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

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Mohit Khera, board-certified urologist and Professor of Urology at Baylor College of Medicine, where he holds the F. Brantley Scott Chair in Urology, to tell women the truth about testosterone — the hormone women actually make more of than estrogen, yet still cannot access in a single FDA-approved formulation. Dr. Khera explains why testosterone is one of the most biologically active hormones in the female body, with receptors in the brain, heart, bone, muscle, and genitalia, and why the research to prove its full benefits for women has simply never been funded. He walks through what low testosterone really looks like, how to get tested properly, why women with low libido are so often handed an SSRI that makes things worse, the truth about pellets, creams, and injections, which side effects are reversible and which are not, and the red flags to watch for when looking for a prescriber. He also shares why sexual dysfunction is a couple's disease, what he calls the "hormonally dangerous decade," and the one intervention he's found that makes women feel even better than hormones. Guest links: Dr. Mohit Khera (Instagram) https://www.instagram.com/drmohitkhera/ Dr. Mohit Khera (X) https://twitter.com/DrMohitKhera Dr. Mohit Khera (LinkedIn) https://www.linkedin.com/in/drmohitkhera/ Dr. Mohit Khera (Website) https://drmohitkhera.com/ Dr. Mohit Khera at Baylor College of Medicine https://www.bcm.edu/people-search/mohit-khera-24469 Books: "The New Perimenopause," by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book "The New Menopause," by Dr. Mary Claire Haver https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/B0CKBZ4K1Z

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  It's not a male hormone. We know if you treat women for decades, you'll see it helps with muscle mass, depression, energy, mood, sleep. Just because the data does not show it does not mean it doesn't happen.

• 0:11Dr. Mary Claire Haver?

  Why don't we have the research?

• 0:13Speaker 00

  It's money. The funding for men is at least 20x or more than in women.

• 0:18Dr. Mary Claire Haver?

  Wow. Talk to me about levels. What do they mean?

• 0:20Speaker 00

  Always start low and go slow. The side effects are related to dose. Acne, facial hair, oily skin.

• 0:27Dr. Mary Claire Haver?

  Those are reversible?

• 0:28Speaker 00

  For many years, I've been treating women with testosterone, giving them hormones. I've found one thing that actually makes them feel better than hormones.

• 0:47Dr. Mary Claire Haver?

  The views and opinions expressed on UnPaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. For years, I've watched women come into my office and tell me their libido is gone. They tell me they barely recognize themselves. They tell me their partner is patient, but they can see the toll it takes. They tell me they've tried everything and nothing works. Their OB GYN told them it was stress. Their therapist told them it was the relationship.

• 1:28Dr. Mary Claire Haver?

  Someone else suggested an antidepressant. Nobody mentioned testosterone. And for years, I didn't either. Not because I didn't believe the data, because there was no FDA-approved formulation. The guidelines were unclear. The field treated female testosterone as French, so I referred out. I hedged, and I watched women suffer with a treatable problem because the research infrastructure was built for men and the regulatory infrastructure had abandoned women. Here is what I know now. Testosterone is one of the most biologically active hormones in the female body. The data on safety is stronger than people think.

• 2:09Dr. Mary Claire Haver?

  The reason it is not FDA-approved for women is not because it doesn't work. It's because nobody funded the trials. Women have been told testosterone will give them facial hair and a deep voice. Women have been told it's experimental. Women have been told to wait. And while women have been waiting, men have had access to testosterone replacement therapy with FDA-approved gels, pellets, injections, and patches for decades. Today's guest has spent his career closing that gap. Dr. Mohit Kara is a board-certified urologist and professor of urology at the Scott Department of Urology at Baylor College of Medicine, where he holds the F. Brantley Scott Chair in Urology. He earned his MBA and his Master's

• 2:54Dr. Mary Claire Haver?

  in Public Health from Boston University and his medical degree from the University of Texas Medical School at San Antonio. He has published more than 160 articles in peer-reviewed journals, written and edited two books in the field of sexual medicine and men's health. Dr. Kara is one of the few academic voices in this country who has consistently made the case that women deserve the same evidence-based access to testosterone that men have had for decades. He is here today to tell women the truth about testosterone, what the research actually shows, what the risks really look like, and what to ask for in a doctor's office that has never prescribed testosterone to a woman. I'm Dr. Mary Claire Haver, a board-certified

• 3:36Dr. Mary Claire Haver?

  obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to UnPaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

• 4:00Dr. Mary Claire Haver?

  Dr. Kara, welcome to UnPaused.

• 4:02Speaker 00

  Thank you. Thank you for having me on the show.

• 4:03Dr. Mary Claire Haver?

  So you spent your training learning to take care of mostly men. I know there were female patients in your residency as well.

• 4:11Speaker 00

  Yes.

• 4:11Dr. Mary Claire Haver?

  But when most people think about urology, they think the male plumbing system.

• 4:15Speaker 00

  Right.

• 4:16Dr. Mary Claire Haver?

  But how did you end up becoming one of the world's loudest voices to me in the academic arena on testosterone and women?

• 4:23Speaker 00

  I gotta tell you a story. So in 2007, I finished my fellowship at Baylor College of Medicine with Dr. Lipsholz. And I was really good at getting men excellent erections, great libidos. And one day, a woman called me, and she was extremely upset. And she said to me, "You've ruined our relationship. Everything was great until my husband met you, and now we fight every single day." And I couldn't understand what she was talking about. In essence, she was saying, "He wants to have sex with me every day now. We haven't had sex in 10 years, and we fight every single day." And I thought to myself, she's right, right? It's okay to leave both libidos low, but you never raise one libido high and the other one to keep it low. So that year, I flew out to go Erwin Goldstein, godfather

• 5:08Speaker 00

  of female...

• 5:09Dr. Mary Claire Haver?

  Yes, yes.

• 5:10Speaker 00

  Yes. And I said, "Teach me everything you've got about female sexual dysfunction, because it's not fair to treat one partner without addressing the other." And since 2007, I've been treating both. Now, if you treat women for female sexual dysfunction, you're gonna have to learn a lot about testosterone, a lot about hormones. And that's where I got into the business. And so we've been doing it ever since.

• 5:30Dr. Mary Claire Haver?

  Wow. In your training, you know, again, I have a urological system. You have a urological system. But like, did you cover female sexual dysfunction at all? Or you just assumed the gynecologists are gonna take care of this?

• 5:43Speaker 00

  Yeah. So we do not get, I did not get any training in my residency or my fellowship in female sexual dysfunction. Let's take it back a step further. If you look at medical school training, there was a survey that just came out, medical school training, 50% of medical students said they never got training on sexual dysfunction at all.

• 6:01Dr. Mary Claire Haver?

  At all.

• 6:02Speaker 00

  At all, right? 65% of residents said they never got sexual dysfunction training at all. And of those that got training, 50% said, "Our training was lousy. I learned nothing," right? So you have to understand that there's very little training that goes on in our academic system. My wife's a family practitioner, and she said to me, "Look, when I see these patients, I have about 18 minutes of patient. I gotta go through diabetes, hypertension, OSAY. I can't get to sexual dysfunction." And I said, "It's extremely important." She goes, "If I even could get to it, I wasn't trained on how to do it," right? "And what am I gonna do if she tells me I have sexual dysfunction?" So it's a big problem.

• 6:43Dr. Mary Claire Haver?

