just the false claims. Other ones are not checking levels is a big red flag. They don't check my levels every time I go in. They just give me the pellet. That's a red flag. That's a big red flag, right? So I think that that's another one. Not checking levels at the beginning is even a bigger red flag. Like how do you – I've seen that though. You know, like not even checking. I told them my symptoms and they gave me the testosterone, right?

1:01:36You know, so monitoring is very important. And then you should be very – I think everyone should just understand what the levels should be. And if your levels are extremely high before the pellets are going in, you should ask why. Say, I understand my levels are 200 and you're about to put another 200 milligrams in, but it's my understanding that the normal range is 20 to 80. Could you explain to me why you're doing this? Just it's very important to know where you should be on your troughs.

1:02:02Dr. Mary Claire Haver:Okay. You mentioned peptides. So let's go there. It's really important. All right. So let's talk. Look, I got into the business because I do a lot of sexual dysfunction, right, for men and women. and testosterone and estrogen progesterone really help with sexual dysfunction. And let's not forget about vaginal estrogen as well. Game changer when it comes to sexual dysfunction, dyspareunia for women as well. But when you talk about other things, when I talk to women, I say, this is my playbook. I look at it like a triangle. I want to get the estrogen, progesterone, and testosterone back to where you were and local vaginal estrogen.

1:02:35That's it. Very simple. Your postmenopausal estrogen, testosterone, progesterone, local vaginal estrogen. There's an outside circle that's very important to me. It's your thyroid. It's your cortisol. It's your growth hormone. I want to look at everything on the outside. That's really important. And then I draw a line down the middle and I say, that's only 50 % of the story. Here's the other 50%. It's diet, exercise, sleep, and stress reduction. I don't have a pill on the planet stronger than diet, exercise, sleep, and stress reduction. You can take my hormones and eat potato chips all day and watch TV, but you are not going to get where you want to get.

1:03:09You have to meet me halfway. That's the theme. And so I have a, I go heavy on diet, exercise, sleep, and stress reduction. I put them on a program. So for many years, I've been treating women with testosterone, giving them hormones. They feel great. I found one thing that actually makes them feel better than hormones. Weight loss. When a woman loses 50, 60, 70 pounds, You've changed her entire life.

1:03:34Dr. Mary Claire Haver:Right. And it's more than the weight. It's how the world sees her, how she moves through the world. Unfortunately, women's body image is so tied to her weight. It's huge. And it gets even better. Her cholesterol goes down. She says, I've stopped my statin. I've stopped my blood pressure medications. My sleep apnea has gone away. You know, my joint pain on my right knee is gone. Like, it is a trickle down of tremendously good effects. Now, imagine if you did the diet, exercise, sleep, and stress, loss, weight, and you did the hormones. It's on fire. I mean, it's unstoppable, right? So just giving her the estrogen progesterone and saying goodbye is a disservice.

1:04:11It's a disservice. Focus on all three. Focus on the outside circle and hit her hard on diet, exercise, sleep, and stress. So what's the peptide that I'm talking about? There's many peptides, but GLP-1s, right? GLP-1 is a peptide. It has revolutionized the way we treat women in our practice, right? Because it's game changer, right? And so you put her on if she – look, what are the benefits? It's FDA-approved for diabetes. Great. FDA-approved for obesity. FDA-approved for sleep apnea. FDA-approved for secondary prevention of cardiovascular disease. Secondary prevention, right? We know that FDA helps with anemia.

1:04:46Dr. Mary Claire Haver:And for our listeners, secondary prevention means you've had a heart attack. Now we're trying to prevent the second one. Right, right. Think about renal protection on renal disease. Kidney disease. And hypertension. Like one peptide has such a profound effect. Now, most of it could be due to weight loss. Secondary, yeah. Right? But the cardiac benefits have been shown to be irrespective of weight loss. Right? So we put them on peptides. There are other peptides that have been very helpful also in this business. It's also been PT-141. I don't know. Tell me about that one. Okay. Do you use it? Yeah, I use a lot of it.

