Latest / The Dr Louise Newson Podcast / 68 – Testosterone: Why is it so hard to access?

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68 – Testosterone: Why is it so hard to access? · The Dr Louise Newson Podcast

0:02
So Susan, it's very exciting to have you here.
0:05
Usually with guests in the US, I've never met them before, but
0:08
I have had the pleasure of meeting you, having lunch with
0:11
you, spending time with you recently at a conference in Los
0:16
Angeles. So it's great.
0:19
MO Kira, who's been on my podcast twice, MO was a great
0:22
friend of my husband, who's also a neurologist, is, it's been on
0:27
my podcast talking about testosterone.
0:29
And everyone wants to know about testosterone.
0:32
And it feels, yeah. And it feels like testosterone
0:37
is almost like a, a naughty word for some people and it's the
0:40
best thing ever for others. So I'm really keen to like just
0:43
talk to you about testosterone, but also about how we can
0:47
individualise care for women and personalized care and, and just
0:53
a bit about your approach really.
0:55
So you're, you're a doctor, you've got a really interesting
0:57
background and you ended up being in America even though
1:03
you're originally from New Zealand.
1:04
So even that's a great story. So can you just say a bit about
1:07
your background before we start talking about testosterone?
1:10
Yeah, Well, that's such a nice introduction.
1:12
Thank you. It's so lovely to be with you.
1:13
And I've been following you for ages and had this amazing
1:16
opportunity to meet you in LA at a meeting.
1:18
And we hit it off and we've got connections, as you said,
1:21
through Doctor Kira, who I just saw on your podcast a few weeks
1:24
ago. So yes, I was born in New
1:26
Zealand, moved here when I was 18, trained as a traditional MG,
1:30
went through the traditional OBGN training.
1:33
And I practiced traditional OBGN for 20 years, delivered 7000
1:36
babies, did all the surgeries, all the wonderful things that we
1:39
can do in that specialty. But as your listeners know, we
1:43
learned nothing about menopause. Like absolutely nothing.
1:47
And so when I reached my mid 40s and started having those
1:50
symptoms myself, I was absolutely clueless about what
1:53
to do to help myself. I went through about a year of
1:57
being untreated. I didn't think I was old enough
2:00
to go through menopause. I was a gynecologist because I
2:02
thought I'm 45, that can't be happening.
2:04
Completely clueless. And then when I finally figured
2:07
out how to replace my hormones safely and I felt amazing, I
2:13
retired from that traditional OB DN practice, went into a
2:16
menopause specific practice in 2020.
2:18
Not the best time to start a business in the middle of COVID,
2:21
but I just had to do it. I'm like, I need to do this.
2:23
Honestly, I thought I would just have a quiet little life with
2:26
just me and my nurse practitioner.
2:27
And that didn't work because it was so popular.
2:29
Now we've got three offices in Texas and growing and 12
2:33
providers and the virtual program and all the things.
2:37
And really, I think that we learn how to be menopause
2:40
doctors by going through menopause frequently.
2:42
Not always, but it becomes much more urgent when it's happening
2:47
to you and all these symptoms that you've been taught or just
2:49
hormonal, or she'll get over it or whatever.
2:51
Or like, holy crap, this is really serious.
2:56
So just to give hope to your listeners, I know they've heard
2:58
it from you too. I felt absolutely horrible, like
3:01
deadly awful. And now I feel better than ever.
3:05
And the difference is just replacing those hormones and all
3:08
of them. Yes, estradiol, progesterone and
3:10
testosterone. Absolutely.
3:13
So important. Yeah.
3:15
And so one of the things about testosterone, I'm learning every
3:18
day is a new day and every day is a learning day.
3:21
I always tell my children, but I'm learning more and more about
3:24
testosterone for my clinical experience.
3:26
So we have thousands of women who use testosterone and I very
3:30
much like to talk about testosterone deficiency like I
3:34
would progesterone deficiency or Esterdale deficiency.
3:37
It's irrelevant what the label is, whether I'm giving them the
3:40
label of PMDD or perimenopause or menopause.
3:44
It's irrelevant actually. But I realise more and more that
3:47
testosterone deficiency occurs quite young for some women.
3:51
There's quite a few women who have probably always been
3:55
testosterone deficiency. I couldn't agree more.