  So in my training, nothing for sexual dysfunction, other than some GSM stuff, like dryness. You know, I knew how to treat that with vaginal estrogen. But I graduate from residency, and I go out into private practice for three years. And outside of obstetrics, which I have an A+ in, you know, in all areas of obstetrics, then I'm doing gynecology. You know, we're doing both. And I can't tell you how many times I get the well woman done, you know, and then as I'm walking out the door, she gathers the courage in her little paper gown with her, you know, lap sheet on to say, "One more thing."

• 7:19Speaker 00

  Right.

• 7:19Dr. Mary Claire Haver?

  And I just remember being a deer in the headlights. Like, I didn't know what to say. I didn't know what to tell her. So what do I do? I walk out and go to my, you know, seasoned, you know, coworkers who had been out in 20, 30 years of practice and be like, "Ms. Smith is complaining of low libido," or whatever she called, however she described it. And their responses were, because they weren't trained, "Oh, give her some wine. You know, tell her to relax, have some wine. She'll get over it." Like, that was it.

• 7:47Speaker 00

  Or take an SSRI, all right? I mean, it's sad. The number one treatment for FSD in the United States is vaginal lubrication. That's it.

• 7:55Dr. Mary Claire Haver?

  So FSD for our listeners, female sexual dysfunction.

• 7:58Speaker 00

  Female sexual dysfunction.

• 7:59Dr. Mary Claire Haver?

  Yeah.

• 7:59Speaker 00

  Of the 48% of women who suffer from female sexual dysfunction, only 19% get therapy. 19%. Now, think about this. If I told you there's a condition that affects 48% of women, would I not get your attention? It's a big unmet need. And then I tell you that the physicians are incapable, are very uncomfortable treating the problem. Big problem, not much doing about treating this. So it's a big problem.

• 8:26Dr. Mary Claire Haver?

  So when we look at where the bias is, okay, when a man has sexual dysfunction, it's automatically assumed to be a mechanical problem, a plumbing problem, right?

• 8:37Speaker 00

  Most of the time.

• 8:38Dr. Mary Claire Haver?

  If we get more blood flow to here. So that's my assumption, right?

• 8:40Speaker 00

  Right.

• 8:40Dr. Mary Claire Haver?

  But for a woman, it's psychological.

• 8:42Speaker 00

  Right, which is not true, right?

• 8:44Dr. Mary Claire Haver?

  So what does the actual number say?

• 8:46Speaker 00

  Yeah. So let's talk about female sexual dysfunction, because it's a loose term. What is it? If a woman suffers from one of four conditions, low libido, decreased arousal, meaning blood flow to the genitalia, orgasmic dysfunction or pain, if she has one of those four, and she's bothered by it, she suffers from female sexual dysfunction, right? So if the woman comes in, she says, "I have really low libido, but I don't really care." She doesn't have FSD, right? So that's a really, how you diagnose it. Male sexual dysfunction, we think of it like erectile dysfunction, and that's a predominant condition. But there's other conditions. Low libido increment, Peyronie's disease, premature ejaculation, delayed ejaculation, anorgasmia. So there are other conditions as well. And the thing

• 9:28Speaker 00

  is that both of these are unmet needs. The funding for men is at least 20x or more than in women. We'll get into that, right? We have a fraction of what we spend in women, just a fraction. It's not fair. And if you look at all the data, say, "Does it work in women?" I have to say, "I don't know. We don't have data. Does this work in women? I'm not sure. We don't have data," which is very, very unfair.

• 9:51Dr. Mary Claire Haver?

  So let's talk about testosterone.

• 9:53Speaker 00

  Yes.

• 9:53Dr. Mary Claire Haver?

  A little bit. It's a really, really hot topic. I, do you do social media at all?

• 9:58Speaker 00

  A little bit.

• 9:59Dr. Mary Claire Haver?

  A little bit, okay. I think I have a PhD in Instagram right now.

• 10:02Speaker 00

  That's right.

• 10:02Dr. Mary Claire Haver?

  So I see a lot of information being served, a lot of misinformation, a lot of misunderstanding, a lot of public debate.

• 10:09Speaker 00

  Yes.

• 10:09Dr. Mary Claire Haver?

  Over this testosterone issue. So one of the things is, you know, how much testosterone does a woman actually have in her body?

• 10:17Speaker 00

  Yeah.

• 10:17Dr. Mary Claire Haver?

  There's some debate over, is it more than estrogen, less than estrogen? Really, walk our listeners through, like, where does it come from?

• 10:24Speaker 00

  Yes.

• 10:25Dr. Mary Claire Haver?

  You know, and how much do we actually?

• 10:26Speaker 00

  Let's look at the differences in sexes. So in men, we know that 90% of the testosterone comes from the testicles, 10% from the adrenal glands. In women, it's different. We know that roughly 50% of their testosterone comes from either the ovaries or the adrenals. 50% comes from peripheral conversion, right? DHE, androgena, so it's a peripheral conversion in the tissues. So we always thought, when a woman goes through menopause, she gets a precipitous drop in her estrogen, progesterone, testosterone, everything drops. That's not true.

• 10:55Dr. Mary Claire Haver?

  Not for testosterone.

• 10:56Speaker 00

  Not for testosterone, right? Because the adrenals can continue to produce as well. And even in the ovaries, even post-menopausal, can still produce some testosterone. So you don't assume she's post-menopausal and the T is low. Check the T. If she's post-menopausal, we assume the estrogen progesterone low, but not the T. So we check it. A woman makes about 300 micrograms of testosterone every single day, 0.3 milligrams. It's very small. It's typically 1/10th to 1/20th of what a man makes, right?

• 11:21Dr. Mary Claire Haver?

  Mm-hmm.

• 11:21Speaker 00

  But it's sufficient. She will convert a lot of that testosterone. But we have to understand, testosterone is extremely important for women as well. It's associated with a male hormone. It is so important for women. Let's look at the receptors.

• 11:34Dr. Mary Claire Haver?

  That's my next question, yeah.

• 11:36Speaker 00

  Where are the receptors located? They're all over in her brain. They're in her heart. They're in her bone. They're in her muscle, predominantly all over the genitalia as well. Look at where the receptors are located, right? She has these receptors for a reason. Now, there are studies suggesting that they may be benefit in muscle, in depression, in muscle mass. But it's conflicting. And someone says to me, Dr. Kara, well, there's not great data. Remember, the global position statement says we should only use testosterone for HSDD. We should, that's a very important point. Right now, every position statement out there says testosterone for women should only be used for low libido or hypoactive sexual desire.

• 12:16Dr. Mary Claire Haver?

  That's another big debate on social media.

• 12:17Speaker 00

  So that's it. So that's what every consensus statement says. But we know, we know, if you treat women for decades, you'll see it helps with muscle mass, depression, cognition, there's energy, mood, right, sleep. We've seen these things. Just because the data does not show it, does not mean it doesn't happen, particularly if you don't spend money on doing the research.

• 12:40Dr. Mary Claire Haver?

  Yeah. So this is a lack of, a lack of a study issue, not that the studies have shown it doesn't help.

• 12:45Speaker 00

  100%, yeah, absolutely not.

• 12:46Dr. Mary Claire Haver?

  Is that, am I correct in saying that?

• 12:47Speaker 00

  And, and there is conflicting data. So some studies show, if you give a woman testosterone, her mood and depression improves. Other studies say it doesn't. Some studies say if you give a woman testosterone, her muscle mass will improve. Others say it don't. But you know their muscle mass improves if you give them testosterone. It's, it's abandoned in athletic sports because it gives you a significant advantage. So the reason why we say it's only used for HSDD, I think, is because we don't have the research to say that it's effective in other areas. But that doesn't mean it doesn't work.