1:05:19So let's talk about it. So in 2015, if you and I went to Walgreens and said, could you put on the counter all the drugs for men to help them have better sex? They'd put over 30 products on there, Viagra, Levitra, Cialis, put all the tests on. He said, by the way, could you put on the counter all the drugs to help women have better sex? Zero. Zero. Not one. He said, wait a minute, that's not fair. How did this happen? In 2015, the world got Adi, flabantrin, first FDA-approved drug, daily medication, great medication. We had Cindy on. Yes. Great medication, right? You take that medication every single day, significantly improves her desire for sex, period.

1:05:58That's the FDA-approved medication, right? And we at Baylor said we started noticing women started having improvements in orgasmic function as well. So very quickly, I got an FDA-approved trial to treat men with Adi versus placebo. we showed that in men who take ADD also, not only improvements in desire, but they also improve their orgasmic function as well. And we even wrote it up as a paper, right? But then in 2019, another drug came out for women called bremelanotide. It's an injection. She injects 45 minutes prior to intercourse. And it actually goes into the center of the brain called the mediopriacin nucleus where she increases her desire for sex.

1:06:35It's extremely effective. Now, she can have nausea if she takes it. So typically only can inject eight times a month. It's an injection. It's called bremelanotide. It's a peptide. And it increases her desire for sex. And we also see it increases her orgasmic function as well. And we use a ton of it in men off-label as well. Oh, I didn't know.

1:06:53Dr. Mary Claire Haver:I was going to say, yeah. A ton of it. And what we do is we found that if we use it way ahead of time, not 45 minutes before, but six to eight hours ahead of time, it actually works more effective than just 45 minutes before. And it has the dopamine pathway? It has dopamine. It would have been just melanotide. A little bit different. It's called melanotide. Yeah, melanocortin. Yes, melanotide. It's a little bit different. And Adi improves dopamine, but this one actually improves melanotide, goes to the pathway. So it's actually very effective. And so now we have two drugs for women, FDA approved, to help them with sexual dysfunction.

1:07:24Now, a lot of the peptides, when a woman says, she comes to me and says, I want peptides. She typically is not talking about these. She's talking about that BPC-157, that TB-500. I mean, there's a lot of peptides out there that you can use. And just a little story. In 2023, the FDA pulled all the peptides off the market. And I used to write a lot of peptides. And once they pulled it off, I stopped for safety concerns. And they put them in something called category two, which means it's dangerous. You cannot compound it. The second they put it in dangerous, you cannot compound it. The compounders, those 503As, could not make it.

1:07:58So where did it come from? China, overseas. I call it the underground. When you look at those peptides, bacteria, heavy metals, not the right doses. So it's dangerous, right? But they're looking for other peptides like MOTC, all these other different peptides. In July of this year, July 2026, the FDA is going to announce which ones are legal again. So we're kind of on a lookout for those.

1:08:20Dr. Mary Claire Haver:Okay. Which ones are you excited about becoming legal again? I think BP-157 with TB-500 is excellent. Okay. And unfortunately, there's only been animal studies. But talk about regenerative, talking about pain, healing, wound injury. Yeah, what's their method of action? Yeah, so BP-157 is a gastric peptide. It's from the gut. But when the patients inject it, we've seen significant improvements in their overall healing and recovery. Hey, I injured my shoulder. Hey, I've got some joint pain. Now, I don't prescribe it since it was banned. But on July 23rd of this year, I'm going to find out if I can re-prescribe it.

1:08:55MOTSI is another one that helps lose weight. It helps metabolic and obesity. It helps women drop the weight as well. There's one that a lot of women like. It's GHKCU, which is copper. which is used on the face and it's an injectable as well. That's very popular. And that's going to come up for a vote in February of 2027 if it comes off the ban list. So I think all of you that are using peptides, be careful because you don't know where it's coming from, what's in it. It's better to make sure that they are approved by the FDA and then a 503A can legally make it. And then we have a better chance of getting better quality.