3:59
And I knew nothing about this. So what what I was taught, which
4:01
was sort of nothing, it was less I was taught then it was just
4:05
sort of this assumption that we go through our menstrual lives
4:08
and then all of a sudden we go through menopause and all three
4:10
hormones drop or maybe maybe didn't even hear about the third
4:13
one, testosterone. But what happened in my case is
4:15
I was still perimenopausal. I was still ovulating and still
4:19
making estrogen and progesterone, but my
4:21
testosterone was almost zero. And all of the symptoms that I
4:25
had initially, or many of them were related to that particular
4:28
hormone being low. And I can't tell you the number
4:31
of times I wish I could go back and apologize to the women that
4:34
I misdiagnosed before this happened to me.
4:36
And I probably told them you're fine.
4:38
You know, you're still having periods, so maybe you just need
4:40
an antidepressant, or maybe you need some, you know, marriage
4:44
counseling or all the other stupid stuff we say when we
4:48
don't know. But in my case, a little bit of
4:52
testosterone replacement changed my life.
4:55
I don't want to overstate it, but it literally turned me back
4:58
into somebody that I recognized as myself again.
5:02
Yeah, I, I remember about six or seven years ago, I was called up
5:08
from NHS England with someone quite senior and he did a Zoom
5:12
call with me and he said, Louisa, I thought in medicine
5:15
you were taught first do no harm.
5:17
And I said, yes, of course, what are you talking about?
5:20
He said what? I've heard that you prescribe
5:22
testosterone to women with regular periods.
5:25
And we've all had a meeting about this and discussed it and
5:27
we've agreed that this is a dangerous practice.
5:31
And I said, well, I beg to differ actually, because I have
5:35
seen first hand lot of women who have improved.
5:37
And they said, he said, well, we've all agreed that as placebo
5:41
and it's dangerous, which you're doing.
5:43
And I, I didn't have the confidence that I do now.
5:46
I haven't didn't publish like I do now and I didn't have the
5:50
number of patients that I do now.
5:52
And I went away from that meeting and got very upset and
5:56
actually cried because I was crying for all those women that
6:00
I've been denied a very safe hormone.
6:02
And it's a shame. It's called testosterone because
6:05
everyone thinks it's a male hormone.
6:07
And like you, I feel very different when I use
6:12
testosterone. And I wish I'd started it about
6:15
10, maybe 20 years before I did. I had my third daughter when I
6:19
was 40, but I know I was struggling from about the age of
6:23
35. And looking back, like I feel
6:26
sharper and brighter and more mentally able now than I was
6:30
probably 20 years ago. You know, it's not such an
6:33
effort to think, you know? So interesting.
6:37
And we've, I've heard many of your guests talk about this
6:40
before, but it does just, you know, lead one to be kind of
6:43
upset about, you know, how men are treated when their
6:46
testosterone drops. Say, for example, might drop by
6:49
50% between age 30 and 50 for the average man.
6:54
And he very rightly so, is going to get replacement if he's
6:57
symptomatic and houses drop by close to 100%.
7:01
Yet we're not offered treatment. And the international consensus
7:04
that you're well aware of from 2019 is 6 years old now
7:08
basically says chest cells are only appropriate for post
7:10
menopausal women, which makes no sense at all.
7:14
But if you're somebody who isn't is experienced as you and I in
7:17
seeing patients and are just referring to the guidelines, you
7:20
know, doctors, it's very wonderful that we have these
7:23
great groups to make consensus statements to guide us.
7:26
However, there and you know, not always so right.
7:30
If you're in if you're in practice, like you and I are
7:32
seeing thousands of patients, we're going to learn things that
7:37
are not in the consensus statement because it takes
7:40
decades for 25 physicians to agree on anything and then
7:44
publish it. So if we waited for that to
7:46
happen, we would all be suffering for decades.
7:49
So sometimes it's just common sense.
7:50
OK, this this patient's, you know, presenting with multiple
7:53
low testosterone symptoms. Her blood level shows her
7:56
testosterone is low. We replace it appropriately for
7:59
a woman and lo and behold, she feels better.
8:01
What on earth could be wrong with that?
8:04
No matter how old she is. Yeah, I totally agree.
8:07
And one of the things I've written a lot in my book, The
8:10
Power of Hormones is about how all three hormones, progesterone
8:15
and testosterone work in the body.