• 13:16Dr. Mary Claire Haver?

  Why don't we have the research?

• 13:18Speaker 00

  It's money. It comes down to money. Look, I was involved in the TRAVERSE trial.

• 13:22Dr. Mary Claire Haver?

  Yeah.

• 13:22Speaker 00

  The TRAVERSE trial was the largest randomized placebo-controlled trial. We were asked in 2015, nine of us, to develop this trial. We spent over $500 million to show that testosterone did not cause a heart attack. The largest randomized placebo-controlled trial, 5,246 patients. We will never spend that on a woman trial to look at testosterone. There's not even close. I don't think we'd even spend $100 million.

• 13:45Dr. Mary Claire Haver?

  Who paid for that trial?

• 13:46Speaker 00

  It was industry, right? So industry paid. But that was with, the FDA had said, "Look, we have a warning. We have a sense that..."

• 13:53Dr. Mary Claire Haver?

  There was a Black Box warning on...

• 13:54Speaker 00

  Yeah. In 2015, they put it on there because of four studies. So 200 studies said that testosterone does not increase the risk of a heart attack. 200 studies said that if you give testosterone, it may improve cardiovascular risk. Four non-randomized, non- placebo-controlled studies, bad studies came out from 2010 to 2014, saying that if you give testosterone to a man, it may increase his risk for a heart attack. So in 2015, the FDA said, "You know what? We want a large study. We want you to show us that it does not increase the risk of a heart attack." So we did it. We enrolled our first patient in 2018, our last patient in 2022, and we showed that there was no increased risk in cardiovascular events in men taking testosterone. In February 28th, 2025, big day for me, the

• 14:37Speaker 00

  FDA announced, "We're taking off the Black Box warning. It does not cause cardiovascular risk." So that was really important. But you, they're not going to spend that money on women to look at testosterone and their benefits, and that's the problem. We spend a fraction of what we spend on, on women as we do in men.

• 14:54Dr. Mary Claire Haver?

  You describe testosterone as the most biologically active hormone in the female body.

• 14:59Speaker 00

  Yes.

• 14:59Dr. Mary Claire Haver?

  What makes you say that?

• 15:00Speaker 00

  Because you look at the receptors. They're everywhere. If you look at the location of the receptors, plus, women have a much higher content of testosterone than estradiol. Women think, I don't make...

• 15:09Dr. Mary Claire Haver?

  Now, that's a big controversial topic.

• 15:11Speaker 00

  That's right.

• 15:11Dr. Mary Claire Haver?

  Like, someone tried to do a takedown of this, but, so walk me through what that means and how we measure it.

• 15:16Speaker 00

  We measure it differently. So if you measure estrogen, if you measure testosterone, it's a nanogram per deciliter.

• 15:21Dr. Mary Claire Haver?

  Okay.

• 15:21Speaker 00

  Right? If you measure estrogen, it's picogram per milliliter, right? So it's different, right? But if you do the conversions, you actually make more, a woman makes more testosterone than estrogen, right? She makes more testosterone than estrogen.

• 15:32Dr. Mary Claire Haver?

  Right. And then we convert some of that testosterone to estrogen.

• 15:34Speaker 00

  To estrogen, right. But, but she makes more. So to tell me that she doesn't need it, it's, she makes more testosterone than estrogen. That's a really important point. She has receptors all over her body looking for testosterone, right? When she's deficient, why can we not give it back to her? Let's hold this thought for a second. Let's say she's deficient in another hormone. She's deficient in thyroid.

• 15:57Dr. Mary Claire Haver?

  Mm-hmm.

• 15:58Speaker 00

  Insulin.

• 15:58Dr. Mary Claire Haver?

  Insulin.

• 15:59Speaker 00

  Cortisol, estrogen, progesterone, any hormone she's deficient in, we're okay in giving it back to her. Why not testosterone? What is the logic by not giving her back a hormone that she already makes, higher content than even estradiol? What is the logic?

• 16:15Dr. Mary Claire Haver?

  If I were to give you another $500 million.

• 16:18Speaker 00

  Yeah.

• 16:19Dr. Mary Claire Haver?

  But I'm going to ask you to study women this time.

• 16:20Speaker 00

  Yes.

• 16:21Dr. Mary Claire Haver?

  What would that study look like?

• 16:22Speaker 00

  That study would look like looking at depression, bone mineral density. It would be looking at cardiovascular risk. I think that testosterone is cardiovascular protective, right? It would be looking at diabetes, obesity. I would want to look at everything that we looked at in men, which I know, and to look at women. I don't think men and women are that different, like, in terms of cardiovascular, muscle. I mean, if there's a strong signal that it's going to help men, I think it's going to help women. But I have to show it.

• 16:49Dr. Mary Claire Haver?

  Right.

• 16:49Speaker 00

  So give me the money and I'll show you.

• 16:51Dr. Mary Claire Haver?

  Okay.

• 16:52Speaker 00

  Yeah.

• 16:53Dr. Mary Claire Haver?

  So what does low testosterone really actually look like in a woman?

• 16:58Speaker 00

  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.

• 17:12Dr. Mary Claire Haver?

  Okay.

• 17:12Speaker 00

  She'll say that I have a depressed mood, change in my mood, decreased energy, right? Poor cognition's 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. And there are many studies showing that if you place a woman with HRT, and you put her on estrogen 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 and P-related.

• 17:46Dr. Mary Claire Haver?

  We do see that in clinical practice.

• 17:48Speaker 00

  Yes.

• 17:48Dr. Mary Claire Haver?

  You know, we always, you know, I'm a gynecologist, I'm a menopause specialist, so we start with estrogen and plus or minus progesterone, depending on, you know, uterus and sleep issues.

• 17:57Speaker 00

  Sure.

• 17:57Dr. Mary Claire Haver?

  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.

• 18:06Speaker 00

  Across the board. And Louise Newsom just published that big study in her group.

• 18:09Dr. Mary Claire Haver?

  Yeah.

• 18:09Speaker 00

  When she added the T, those patients saw greater improvements in menopausal symptoms than just estrogen progesterone alone.

• 18:16Dr. 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.

• 18:24Speaker 00

  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 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, you know, it's about 150, 160 patients a week, 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.

• 19:04Dr. Mary Claire Haver?

  Yeah.

• 19:04Speaker 00

  And so it's busy.

• 19:06Dr. Mary Claire Haver?

  That's awesome.

• 19:07Speaker 00

  Yeah.

• 19:07Dr. Mary Claire Haver?

  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?

• 19:19Speaker 00

  So common. Because getting her testosterone drawn is something that's last on most clinicians' minds, right?

• 19:24Dr. Mary Claire Haver?

  Yeah.

• 19:25Speaker 00

  So she comes in and she has these symptoms.

• 19:26Dr. Mary Claire Haver?

  It wasn't even on the checklist.

• 19:27Speaker 00

  It's not on the checklist. A TSH is on the checklist.

• 19:30Dr. Mary Claire Haver?

  For sure.

• 19:31Speaker 00

  For sure. Clinical depression is on the checklist, and they may check for...

• 19:34Dr. Mary Claire Haver?

  We screen for everybody.

• 19:35Speaker 00

  Right. So depression, but the T is one of the last on the list. And what's unfortunate is that many women, I've seen this, will come in with those symptoms and they'll be given an SSRI, okay? Say, "We, 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?

• 19:56Dr. Mary Claire Haver?

  It's plummeting.

• 19:57Speaker 00

  It's plummeting.