1:09:27Dr. Mary Claire Haver:Okay. Yeah. In our clinic, we don't. We're so busy doing PET, PET, PET plus now, GLP-1s or terzepatops. And hopefully Reda True Tide. Yeah, Reda True Tide. Next year, hopefully. So, yeah, we're getting close. That's really big on social media right now. Yeah, it's really big. The Reda Reddits. Yeah, the only thing is that, you know, people get Reda True Tide illegally. You can get it, but it's not FDA approved. I heard. We haven't seen it, smelled it, but I know it's out there. Yeah, but the initial, like the Triumph trial and all the recent data, it's so impressive. So they have the greatest amount of weight loss.

1:10:00It's about 27%. You know, trisopatide's at 21 % and semaglutide's at 15%. So greatest amount of weight loss has three drugs in it, but has at least side effects. So very excited to see what this drug can do when it comes out.

1:10:12Dr. Mary Claire Haver:So you touched on women's sexual health research funding. Yes. And the disparity, which is ridiculous. Yeah. What do you think it's going to take to change that? First of all, I got to tell you something very important. It's not just women and men. Let's kind of put this. It's both. And I'll tell you why. Let me tell you why. Let's look at some statistics. A guy named Dr. Fisher in 2005 did a study. He said, let's take couples and let's look at what happens when a man develops erectile dysfunction in that relationship. Let's look at the women before and after he develops erectile dysfunction. When a man develops erectile dysfunction, a woman has a 33 % to 50 % chance of developing female sexual dysfunction.

1:10:54It was just his condition caused her FSD. So if she was really smart, she'd want to do everything she could to make sure he doesn't get ED to protect her FSD. Now flip it. They've also shown that when a woman develops FSD, a man is 3x more likely to get erectile dysfunction. So if I was really smart, I'd want to make sure my wife does not get FSD to protect my erectile function, right? I mean, the correlation is very tight. Well, now talk about treatments. Goldstein did the best studies on this. One of them was he gave all these men Levitra, a drug to help with erections. He gave all the women at home an FSFI questionnaire, female sexual function index questionnaire.

1:11:32He said, I don't want to meet your wife. I don't want to talk to her. Just give her the questionnaire. And he gave half the men placebo. The men that took the Levitra, who had a significant improvement in rectal function, the partner's sexual function scores skyrocketed. Her libido, her arousal, her orgasmic function. The men who got a placebo, those partners did not have any improvement at all. What am I telling you? I'm treating the partner just by treating the other partner. and I never even met her, right? It's so tied together that if you treat one partner, you're actually treating the other.

1:12:02So I tell the residents, you want to give that man Viagra and you're going to help his erections? Guess what? Skyrocket his partner's libido and watch what happens to his erections, right? They're so tied together. It's very important. So that's why I think when you look at conditions like menopause, when you look at hypogonadism in men, we suffer the same thing. It's not just one person going through it. Like when my wife was going through menopause and she had hot flashes, low libido. She was irritable. It was affecting her, but it was also affecting me, right? And if I was smart, I would do everything I can to improve her menopausal symptoms, not only to help her, but also help myself.

1:12:38Dr. Mary Claire Haver:Yeah. Right. It's a couple's disease. Everything is menopause is not just about her. Hypogonadism, low testosterone is not just about him. It affects both of them. Do you ever see couples in clinic together? I insist. Jim Simon does the same thing. Yes, I know. Yeah. And cyst. I want to see. And don't forget the, I call it the hormonally dangerous decade, 50 to 60. That is the hormonally dangerous decade. Why do you say that? Because women are going through menopause and that's where hypogonadism or low T in men go up. So what is hypogonadism? It means men have low testosterone. What do they suffer from?

1:13:10Low energy, low libido, erectile dysfunction, increased fat deposition, decreased muscle mass, depression, poor sleep. Well, if I was going through that, you don't think it's going to my wife, right? And she at the same time is going through menopause, mood changes, poor sleep, hot flashes. It's a setup for disaster 50 to 60, right?