8:17
And I've, I've spent quite a lot of time writing about how it
8:21
works in the brain. So testosterone is very
8:24
important, as you know, in every cell in our, in our body and
8:27
brain, but it helps the communication with those neurons
8:31
and it helps build that myelin sheath, which is like the
8:34
conduction part really, isn't it, of the nerves.
8:37
So it helps everything fire very quickly and effectively, but it
8:40
also helps with metabolism. It helps with glucose metabolism
8:44
in the in the brain as well and helps all the cells to work
8:49
better. And if you go within the cell,
8:51
it helps all our mitochondria, which is the powerhouse of all
8:54
our cells, to function better and reduce inflammation
8:59
throughout our brain and body. So it has really important
9:02
physiological actions everywhere.
9:05
So this obsession about libido, it's just weird in some ways is
9:10
I don't it, it's quite degrading actually for women like and and
9:17
don't even like like you. I'm very happy talking about sex
9:20
and I think it's important that people should have libido and
9:23
great orgasms. But I don't think that's the
9:26
only thing we should be thinking of when we're talking about a
9:29
hormone that has these effects everywhere in the body.
9:32
It just seems weird. The idea, right, of course, the
9:36
idea that this very powerful hormone that we're now
9:40
potentially lacking and perimenopause or menopause or
9:44
even younger could only have one benefit.
9:47
It makes no sense. It doesn't target one thing.
9:50
And so currently in the United States, and I think in the UK as
9:54
well, we're instructed if we read these consensus statements
9:58
to we can only say that testosterone is beneficial for
10:02
HSDD or low sex drive and not all the other things, which
10:05
obviously it's great for many things.
10:08
I absolutely love the paper that you published recently about
10:11
cognition and testosterone because I hear from my patients,
10:13
I'll tell you the same happened to me.
10:15
Words like optimism and motivation and getting my pet
10:19
back and you know, just saying yes to social invitations
10:23
instead of like, oh, I don't want to go.
10:25
I just feel kind of, and it's often misdiagnosed as
10:27
depression, as you know, and it's in it maybe sometimes
10:31
depression, but why don't we try replacing the natural hormones
10:35
first? Because more often than not that
10:38
resolves the issue for the patient.
10:39
I can remember myself within two weeks of starting on hormones,
10:43
going from just kind of feeling something is wrong with me,
10:46
blah. I don't have any energy,
10:47
motivation, no sex drive, but also no other types of drive.
10:52
Just motivation, optimism, feeling about the future, all
10:57
those feelings. All of that got better.
11:00
And I actually started testosterone by itself because
11:03
I'm a scientist. I want to do a study.
11:05
I didn't want to start three things at once, so I started it
11:08
alone. And this is a study with one
11:10
person in it, but it's certainly been duplicated many times in
11:13
your clinic, mine and and other anecdotal studies.
11:16
It works. And, you know, if we're waiting
11:20
20-30 years for a randomized controlled trial that no one's
11:23
going to pay for in the meantime, everyone's going to
11:25
suffer. So, yeah, the idea that it's not
11:28
safe to take a natural hormone that we've had all of our lives
11:31
makes absolutely no sense. We have to move away from that.
11:35
So I totally agree. And over here more women, same
11:38
in the US and global actually are understanding.
11:41
They're reading the same evidence as we are.
11:43
They're reading basic Physiology as well and they're
11:45
understanding the importance of this natural hormone.
11:47
So they're asking for it more. More and more women are being
11:50
turned away for the wrong reasons for testosterone, but
11:53
some people are taking it. So testosterone prescribing over
11:57
here for women has overtaken for men, which I think is wonderful.
12:02
Good for you. Probably largely due to you SO.
12:04
Yeah, so, but recently it was written about in one of our
12:08
local papers or our national papers and the one of the ex
12:13
chairs from the British Menopol Society was writing about the
12:16
harms of testosterone and she said it's abusive that women are
12:21
being prescribed so much testosterone.
12:23
Now, I think coming from a healthcare professional, that's
12:26
quite a strong language saying it's abusive to prescribe
12:29
testosterone. And I think there are many drugs
12:32
that may be abusive when they are definitely associated with
12:36
harms, you know, without informing patients.
12:38
But testosterone isn't 1 of my lists.
12:40
I feel it's one of the most safe and transformational medications
12:47
that I've ever prescribed as a doctor, actually.