• 19:57Dr. Mary Claire Haver?

  It's plummeting.

• 19:58Speaker 00

  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, normalize her, and then see if you need something else, right? But not the reverse.

• 20:12Dr. Mary Claire Haver?

  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.

• 20:19Speaker 00

  Yeah.

• 20:19Dr. Mary Claire Haver?

  What is the scientific validity of doing a free versus a total?

• 20:23Speaker 00

  So, look, if you look at the global consensus position statement, the statement states that you should only look at total, right? And there's reasons for this because we know that as you get to T levels below 100, the assays-

• 20:34Dr. Mary Claire Haver?

  Like female levels?

• 20:34Speaker 00

  Yes, female levels. The assays become more inaccurate, right? So if you really want the most accurate testosterone level, then you want to get LCMS, right? And you want to get something, but it's hard to get LCMS since it's expensive. So we use amino assays as a surrogate model.

• 20:48Dr. Mary Claire Haver?

  And for our listeners, what is LCMS?

• 20:49Speaker 00

  The good cometography 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. 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.

• 21:11Dr. Mary Claire Haver?

  Oh, wow.

• 21:11Speaker 00

  So do women. So just remember that. We also know that-

• 21:14Dr. Mary Claire Haver?

  How much is that fluctuation?

• 21:15Speaker 00

  It's about 25% from morning to evening on testosterone. But at younger ages. So as she gets older, she loses the diurnal variation just like men. But it's a 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. 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 are, 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, I'll want her in the follicular phase, day three to seven roughly to check it. But she's post, most are postmenopausal, that's fine. So early morning fasting if you can. But we use LCMS.

• 21:57Speaker 00

  Now, the guidelines say, don't use free T. And I don't completely agree with that. We do know in the male population, free T is the best predictor of symptoms. It's been shown, EMAS study, no more shown, that your body doesn't care about the total.

• 22:13Dr. Mary Claire Haver?

  Right.

• 22:13Speaker 00

  It only cares about the free.

• 22:14Dr. Mary Claire Haver?

  It's the active.

• 22:14Speaker 00

  It only is the active. And so it's not that different in women also. It's the, it's the active. In certain women, the SHBG can be very elevated.

• 22:24Dr. Mary Claire Haver?

  Okay, so walk me through SHBG for our listeners.

• 22:26Speaker 00

  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?

• 22:46Dr. Mary Claire Haver?

  Oral estrogen.

• 22:47Speaker 00

  Oral estrogen and birth control.

• 22:48Dr. Mary Claire Haver?

  Yeah.

• 22:49Speaker 00

  Yeah, yeah, yeah.

• 22:50Dr. Mary Claire Haver?

  Ethanol estrogen.

• 22:51Speaker 00

  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 T will permanently be low. So I see a woman, she's been, she said, look, I took birth control 20 years ago. Yeah, I took it, yeah, I took it 20 years ago, but I took it for 10 years. You 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.

• 23:34Speaker 00

  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.

• 23:46Dr. Mary Claire Haver?

  Are there ways outside of elevating testosterone? Like, how can I get my SHBG down if it's elevated?

• 23:52Speaker 00

  Yeah, so, 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 increase 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. Testosterone in itself lowers SHBG-

• 24:26Dr. Mary Claire Haver?

  So it feeds back to the liver somehow?

• 24:27Speaker 00

  And drops the SHBG level. So you're increasing total T and you're dropping SHBG, and that helps a lot.

• 24:34Dr. Mary Claire Haver?

  Welcome back to another Midi Pause. 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 2:00 AM, 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, or feeling exhausted, no matter how many hours they're technically getting. And it's not just inconvenient.

• 25:18Dr. Mary Claire Haver?

  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

• 26:02Dr. Mary Claire Haver?

  blood sugar balance. 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. Midi Health 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 Midi looks at the bigger picture. They help women identify why sleep is being disrupted, not just how to temporarily mask it.

• 26:44Dr. 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.

• 27:28Dr. Mary Claire Haver?

  I'm getting my blood drawn. I'm doing it in the morning, I'm doing it fasting.

• 27:36Speaker 00

  Yes.

• 27:36Dr. Mary Claire Haver?

  And I'm postmenopausal, so time of the month does. But if I'm peri, which a lot of our patients are, we have them try to come in, you know, in the follicular phase.

• 27:43Speaker 00

  Yeah.

• 27:44Dr. Mary Claire Haver?

  Because we're doing a bunch of other labs, too. And, okay, talk to me about levels. What do they mean?

• 27:49Speaker 00

  Yeah, so let's talk about levels. Guidelines will tell you that we should put them back into the premenopausal range.

• 27:56Dr. Mary Claire Haver?

  And what is that?

• 27:57Speaker 00

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

• 28:29Dr. Mary Claire Haver?

  If they're symptomatic.

• 28:30Speaker 00

  Yeah, so, so I use that as a judgment. Just like you would treat a woman who had, needed estrogen/progesterone, you, OB-GYNs do it on symptoms. You don't check levels. I've never seen, let me check estrogen, oh, you need, they, you come in, she still has vasomotor symptoms, what do you do?

• 28:46Dr. Mary Claire Haver?

  Yeah, the guidelines don't support-

• 28:47Speaker 00

  You just give her more estrogen, right? Right. So the fear is that you don't want to get superphysiologic 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. So I showed the DNA in the men and the women, and 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 T. And we showed, we published also in women, a very similar paper. What does that mean? All of us are different.

• 29:29Dr. Mary Claire Haver?

  Levels don't matter.

• 29:29Speaker 00

  Well, to some people, 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.

• 29:38Dr. Mary Claire Haver?

  Yeah.

• 29:38Speaker 00

  Okay? It doesn't mean that everyone has to feel great at 60. Maybe she feels great at 80, and she feels great at 40.

• 29:44Dr. Mary Claire Haver?

  And what if she feels great at 100 or 120?

• 29:46Speaker 00

  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 superphysiologic levels at a sustained superphysiologic level. If they're transient for a while, I agree. If the woman is in the upper quartile of normal, and she still has symptoms, that's your clue to say, what else is going on? So I will tell the residents, I say, look, we got this patient, it's the upper quartile of normal. His or her testosterone level is right where it needs to be. Well, Dr. Kira, let's raise it, let's raise it to superphysiologic levels. No, let's first look and see what else could be causing her symptoms, and then we'll talk about it. Let's, 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.

• 30:30Speaker 00

  First, look at everything else-

• 30:32Dr. Mary Claire Haver?

  Yeah.

• 30:32Speaker 00

  -before you tell me you want to raise it to the superphysiologic level.

• 30:35Dr. Mary Claire Haver?

  Yeah, that makes sense. So testosterone has been used in women, we looked at the data since 1935.

• 30:42Speaker 00

  Yeah.

• 30:43Dr. Mary Claire Haver?

  In some way.

• 30:43Speaker 00

  Yeah, some ways.

• 30:44Dr. Mary Claire Haver?

  And yet, here we are, it's 2026, and there is no FDA-approved testosterone formulation for women. How is that possible?

• 30:53Speaker 00

  I want to talk about the history, it's so interesting.

• 30:55Dr. Mary Claire Haver?

  Okay.

• 30:56Speaker 00

  1935, Bu Nenarussica actually invented or synthesized testosterone. Back then, it was an oral testosterone, in 1935. In 1939, a physician named Alfred Lozier, he was an OB-GYN 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 were breastfeeding during their menstrual periods also have a lot of testosterone in their urine. So he started giving this woman with mastitis 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 OB-GYN in Canada.