1:13:29Dr. Mary Claire Haver:It's a hormonally dangerous decade. And if you don't understand that it's your hormones, if people sometimes don't even realize to check my hormones, they just live with it. Check the hormones. It's a dangerous decade. Wow. Sometimes in our clinic, treating someone's hormones will give them clarity to realize they want to leave a relationship. Sure. You know, that they've been kind of just limping along and then we kind of give them their resilience back and they're like, you know what? I got 30, 40 more years left. Yes. This is not my person. Yeah. So I see it go both ways. Yeah. I see it in men also, but more of that is libido.

1:14:08So his libido goes up. she's not interested in gaining sexual activity and then he may look elsewhere so it can be a problem too that's why it's really important counseling the couple if i'm treating the couple and i elevate both i'm less likely to have a problem yeah no that's great yeah um so what

1:14:28Dr. Mary Claire Haver:do you say to a woman who walks into a doctor's office and and wants to be evaluated for testosterone like she's not coming to you she's not coming to me and she's been dismissed yeah you know and then In menopause, the average, you know, when you look at the data, women will go six to ten times to a doctor before they're able to connect the dots, especially if she has multiple kind of vague. You know, most of us know hot flashes, but, you know, if she's coming in with palpitations, anxiety, weight gain, you know, irritability, a lot of clinicians just because of lack of training aren't connecting the dots.

1:15:00Dr. Mary Claire Haver:Yeah. And same with testosterone. You know, testosterone, I feel like for women is where menopause was 10 years ago. Yeah. And so how do you counsel her? Like, you know, find an Ishwish or you said ASRM? SMSNA. Ishwish Menopause Society. And we'll put the links in the show notes for everyone. Three phenomenal societies that are really proactive in helping women get therapy and treatment. They're phenomenal. But you have to insist. The best way I'm noticing is social media. I've watched your social. It's amazing. So women are learning from the social media and you're telling them, get your levels checked.

1:15:33Insist to get your levels checked. In fact, you don't even have to have a prescription or a doctor's appointment to get to the level set. Yeah, you can go direct through Quest and LabCorp. And you can get your own levels checked. So I tell patients, be proactive about your health. You have to be the best advocate for your health, not your doctor. You have to be the best advocate. If you know something's wrong, check your levels. There's no harm. Insist on asking your provider, can you please check my testosterone level? Be open. Be frank. Can you please check my hormones? Right? If they say no, then I think you need to find someone else who will.

1:16:06Dr. Mary Claire Haver:Okay. Very fair. So any other labs they should request besides testosterone? Look at the great mimickers. The great mimickers of low T, there's two big ones, hypothyroidism and depression. If someone is depressed will have very similar symptoms, someone who has hypothyroid, check the TSH, take the free T3 and T4, check those levels. But I check a lot of other things. Check wellness. Like check her lipids. Check her hemoglobin A1C. Check her cholesterol. Like check the overall health of the patient. We didn't talk about that. We talked a little bit about weight. But exercise, diet, sleep. Sleep is like critical.

1:16:42Critical. And stress reduction. Each one independently has a profound effect on our overall health. And so we absolutely want to check all the other variables.

1:16:52Dr. Mary Claire Haver:What are you working on right now, research-wise? Well, I just finished my book. It's coming out March 2027. Oh, amazing. Yes. It took me a year and a half. We're good. I'm not getting it. Yeah. Yeah. So it's coming out in March. And so we're very excited. We're doing a lot of work right now. What is it about? I don't know. It's about sexual health span. So you know how we all have our lifespan? Yeah. Okay. So you'll live, I'll live till 90, hopefully. And we have our health span, right? Right. The years you live healthy. Healthy. Without chronic disease. And all of us want our health span to last as long as our lifespan.

1:17:25That's it. That's all I'm asking for. But there's different types of health spans, right? There's your mental health span. I don't want to mention Alzheimer's. Yeah. Right. I was my physical health span. I want to be physically. And there's my sexual health span. Right. And the issue is all of us. You tell most men, I want my sex span to last as long as my lifespan. If you tell a man or a woman, you're going to live till 90, but you can only have sex till 50. They'll say that's unacceptable. But I say you'll be healthy. You'll be healthy. Your health span will last as long as your lifespan. No, I want my sex span to last as long as my lifespan also.