12:51
Mind boggling how that statement could arise, but I can.
12:55
I can perhaps or see an inkling of where that might have come
12:59
from because there were in the past and still exist certainly
13:02
in this country, clinics where patients are given unsafe drugs
13:07
that are either not biologically identical testosterone or doses
13:12
that are way too high for a female.
13:15
And so I think because that happens, it's sort of we could
13:19
throw the baby out with the bath water and say just because in my
13:23
opinion, irresponsible practitioners might offer this
13:27
doesn't mean that there are responsible practitioners
13:31
offering it. So if patients have to be really
13:35
careful and smart about whom they trust with their health
13:40
care field. And it's very important,
13:44
anything that we prescribe, anything we do, if you do it too
13:47
much or too little, it's not going to have the same effects.
13:49
So, so like me, you're very keen in holistic care and you know,
13:54
you're the most amazing athlete. Like I'm just like so impressed
13:58
with all this. Yeah, the triathlons that you do
14:02
is just amazing. But but exercise, nutrition is
14:07
like a no brainer. Everybody should do that.
14:09
But when we talk about hormones, we both agree that we're
14:13
individual and personalized hormone balance is crucial.
14:18
And so there's been a lot of debate, especially since the
14:21
Panorama program that was made about me, about high doses that
14:25
I prescribed to some women. And it's been very damaging over
14:29
here in the UK, and I know it's filtrated into other countries,
14:32
because then people think that these high doses somehow are a
14:36
problem. Now, one of the reasons I
14:39
prescribe higher doses for a minority of women in follow-ups
14:42
is because they're not absorbing through the skin very well.
14:46
And so I spend a lot of time with patients optimizing doses,
14:50
but also not just the dose, the formulation.
14:53
So people really vary with how they absorb through the skin,
14:57
whether it's a gel, a cream, a patch, you've got pellets of
15:00
testosterone. It's it's sort of the first
15:03
thing in my mind is making sure that it's the proper hormones.
15:07
So is it progesterone, not a synthetic progesterone?
15:10
Is it estradiol, not ethanol, estradiol.
15:12
Is it pure testosterone like you say, not some sort of anabolic
15:16
steroid that's been made by goodness those who?
15:19
And then it's like a starting dose is pretty standard for a
15:23
lot of people. But then on the follow up, the
15:26
whole way that it's been absorbed into the body is really
15:31
important, isn't it? And it varies so much between
15:33
people. Oh, so true.
15:35
So if you're putting something on the skin, one of the
15:39
interesting things that I honestly did not know until
15:41
probably a few years ago is that the drug companies that make
15:44
this stuff, let's just say, for example, as standard starting
15:47
dose for testosterone would be 5 milligrams a day in Australia,
15:51
that's 5 or 10, right? So let's just say 5 to be
15:54
conservative. The understanding is that we're
15:57
only going to absorb 10% of that.
15:59
So there there's a guess that 90% of it will be lost.
16:03
Well, that's a pretty wild guess.
16:05
Is it 5% or 82, 2%? Like we have no idea.
16:10
Everybody's skin's different, like where it's placed at the
16:14
time of the day, the temperature, whether you
16:15
exercise, if you've exfoliated your particular type of skin.
16:20
So we can use the same dose just like you said.
16:22
And we start with a reasonable dose like say 55 milligrams, for
16:26
example, and then measure it. And I'll get quite different
16:30
results from different patients. Now, no harm will happen in that
16:33
couple of months of I tell patients this is a trial for you
16:38
because you're an individual. It's an experiment with one
16:40
person in it, but it's a safe experiment because hundreds of
16:44
thousands of other women have tried before you.
16:46
And this is a very safe dose. It might be too low and we may
16:49
have to increase it. By no means is it going to be
16:52
too high. So there's no harm.
16:55
But I think this idea that it's precision medicine, I mean, if
16:59
we're putting a gel, especially if we're using something like
17:02
the in, in this country, the the male gel and being asked to
17:05
divide this into 10 and what possible planet is that
17:09
precision medicine? That is like guesswork.
17:12
That's the best. But I mean, this is what we
17:14
have. So I mean, no, nothing wrong
17:16
with doing that, but we have to understand it's a guess and we
17:20
don't know how much you're going to absorb, but it's not harmful
17:23
to try. Now men use gel and they have
17:25
exactly the same issues. They don't know how much they're
17:28
going to absorb. The doctor measures it later.