• 31:39Dr. Mary Claire Haver?

  Right.

• 31:40Speaker 00

  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 estrogen test, I don't know if you remember that.

• 31:58Dr. Mary Claire Haver?

  Yeah, I used to describe it.

• 32:00Speaker 00

  Estrogen test, basically was methylated testosterone and estrogen, and it was out in 1965 for women.

• 32:05Dr. Mary Claire Haver?

  And it was an oral?

• 32:06Speaker 00

  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, so took it off the market. Strike number two was Intrinza, I don't know if you remember, Intrinza was a patch, and it was a patch that were women, it 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, and he was doing the clinical trials. And it was a patch, it was 300 micrograms, and they almost made it through the FDA, they had great data, like efficacy was fantastic, they had a large Phase IV cardiovascular study, looked really good. And the year they tried to get it passed was right after the WHO came in.

• 32:50Dr. Mary Claire Haver?

  WHO.

• 32:51Speaker 00

  Right after. And the reason why it was turned down, if you read, was the theoretical potential adverse risk. Great data, so that was strike two. Then Libygel was our third hope, the most recent.

• 33:05Dr. Mary Claire Haver?

  Libygel, yeah.

• 33:06Speaker 00

  Yeah, recently, and so Libygel 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 Androfim, 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, zero, zero for women, not one FDA-approved product for women, which is unfortunate, right? Now, it's not illegal to give a woman testosterone.

• 33:46Dr. Mary Claire Haver?

  No, it's off-label.

• 33:47Speaker 00

  It's off-label, but that's where the problem is, it gets unregulated, the levels get crazy, you have to do 1/10 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, pay $10 copay, by the way.

• 34:02Dr. Mary Claire Haver?

  Yeah.

• 34:03Speaker 00

  $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. So 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, that, that's unfair, why do they get to do that? And I said, I agree.

• 34:20Dr. Mary Claire Haver?

  Right.

• 34:21Speaker 00

  Yeah.

• 34:22Dr. Mary Claire Haver?

  So how, what are women actually using? I mean, I know, in the landscape, we've got compounded versions.

• 34:28Speaker 00

  Yes.

• 34:29Dr. Mary Claire Haver?

  When I first started, you know, putting a toe in the water, after long heartfelt conversations with Kelly Casper Center, Rachel Rubin, and Ishwash, you know, doing an Ishwash conference, I'm like, okay, I've got enough data in my mind to justify doing this, but I was scared of it.

• 34:42Speaker 00

  Sure.

• 34:43Dr. Mary Claire Haver?

  Right, I was taught to be scared of testosterone, it was a bad hormone.

• 34:45Speaker 00

  Right.

• 34:46Dr. Mary Claire Haver?

  For women. So I couldn't get access, I couldn't get my patients to be able to afford the, you know, using the men's versions at the time.

• 34:54Speaker 00

  Sure.

• 34:55Dr. Mary Claire Haver?

  We have a workaround for that now. So I was compounding at a local pharmacy. But then, a lot of women were coming in who were already being given certain other forms, like pellets, and from a certain company, but they were coming in with, to me, astronomical levels of testosterone.

• 35:10Speaker 00

  Right.

• 35:11Dr. Mary Claire Haver?

  And this was weeks out from their implants. So it is the Wild West out there right now.

• 35:17Speaker 00

  It's the Wild West.

• 35:18Dr. Mary Claire Haver?

  So walk me through how you try to give testosterone to your patients.

• 35:20Speaker 00

  Sure. So I think when you look at all the consensus statement guidelines, what is the main concern? The two main concerns are superphysiologic dosing and compounded, meaning unregulated. So if you had something that wasn't superphysiologic and wasn't compounded, you feel the safest, right? So I tell women, look, testosterone's 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.

• 35:46Dr. Mary Claire Haver?

  Right.

• 35:47Speaker 00

  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 sometimes commercially available gels, and we try to use 1/10 the 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, 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. Anything you do.

• 36:14Dr. 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.

• 36:18Speaker 00

  Right, but let's talk about this. I use a lot of pellets in women, and I use the commercially available one, Testapell, right? It's commercially available, so it's not compounded.

• 36:25Dr. Mary Claire Haver?

  Yeah.

• 36:26Speaker 00

  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, what 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, Cara, 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's going to tell me that,

• 37:11Speaker 00

  right? But they say, yeah, if you put 200-milligrams every three months and don't check levels, which happens.

• 37:17Dr. Mary Claire Haver?

  Which happens a lot.

• 37:18Speaker 00

  That's a problem.

• 37:19Dr. Mary Claire Haver?

  Yeah.

• 37:20Speaker 00

  That's a big problem.

• 37:21Dr. Mary Claire Haver?

  And that's not a pellet problem, that's a method of, you know, that is...

• 37:23Speaker 00

  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.

• 37:43Dr. Mary Claire Haver?

  Yeah.

• 37:44Speaker 00

  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. I 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 0.1cc, 25-milligrams per ml, on Sunday and Thursday. We do the same for men, it works great.

• 38:09Dr. Mary Claire Haver?

  Different dosing, though.

• 38:10Speaker 00

  Different dosing, much different dosing, right? Much different dosing, and in fact, it's, you know, 20...

• 38:14Dr. Mary Claire Haver?

  So you do it bi-weekly or twice a week?

• 38:15Speaker 00

  Bi-weekly, because we showed many times, if you microdose it, you don't get the spike, and it decreases the rate of hirsutism, 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. So 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?

• 38:53Dr. Mary Claire Haver?

  Mm-hmm.

• 38:54Speaker 00

  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.

• 39:06Dr. Mary Claire Haver?

  Awesome.

• 39:07Speaker 00

  Right? But you get to choose, just like I give the men, you get to choose, right?

• 39:10Dr. Mary Claire Haver?

  The creams, injections, pellets, is dosing a lot different, like, there's different concentrations?

• 39:16Speaker 00

  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 0% penetrance, you get nothing.

• 39:40Dr. Mary Claire Haver?

  Nothing.

• 39:40Speaker 00

  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. So in our paper, we showed, this was with Androgele and Testin 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.

• 39:57Dr. Mary Claire Haver?

  I mean, we just, Louise Newsom showed that with the estrogen patches.

• 40:00Speaker 00

  Right.

• 40:01Dr. Mary Claire Haver?

  You know, or the transdermal estrogen options, 20% variance.

• 40:04Speaker 00

  Yes, and everyone has a different percentage. So that's why if you give a woman four milligrams of testosterone in a cream, some women need a higher level. You say, how can you 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.

• 40:22Dr. Mary Claire Haver?

  Right.

• 40:22Speaker 00

  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.

• 40:29Dr. Mary Claire Haver?

  Right.

• 40:30Speaker 00

  So 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 1/10 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, remember.

• 40:52Dr. Mary Claire Haver?

  How do you pick a compounding pharmacy for the clinicians listening?

• 40:55Speaker 00

  Really important. Let's look at the different grades. The top is a 503B. This is a 503 compounder. These are compounding pharmacies that make bulk, okay? And 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.

• 41:27Dr. Mary Claire Haver?

  Okay.

• 41:28Speaker 00

  And if something is not allowed to be made by a 503A, because there's, we can talk about peptides, actually very important. If they're not allowed to be made by a 503A, they're made by what I call the underground. They'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.

• 41:54Dr. Mary Claire Haver?

  Amazing. What about oral formulations for testosterone?