1:17:56So the book is about sex span, prolonging your sex span. Right. And how do you do that? and there's many ways to do it and hormones is a big part of it for men and women. The other part is keeping your partner healthy. So let's say tomorrow my partner, my wife says to me, I'm never having sex with you again. Guess what? I'm never having sex again. Your partner controls your sex band, right? And if your partner says, I'm never having sex with you again, that's it. So what do you want to do to prolong your sex band? Keep your partner healthy because your partners are healthy, it's a problem and keep your partner engaged.

1:18:28If you want to prolong your sex band, keep your partner healthy and keep your partner engaged to prolong your sex band. So it's very important. And the whole book goes into everything about diet, exercise, sleep, and stress. And how it affects. How it affects sexual function. Amazing. And how to prolong your sex band. I've been really big into wellness lately. I think it's really important. And I give this analogy, and I just want to share it with you. I think as we exercise and we stay healthy and we do things, I look at it like a plane. And the plane starts getting altitude. We get higher and higher altitude.

1:18:56but all of us one day at some age, the engine turns off. Okay. When the engine turns off, no matter how hard you work out and how well you eat, you will not gain any more altitude. But at that point, you're going to start coasting. If your altitude's high, you're set. If your altitude's low, you're in trouble, right? So you want to make sure that when your engine turns off, your altitude's as high as you can get, but you can't make that decision at 72. You got to do it at 52, right? At 72, I said, I want my altitude to be high. Too bad. And you only get one shot. There's no redo. So we start now.

1:19:31Dr. Mary Claire Haver:That's a great analogy. Yeah, because that's it. We're always going to have one day where we're the healthiest we're ever going to be, and you're going to coast and decline from there. Right. So you want that altitude as high as you can be. And once it coasts, you want the slope to be light. You don't want a deep slope. Now, you can control the slope at that age. You won't be able to go higher, but you can control the slope with diet, exercise, and sleep, right? Yeah. But wouldn't it be great if you had a high altitude? To start. Then your lifespan and healthspan will be the same. That's all you care about.

1:19:58Dr. Mary Claire Haver:That's amazing. Any new trials you're watching or excited about? Yeah, we're doing a lot of work on GLP-1s and fertility. So we're using GLP-1s to see if it makes fertility. We're using a lot of oral testosterone. We found that oral testosterone doesn't suppress sperm production in men, so we're doing that as well. We have a new ultrasound machine that actually can look inside the testicle and find sperm. And so in the old days, you have to open it and keep looking. Now we can have a much better picture of where it's located and grab it before no one else is doing this. So we have a lot of clinical trials going on right now.

1:20:32That's amazing.

1:20:32Dr. Mary Claire Haver:If you could tell every woman over 40 three things about testosterone, what would they be? It's not a male hormone. It's a human hormone. Women make more testosterone than any other hormone in the body, including estrogen. And if you have signs and symptoms, check your levels. It's a simple blood test. That's all I'm asking. Check your levels. And if it's low, get therapy. It can make a profound impact on your quality of life and your partner's quality of life. Amazing. Yeah. Anything else you want to leave with our audience? No, I just, I think it's really important that everyone understands the importance of this hormone.

1:21:07Dr. Mary Claire Haver:How can our listeners find you? I'm at Baylor College of Medicine. I'm on Instagram, not as much as you, but at Dr. Mohit Kira. Okay. And are you taking patients? I am. Is your clinic still taking patients? Still taking patients. Yeah. That's amazing. Well, thank you so much for coming on On Pause. Thank you for having me on the show. This has been invaluable for our audience. I appreciate it. Thank you so much. You can watch full episodes of this podcast on YouTube at Dr. Mary Claire. You can also find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepauslife.com.

1:21:43Dr. Mary Claire Haver:Unpaused is presented by Odyssey in conjunction with Good Roommate Media and Longwave Digital. This episode was sponsored by MidiHealth. The first virtual clinic created for women, by women, for the treatment of menopause. Don't let anyone tell you menopause is something you have to suffer through alone. Midi can help. Visit JoinMidi.com to learn more.