17:32
There's there's really no difference.
17:33
So I, I get annoyed to say the least, with the fact that men
17:37
have all these different options and they are offered these
17:41
options and counseled by their provider and they get to choose
17:44
the one that's best for them. And everybody's happy about
17:46
that. For some reason, it's different
17:49
for women. We're not allowed to use
17:51
anything except the male product divided by 10.
17:55
God forbid we use anything that's, you know, a personalized
17:58
dose like one of these that that's, that's bad.
18:01
And of course, pellets are even worse.
18:03
But truly, it's the same hormone.
18:06
So the way we deliver an entire system really doesn't much
18:09
matter so long as we follow it and we're careful and judicious
18:13
and, you know, start with a reasonable dose and then listen
18:16
to the patient, which is ultimately much more important
18:18
than what the blood test says and my.
18:21
It's what is, it's, so it's so important, you know, having
18:25
anything made, whether it's like you say, made in a pellet, made
18:28
in a cream, made in a gel, as long as it's a proper
18:31
testosterone at a dose that's suitable for women, it's a lot
18:35
safer. And a few months ago I, I've
18:39
used the cream for, for many years and I decided to try the
18:42
gel 'cause I wanted to see is it, how easy is it to divide
18:45
something by 8? And obviously it's impossible,
18:48
but I also find that the gel's quite slippery and it's sort of,
18:51
some of it fell onto the floor when I was using it.
18:53
But I persevered. But actually it only took about
18:57
four or five days and I realised I couldn't think straight at
19:01
all. I, we went joy.
19:02
We were just went down to Oxford, which is only an hour
19:05
away from here. And I fell asleep in the car
19:06
like an old woman. I really wasn't concentrating.
19:09
My husband said to me, have you been playing with your hormones?
19:11
You're acting like you used to be.
19:14
And I thought I'm just, I just wasn't observing it because I
19:17
thought maybe I'm tired, you know, I'm very busy and maybe
19:20
things are catching up. So then I thought I can't carry
19:23
on like this because I did feel like that cotton wool brain.
19:26
So then I went back to the cream and literally within a few days
19:29
I'm like, well, I'm back. And it's very interesting that
19:33
the same dose, you know, different vehicles, different
19:36
way of absorbing makes such a difference.
19:39
And if you've done my levels, who knows?
19:42
Like, and I think we do do levels and you'll, you're the
19:46
same and they're a guide. One of the things that I do want
19:50
to talk about though, is the baseline levels.
19:52
So we do levels, we do blood tests like I'm sure you do on
19:56
our new patients for two reasons.
19:58
One, it's quite interesting to see what the hormone levels are.
20:01
But secondly, we do other blood tests to make sure they're not
20:04
low in iron or vitamin D or under active thyroid because we
20:07
can't be saying all your symptoms are due to.
20:10
Low hormones. So as you know, you know,
20:13
practitioners, we, we look at everything.
20:15
So, so that's important. But when you get the blood
20:18
results back, often the laboratories will say the
20:21
results are normal but the results are very low.
20:26
So even if your level is next to nothing.
20:28
I had someone recently had testosterone level was less than
20:31
0.4, which basically means they can't find any.
20:35
It still was marked as normal because they're saying it's
20:38
normal to not have testosterone if you're in your 50s.
20:41
That's right. Whereas it's just bonkers,
20:44
isn't. Yeah, so that's a whole nother
20:48
thing. When I was in traditional
20:50
medicine, this is truly the way most doctors practice in this
20:53
country. Probably it's the same there.
20:55
I was so busy that I had a nurse practitioner and I said just
20:58
scan down the labs and tell me the ones that are abnormal.
21:01
I wasn't looking at every line by line.
21:03
I didn't understand that the reference range that labs use is
21:07
just simply saying this is what most people have.
21:09
It's not in any way thing. This is optimal.
21:12
So a woman who's 50, as you know, if she hasn't an estradiol
21:15
of 0, that's going to be in the normal column, or a testosterone
21:18
of almost zero, it's in the normal column.
21:21
What they mean by normal is common, not optimal.