• 41:58Speaker 00

  Yeah, so right now, we don't have, now, look, the only thing I have against orals slightly is the increase in SHBG. So they will, just like estrogen, the oral teas will increase the SHBG. But the new andecanoate orals don't.

• 42:12Dr. Mary Claire Haver?

  But it's only in Australia, right?

• 42:13Speaker 00

  Well, not yet. It's coming. In the US, they're about to come. The oral andecanoates 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, and the lowest dose, one of those by Kaiser Traxx, it's 100 milligrams. It'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, I don't know if you know this, we did a lot of work with the FDA also.

• 42:54Speaker 00

  And this administration is very pro-hormones and testosterone for men and women.

• 42:59Dr. Mary Claire Haver?

  Look what they did for the estrogen black box.

• 43:01Speaker 00

  Yeah, and for us also, on April 16th, they lifted, they're lifting the indications for men for use. So they're really proactive. And I think that we will see a testosterone for women within the next two years. I do.

• 43:15Dr. Mary Claire Haver?

  Okay, I really hope so.

• 43:16Speaker 00

  I do, too.

• 43:17Dr. Mary Claire Haver?

  It would just, 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.

• 43:27Speaker 00

  Yeah.

• 43:28Dr. Mary Claire Haver?

  Now, let's talk about, why do we worry about superphysiologic dosing? What's the point?

• 43:32Speaker 00

  Well, so there's a couple of things. We have most of the data in men, but there's some in women. But a superphysiologic dose is 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, which, and fibrosis, which is not reversible, right? You see in Athlete 2 Dope as well that you actually see increased cardiovascular events in young ages, right?

• 43:52Dr. 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 superphysiologic of testosterone. Every woman assumes she's going to grow hair where she doesn't want it or have a deepened voice. You know, walk me through what the data actually says about side effects.

• 44:09Speaker 00

  The most important thing to realize is side effects are related to dose.

• 44:13Dr. Mary Claire Haver?

  Okay.

• 44:13Speaker 00

  Right? 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. So you always start low and go slow. The most common side effects are acne, facial hair, oily skin.

• 44:29Dr. Mary Claire Haver?

  Those are reversible?

• 44:31Speaker 00

  Right, it's reversible. And if you started low and went slow, you would notice if she 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 says, I am, but I love the testosterone so much, I will deal with it. Great, that's fantastic, right? But you're, 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 clitoromegaly, enlargement of the clitoris. You start seeing deepening of the voice, right? You can actually see, start seeing something about a 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.

• 45:13Speaker 00

  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 in 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. You 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.

• 45:39Dr. 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.

• 46:02Speaker 00

  Yes.

• 46:03Dr. Mary Claire Haver?

  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?

• 46:11Speaker 00

  Yeah.

• 46:11Dr. Mary Claire Haver?

  Through sarcopenia or osteoporosis, you know, as she ages?

• 46:14Speaker 00

  Yeah, I love that question. So let's look at frailty 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. So we're fixated on giving estrogen for bone mineral density.

• 46:46Dr. Mary Claire Haver?

  Yeah.

• 46:46Speaker 00

  But the studies show that the combination is better than the independent, right? 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.

• 47:01Dr. Mary Claire Haver?

  Okay.

• 47:01Speaker 00

  Same with men. Identical story. Give testosterone, increases bone mineral density. If I give a man testosterone, can I decrease the risk of bone fracture? We're not there yet, right? So we have, now, it doesn't mean it can't.

• 47:12Dr. Mary Claire Haver?

  We just haven't shown it. We haven't looked at it.

• 47:14Speaker 00

  Yeah, but it is interesting. I would assume that if I'm going to increase her 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 that said, we only approve this for HSVD. 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. Remember, they're bodybuilders. They get significant increases in muscle mass.

• 47:44Dr. Mary Claire Haver?

  Yeah.

• 47:44Speaker 00

  It's the testosterone that helps.

• 47:46Dr. Mary Claire Haver?

  They're also lifting.

• 47:47Speaker 00

  They'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.

• 48:11Dr. Mary Claire Haver?

  Okay. I mean, we counsel around the triad, right? Testosterone, lifting, and protein. You have to have the substrate, the stimulus. Yeah, and then the hormones make it all.

• 48:20Speaker 00

  Yes, very important.

• 48:21Dr. Mary Claire Haver?

  To stack the cards in your favorites. 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.

• 48:30Speaker 00

  We do, too. And someone says, I'm going to take that testosterone and improve my muscle mass. I say, no, if you're not lifting weights and eating protein.

• 48:42Dr. 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.

• 48:53Speaker 00

  Yeah, I've seen a couple of papers and I know the authors have done it and I say it's you cannot make that claim at this point.

• 48:58Dr. Mary Claire Haver?

  Okay.

• 48:59Speaker 00

  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, be careful. There's

• 49:08Dr. Mary Claire Haver?

  Inverting.

• 49:09Speaker 00

  Yeah, well, there's a difference between andogenous testosterone and exogenous testosterone. So the UK Biobank is a big study, it's out of the UK, just came out. They 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 they have a reduction in breast cancer. Others have shown the same thing. So giving is very different than just what's floating around, right?

• 49:35Dr. Mary Claire Haver?

  Okay.

• 49:36Speaker 00

  And so in the floating around, I just want to be fair. So there's some controversy, but 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. And 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 saying it's 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.

• 50:12Dr. Mary Claire Haver?

  Okay. What is proper monitoring?

• 50:15Speaker 00

  Yes.

• 50:15Dr. Mary Claire Haver?

  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?

• 50:23Speaker 00

  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 a 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. Do I need a titrate? Do I need to change anything? And then we will see them, if they're on a gel or a 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 see them every four to five months. If they're on an injectable, then it's really going to be every six months

• 51:04Speaker 00

  for life. So it really depends. Now, I prefer to know the trough. I want to 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 erythrocytosis, polysethemia. We don't see it more in men. We don't see it that much in women, but they do. And then women can also get hypertension with testosterone. It's really important to know that. Should check the blood pressure.

• 51:26Dr. Mary Claire Haver?

  Okay.

• 51:27Speaker 00

  So, 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 in 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?

• 51:41Dr. Mary Claire Haver?

  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?

• 51:54Speaker 00

  Yeah.

• 51:54Dr. Mary Claire Haver?

  And what are red flags to look for when they're looking for a practitioner?

• 51:57Speaker 00

  Yeah. I think Ishwish is a great society that has find a provider. On their, so is the SMS and A, two great menopause society as well, great societies to help find providers. Red flags, I think, are sometimes false claims, like anti-aging, cardio protective, 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.

• 52:25Dr. Mary Claire Haver?

  Okay.

• 52:25Speaker 00

  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.

• 52:31Dr. Mary Claire Haver?

  Oh, gosh.

• 52:31Speaker 00

  Like, I've seen that, though. You know, like, not even checking, I told them my symptoms and they gave me the testosterone, right? You 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 mg 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.

• 53:02Dr. Mary Claire Haver?

  Okay. You mentioned peptides, so let's go there.

• 53:05Speaker 00

  Yes, it's really important.

• 53:06Dr. Mary Claire Haver?

  All right.

• 53:07Speaker 00

  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, testosterone back to where you were and local vaginal estrogen. That's it. Very simple. Your post-menopausal 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

• 53:51Speaker 00

  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. You 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 the hormones, weight loss. When a woman loses 50, 60, 70 pounds, you've changed her entire life.

• 54:35Dr. 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.

• 54:43Speaker 00

  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 unsolvable, right? So just giving her the estrogen, progesterone, and saying goodbye is a disservice. It's a disservice. Focus on all three vaginal, 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-1's, right? GLP-1's a peptide. It has revolutionized the way we treat women in our practice, right?

• 55:28Dr. Mary Claire Haver?

  Same, 100%.

• 55:28Speaker 00

  Because it's game changer, right? And so you put her on, if she, if she, look, there's, 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, it helps with anemia.

• 55:47Dr. 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.

• 55:51Speaker 00

  Right, right. Think about renal protection or renal disease.

• 55:54Dr. Mary Claire Haver?

  Kidney disease.

• 55:55Speaker 00

  And hypertension. Like, one peptide has such a profound effect. Now, most of it could be due to weight loss.

• 56:01Dr. Mary Claire Haver?

  Secondary, yeah.

• 56:02Speaker 00

  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.

• 56:16Dr. Mary Claire Haver?

  I don't know. Tell me about that one.

• 56:17Speaker 00

  Okay, so let's, yes, yeah, I use a lot of it. So 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, Avitra, Cialis, put all the testosterone. He said, by the way, could you put on the counter all the drugs to help women have better sex? Zero.

• 56:40Dr. Mary Claire Haver?

  Zero.

• 56:41Speaker 00

  Zero. Not one. He said, wait a minute, that's not fair. Like, where, how did this happen? In 2015, the world got Addi, Flabanserin, first FDA approved drug, daily medication, great medication.

• 56:51Dr. Mary Claire Haver?

  We had Cindy on.

• 56:52Speaker 00

  Yes. Great medication, right? You take that medication every single day, significantly improves her desire for sex, period. That'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 Addi versus placebo. We showed that in men who take ADI 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 medial parietal nucleus, where she increases her desire for sex. It's extremely effective.

• 57:37Speaker 00

  Now, she can have nausea if she takes it. So typically, you 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.

• 57:53Dr. Mary Claire Haver?

  Oh, I didn't know. I was gonna say, yeah.

• 57:55Speaker 00

  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.

• 58:05Dr. Mary Claire Haver?

  And it has the dopamine pathway?

• 58:06Speaker 00

  It has dopamine. It would have been just melanotide, a little bit different. It's called melanotide. Yeah, melanotide, so a little bit different. ADI has, it 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. Now, a lot of the peptides, when a woman says, I want, she comes to me and says, I want peptides. She typically is not talking about these. She's talking about that BPC157, that TB500. 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,

• 58:51Speaker 00

  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. So 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 Motsi, 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.

• 59:21Dr. Mary Claire Haver?

  Okay. Which ones are you excited about becoming legal?

• 59:23Speaker 00

  I think BP157 with TB500 is excellent.

• 59:27Dr. Mary Claire Haver?

  Okay.

• 59:27Speaker 00

  And unfortunately, there's only been animal studies. But talk about regenerative, talking about pain, healing, wound injury.

• 59:35Dr. Mary Claire Haver?

  Yeah, what's their method of action?

• 59:36Speaker 00

  Yeah, so BP157 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.

• 59:50Dr. Mary Claire Haver?

  Right.

• 59:51Speaker 00

  But on July 23rd of this year, I'm going to find out if I can re-prescribe it. Motsi is another one that helps lose weight. It helps with metabolic and obesity, 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 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 banned 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. Just, it's better to just 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.

• 1:00:27Dr. Mary Claire Haver?

  Okay.

• 1:00:28Speaker 00

  Yeah.

• 1:00:28Dr. Mary Claire Haver?

  In our clinic, we don't. We're so busy doing PET, PET plus now GLP-1s or tirzepatide, and then hopefully retretutide.

• 1:00:38Speaker 00

  Yeah, retretutide next year, hopefully.

• 1:00:40Dr. Mary Claire Haver?

  So yeah, we're getting close.

• 1:00:41Speaker 00

  Yeah.

• 1:00:42Dr. Mary Claire Haver?

  That's really big on social media right now.

• 1:00:44Speaker 00

  Yeah, it's really big.

• 1:00:45Dr. Mary Claire Haver?

  The reta, reddits.

• 1:00:46Speaker 00

  Yeah. The only thing is that, you know, people get retretutide illegally. You can get it, but it's not FDA-approved.

• 1:00:52Dr. Mary Claire Haver?

  I haven't seen it, smelled it, but I know it's out there.

• 1:00:55Speaker 00

  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. It's about 27%. You know, tirzepatide's at 21%, and semaglutide's at 15%. So greatest amount of weight loss. It 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.

• 1:01:13Dr. Mary Claire Haver?

  So you touched on women's sexual health research funding.

• 1:01:17Speaker 00

  Yes.

• 1:01:18Dr. Mary Claire Haver?

  And the disparity, which is ridiculous.

• 1:01:21Speaker 00

  Yeah.

• 1:01:21Dr. Mary Claire Haver?

  What do you think it's going to take to change that?

• 1:01:24Speaker 00

  First of all, I got to tell you something very important. It's not just women and men. Let's kind of put this.

• 1:01:29Dr. Mary Claire Haver?

  It's both.

• 1:01:30Speaker 00

  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. And 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. He, we just, it 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.

• 1:02:11Dr. Mary Claire Haver?

  Wow.

• 1:02:12Speaker 00

  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, this, 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 their erections. He gave all the women at home an FSFI questionnaire, Female Sexual Function Index questionnaire. He 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 erectile function, the partner's sexual function scores skyrocketed. Her libido, her arousal, her orgasmic function. The men who got 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,

• 1:02:57Speaker 00

  and I never even met her, right? It's so tied together that if you treat one partner, you're actually treating the other. So 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.

• 1:03:39Dr. Mary Claire Haver?

  Yeah.

• 1:03:39Speaker 00

  Right? It's a couples disease. Everything is, menopause is not just about her. Hypogonadism, low testosterone, is not just about him. It affects both of them.

• 1:03:48Dr. Mary Claire Haver?

  Do you ever see couples in clinic, like together?

• 1:03:51Speaker 00

  I insist.

• 1:03:51Dr. Mary Claire Haver?

  Jim Simon does the same thing.

• 1:03:53Speaker 00

  Yes, I know, Jim. Yeah, I insist. I want to see, and don't forget the, I call them the hormonally dangerous decade.

• 1:03:58Dr. Mary Claire Haver?

  Whoa.

• 1:03:59Speaker 00

  50 to 60. That is the hormonally dangerous decade.

• 1:04:02Dr. Mary Claire Haver?

  Why do you say that?

• 1:04:02Speaker 00

  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? Low 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 affect 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? It's a hormonally.

• 1:04:31Dr. Mary Claire Haver?

  It's the great divorce, the menopause divorce.

• 1:04:33Speaker 00

  It's a hormonally dangerous decade. And if you don't understand that, it's your hormones. If, people sometimes don't even realize, I check my hormones. Just live with it. Check the hormones. It's a dangerous decade.

• 1:04:45Dr. Mary Claire Haver?

  Wow. Sometimes in our clinic, treating someone's hormones will give them clarity to realize they want to leave a relationship.

• 1:04:53Speaker 00

  True.

• 1:04:54Dr. Mary Claire Haver?

  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've got 30, 40 more years left.

• 1:05:02Speaker 00

  Yes.

• 1:05:02Dr. Mary Claire Haver?

  This is not my person.

• 1:05:03Speaker 00

  Yeah.

• 1:05:04Dr. Mary Claire Haver?

  So I see it go both ways.

• 1:05:05Speaker 00

  Yeah.