21:24
So if we're looking at labs, and I totally agree with you, we
21:27
want to look at the number, not the reference range, and develop
21:32
an idea of what's optimal. Now, there's a lot of
21:35
disagreement about what optimal levels are, but it's one of the
21:37
pieces of the pictures. How do you feel everybody feels?
21:41
Well, almost everybody does not feel well when her estradiol and
21:44
testosterone are 0. So how does the patient feel?
21:47
We replace it, get it up to reasonable levels based on
21:52
reasonable common sense, and then if she feels better, that's
21:55
great. But I it gets missed so often.
21:57
I can tell you back in the bucket of things I missed when I
22:00
was in traditional medicine, I would have done the same thing.
22:02
We we just were trained to look for stuff that turned threat.
22:07
Exactly. If it's got an asterisk in red,
22:09
then you then you pick it out in the other ways you didn't.
22:12
And that's really important because so many people over here
22:14
now are asking for their blood tests and then they're told it's
22:18
normal and then they're not. It's not normal.
22:20
I'm here all the. Time.
22:21
Yeah. And then when we review patients
22:24
when their own hormones, we do repeat levels.
22:26
But again, they're a guide. And I know you have done this
22:30
like I've done, it is measured your own hormone blood test over
22:33
the course of a day and it really fluctuates and changes.
22:37
Yeah. And so, but the other thing I
22:39
was taught as quite a young doctor many years ago was that
22:42
you look at the patient before you look at the blood results.
22:46
We've had patients, and I know you have, that have had raised
22:49
levels and it's caused panic. You know, alarm bells ring in
22:53
other people's surgeries. But then I look at the patient
22:56
and she's telling me she feels well, she has no side effects.
22:59
So what I usually do is say we'll just continue as you're
23:02
doing. Let's repeat your blood test in
23:04
two or three months time. Let me know if you have any side
23:07
effects or problems. And then usually when they
23:09
repeat it, the level's absolutely fine because it's
23:12
only a snapshot. It's like a little window, isn't
23:15
it, to what's going on it? Doesn't matter because.
23:17
Yeah, totally. Yeah, So obvious things like
23:21
what time of day you got your blood drawn.
23:23
I have some patients who use their testosterone morning and
23:26
night, so we want to measure it in the middle of the day.
23:29
Well, not every doctor is going to say that if you measure it an
23:31
hour after you put it on, it's going to look a little higher.
23:34
On the other hand, if you missed a dose, it's going to look a
23:37
little lower. I mean, there's so many factors
23:39
that can affect. We've got a, like you said, look
23:41
at how the patient's feeling. If it's a little bit higher than
23:46
the consensus suggests, it should be in the patient's
23:48
feeling well and not having any side effects.
23:50
There are so many things that can affect that.
23:52
In the United States, we're still instructed and the
23:55
consensus paper says measure total testosterone, not free
23:59
testosterone. And that's a whole nother
24:00
conversation. The total testosterone doesn't
24:03
really represent what's available for use, but there's
24:06
no consensus about what free testosterone should be.
24:09
So we're really having to use our common sense, and God forbid
24:12
doctors should use that common sense.
24:15
Yeah, my dad was a doctor. And I mean, his whole clinical
24:18
practice was based on common sense because they they didn't
24:20
have all of these tools. I think we've somewhat lost our
24:23
common sense. I totally agree.
24:25
I think we've lost confidence as well actually somehow as
24:29
doctors, we're so worried that something awful is going to
24:32
happen and, and we're just writing up some data with Mokira
24:35
actually looking at nearly 2000 women who have been on
24:39
testosterone to see if they have side effects.
24:42
So none of my clinicians can save the record unless they mark
24:45
any side effects with testosterone.
24:48
And the clinicians get a bit annoyed because they have to go
24:51
and answer this temp, these templates.
24:53
But it's really important actually.
24:55
And we're finding vanishingly rare side effects.
24:58
The commonest as we know is you can get some hair growth where
25:02
you rub on the cream or gel because it can stimulate the
25:04
hair particles. But most women can deal with a
25:07
slight hair growth on their thighs, their brains working.
25:10
But there's the hair on the face, the voice changes, skin
25:14
changes, vanishingly rare. And actually the few people that
25:18
had side effects have still carried on with their
25:20
testosterone. It hasn't been enough for them
25:22
to change testosterone. And I think that's really
25:25
reassuring actually, because if it's prescribed that the right
25:29
dose to the right person at the right time, it's very unusual to
25:33
get side effects, isn't it? Well, absolutely.
25:35
And I'll just just this is not, I do not believe this is true.
25:38
But if I play the devil's advocate and I said that, OK,
25:42
certain patient is going to have oily skin, acne, maybe a few
25:47
black hairs on her chin. She's not going to have cancer,
25:51
heart disease, never been shown to increase death from anything
25:55
apart from these what, what I call nuisance symptoms.
25:57
If it's given at a reasonable level, ask the patient what she
26:02
wants to do. I mean, this is a patient
26:04
centered conversation. Like you said, I, if I had those
26:07
symptoms, which I do not, would completely keep taking it
26:10
because I feel so much better. I would just, I would just do
26:13
what I needed to do to take care of those symptoms.
26:15
But if somebody told me I had to stop it because of benign
26:20
symptoms that are really my choice if I want to absorb them
26:23
or not. I mean every drug in the world
26:24
has side effects potentially and we choose if we want to absorb
26:29
those side effects or not and it should be a patient's choice.
26:31
Now I will say we don't really have those side effects of its
26:34
dosed appropriately. And then another point to
26:37
remember is we've got enormous amounts of data on giving
26:40
extremely high doses of testosterone to transgender
26:44
people who want to have masculinizing side effects.
26:47
So this is a wanted and intended result for those patients.
26:51
So we know what happens when we give women male doses of
26:54
testosterone because that community, that's their choice.
26:58
And yes, they have masculinizing effects.
27:01
However, they do not have cancer, they don't have heart
27:03
disease, they don't have any other problems.
27:05
So when people say it's dangerous, it it's not.
27:08
And it's been studied very well in that community and in the
27:11
bodybuilding community. It's not dangerous.
27:13
It just causes nuisance symptoms.
27:15
I know it's. Really reassuring.
27:17
We just had a paper published today actually with Mokira's
27:20
team as well, but looking at our data and it's over 11,000 women
27:24
on testosterone looking at clot risk.
27:27
And we followed people for a year and asked them about clot
27:29
on testosterone as well as Eastern island progesterone.
27:33
And the incidence was, was lower than background actually.
27:36
And the few people that had had a clot, they had predisposing
27:39
factors. So again, it's really reassuring
27:41
for testosterone because there hasn't been much data about
27:44
testosterone and clot. So we we know how safe it is.
27:49
So it's incredibly frustrating. I know you're frustrated and I'm
27:54
frustrated because we are here as very privileged women who are
27:58
able to access testosterone and it's kept our physical health
28:03
and our mental health as good as it can be.
28:06
And I think that's crucially important, but very frustrating
28:09
that the majority of women who have low testosterone globally
28:13
cannot access testosterone. And if they want it, so many are
28:17
denied it. So I'm doing a lot of work and
28:21
and you're helping as well with Balance up to really allow women
28:25
to advocate for themselves and be stronger and have a voice.
28:28
So as I end the podcast, I always ask for three take home
28:32
tips. So what three things do you
28:35
think women should say to their healthcare practitioner if they
28:40
want testosterone but they've been refused it?
28:43
Well, I will struggle to narrow it down to three.
28:47
I think the first thing I might say is that I might be looking
28:50
for another physician. But if that's not possible,
28:54
reminding the physician I've had this, I heard I learned that
28:57
I've had this hormone in my body all of my life, so how could it
29:01
be harmful to replace it? Secondly, might have to bring
29:06
them some of the very good studies that we have about the
29:09
safety and efficacy of testosterone or refer them to
29:12
your site. If I were cheeky, I might say,
29:15
if he's a man, isn't it true that men can have their
29:18
testosterone replaced? So what is the difference with
29:21
replacing it for women? Now, advocating in that way is
29:25
not what we were taught. I was taught to be very polite,
29:27
to believe everything my doctor or my attorney or the priest
29:31
said. But sometimes we have to
29:32
understand that not all doctors are educated the same, and we
29:36
might have to seek out someone else who's on the same page.
29:40
Yeah, it's great advice. And we have to, I think as
29:44
healthcare professionals and educators, we have to help other
29:47
people that aren't our patients to advocate for themselves as
29:50
well. So this conversation is so
29:52
important and I'm very grateful for your time, Susan, and thank
29:57
you.