• 1:05:05Dr. Mary Claire Haver?

  You know?

• 1:05:06Speaker 00

  I see it in men also, but more of that is libido. So 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.

• 1:05:17Dr. Mary Claire Haver?

  Counseling.

• 1:05:17Speaker 00

  The couple. If I'm treating the couple, and I elevate both, I'm less likely to have a problem.

• 1:05:23Dr. Mary Claire Haver?

  Mm-hmm. Yeah, no, that's great.

• 1:05:26Speaker 00

  Yeah.

• 1:05:28Dr. Mary Claire Haver?

  So what do you say to a woman who walks into a doctor's office 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.

• 1:05:37Speaker 00

  Yeah.

• 1:05:37Dr. Mary Claire Haver?

  You know? And in menopause, the average, you know, when you look at the data, women will go six to 10 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.

• 1:06:00Speaker 00

  Yeah.

• 1:06:01Dr. Mary Claire Haver?

  And same with testosterone. You know, testosterone, I feel like for women is where menopause was 10 years ago.

• 1:06:06Speaker 00

  Yeah.

• 1:06:07Dr. Mary Claire Haver?

  And so how do you counsel her? Like, you know, find an ISWISH, or you said ASRM?

• 1:06:12Speaker 00

  SMSN, ISWISH, Menopause Society, three phenomenal.

• 1:06:15Dr. Mary Claire Haver?

  And we'll put the links in the show notes for everyone.

• 1:06:17Speaker 00

  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. Insist to get your levels checked. In fact, you don't even have to have a prescription or a doctor's appointment to get your level checked.

• 1:06:39Dr. Mary Claire Haver?

  Yeah, you can go direct through Quest and LabCorp.

• 1:06:41Speaker 00

  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.

• 1:07:06Dr. Mary Claire Haver?

  Okay. Very fair. So, any other labs they should request besides testosterone?

• 1:07:13Speaker 00

  Look at the great mimickers. The great mimickers of low T, there's two big ones. Hypothyroidism and depression. Someone who's depressed will have very similar symptoms. Someone who's 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.

• 1:07:43Dr. Mary Claire Haver?

  Critical.

• 1:07:43Speaker 00

  And stress reduction. Each one independently has a profound effect on her overall health. And so, we absolutely want to check all the other variables.

• 1:07:53Dr. Mary Claire Haver?

  What are you working on right now, research-wise?

• 1:07:55Speaker 00

  Well, I just finished my book. It's coming out March 2027.

• 1:07:58Dr. Mary Claire Haver?

  Oh, amazing.

• 1:07:59Speaker 00

  Yes, it took me a year and a half. We're good.

• 1:08:00Dr. Mary Claire Haver?

  I get mine.

• 1:08:02Speaker 00

  Yeah, so it's coming out in March, and so, we're very excited. We're doing a lot of work right now.

• 1:08:08Dr. Mary Claire Haver?

  What is it about? I don't know.

• 1:08:10Speaker 00

  It's about sexual health span. So, you know how we all have our lifespan?

• 1:08:15Dr. Mary Claire Haver?

  Yeah.

• 1:08:15Speaker 00

  Okay, so you'll live, I'll live till 90, hopefully, and we have our health span, right?

• 1:08:20Dr. Mary Claire Haver?

  Right. The years you live healthy.

• 1:08:22Speaker 00

  Healthy.

• 1:08:22Dr. Mary Claire Haver?

  Without chronic disease.

• 1:08:23Speaker 00

  And all of us want our health span to last as long as our lifespan. That's it. That's all I'm asking for. But there's different types of health span, right? There's your mental health span. I don't want to mention Alzheimer's.

• 1:08:32Dr. Mary Claire Haver?

  Yeah.

• 1:08:32Speaker 00

  Right? I was, my physical health span, I want to be physically, and there's my sexual health span.

• 1:08:36Dr. Mary Claire Haver?

  Wow.

• 1:08:37Speaker 00

  Right? And the issue is, all of us, you can 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. So, 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.

• 1:09:04Dr. Mary Claire Haver?

  Right.

• 1:09:04Speaker 00

  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. That your partner controls your sex span, 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 span? Keep your partner healthy, because if your partner's unhealthy, it's a problem.

• 1:09:26Dr. Mary Claire Haver?

  Mm-hmm.

• 1:09:27Speaker 00

  And keep your partner engaged. If you want to prolong your sex span, keep your partner healthy and keep your partner engaged to prolong your sex span. So, it's very important. And the whole book goes into everything about diet, exercise, sleep, and stress.

• 1:09:39Dr. Mary Claire Haver?

  And how it affects.

• 1:09:40Speaker 00

  How it affects sexual function.

• 1:09:41Dr. Mary Claire Haver?

  Amazing.

• 1:09:42Speaker 00

  And how to prolong your sex span. I've been really big into wellness lately. I think it's really important, and I've talked, 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 like a plane, and the plane starts getting altitude. We get higher and higher altitude. But 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've got to do it at 52, right? At 72, I say, I want my altitude

• 1:10:27Speaker 00

  to be high. Too bad, right? And you only get one shot. There's no redo.

• 1:10:30Dr. Mary Claire Haver?

  Mm-hmm.

• 1:10:31Speaker 00

  So, we start now.

• 1:10:32Dr. Mary Claire Haver?

  That's a great analogy. Yeah, because that's it. We're always going to, 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.

• 1:10:39Speaker 00

  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?

• 1:10:52Dr. Mary Claire Haver?

  Yeah.

• 1:10:52Speaker 00

  But wouldn't it be great if you had a high altitude?

• 1:10:54Dr. Mary Claire Haver?

  To start.

• 1:10:55Speaker 00

  Then your lifespan and health span will be the same.

• 1:10:57Dr. Mary Claire Haver?

  That's amazing.

• 1:10:58Speaker 00

  That's all you care about.

• 1:10:59Dr. Mary Claire Haver?

  That's amazing. Any new trials you're watching or excited about?

• 1:11:02Speaker 00

  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 immense. 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 had 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're, we have a lot of clinical trials going on right now.

• 1:11:32Dr. Mary Claire Haver?

  That's amazing. If you could tell every woman over 40, three things about testosterone, what would they be?

• 1:11:38Speaker 00

  Yeah. 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.

• 1:12:00Dr. Mary Claire Haver?

  Amazing.

• 1:12:01Speaker 00

  Yeah.

• 1:12:02Dr. Mary Claire Haver?

  Anything else you want to leave with our audience?

• 1:12:03Speaker 00

  No, I just, I think it's really important that everyone understands the importance of this hormone.

• 1:12:08Dr. Mary Claire Haver?

  How can our listeners find you?

• 1:12:10Speaker 00

  I'm at Baylor College of Medicine. I'm not, I'm on Instagram, not as much as you, but at Dr. Mohit Khera.

• 1:12:16Dr. Mary Claire Haver?

  Okay. And are you taking patients? Is your clinic still taking patients?

• 1:12:19Speaker 00

  Still taking patients, yeah.

• 1:12:21Dr. Mary Claire Haver?

  Yeah, that's amazing. Well, thank you so much for coming on on pause.

• 1:12:23Speaker 00

  Thank you. Thank you for having me on the show.

• 1:12:24Dr. Mary Claire Haver?

  This has been invaluable for our audience.

• 1:12:26Speaker 00

  I appreciate it. Thank you so much.

• 1:12:29Dr. Mary Claire Haver?

  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 thepauselife.com. UnPaused is presented by Odyssey in conjunction with Good Roommate Media and Long Wave Digital.