Testosterone Could Help Women's Libido. Why Won't Doctors Prescribe It?

Summary

Podcast Summary: "Testosterone Could Help Women's Libido. Why Won't Doctors Prescribe It?"

All Of It with Alison Stewart (WNYC), Nov 3, 2025
Guest: Susan Dominus, New York Times Magazine reporter

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Overview

In this episode, host Alison Stewart interviews journalist Susan Dominus about her recent New York Times Magazine piece, "I'm on Fire: Testosterone is Giving Women Back Their Sex Drive – And Then Some." The conversation explores the rise of testosterone use among women seeking to boost libido, energy, and wellbeing, and delves into the regulatory, cultural, medical, and ethical issues surrounding this controversial therapy.

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Key Discussion Points and Insights

1. Why is Testosterone a Hot Topic for Women?

• Growing Awareness: Dominus noticed an uptick in testosterone discussions on social media, especially on Instagram, and saw more women openly sharing their experiences.
  • “I think there are some who didn’t even know women have testosterone in their system… it seemed like an interesting opportunity to explore what women were experiencing.” — Susan Dominus (03:51)
• Empowerment & Demands in Healthcare: Women are more assertively seeking hormonal treatments for menopause and decreased libido, but sometimes arrive with incomplete or misleading information.
• Testosterone’s Function: While commonly associated with aggression and sexuality in men, its role in women is less understood, though it’s known to decrease significantly with age (05:00-05:51).

2. Trends, Motivations & Social Influences

• New Movement or Ongoing Practice? Interest has surged recently largely due to the mainstreaming of menopause discussions and influencers touting benefits (04:09-04:46).
• Personal Stories Dominate: Many women hear about testosterone from friends or influencers who frame it as a missing puzzle piece to their health.
  • Testimonial (Social media influencer): "You’re not lazy, you may have low testosterone… I’ve struggled with these for years and explains why I depended on caffeine in the morning…” (07:12-08:03)
• Potential Placebo Effect & Real Outcomes: Some report feeling “more like themselves.”

3. Medical Guidance, Regulations, and Dosage

• No FDA Approval: Testosterone is not FDA-approved for women, and only select medical societies cautiously endorse low-dose, short-term use strictly for low libido.
  • “So as we know, testosterone in any dosage is not approved by the FDA for use in women… The only thing they will tell women is that testosterone at that dose [5 mg] may improve libido — modestly but meaningfully.” — Susan Dominus (08:15-09:34)
• Dangers of High Doses:
  • Some clinics and aesthetic centers prescribe doses far above consensus guidelines, risking unprecedented hormone levels in women (09:35-10:19).
  • Side effects from excessive use include severe irritability, increased aggression, hair loss, and irreversible facial hair growth.

4. Personal Experiences: Callers and Testimonials

• Cynthia (10:59):
  • Started low-dose topical testosterone at age 47 for energy, mood, and libido changes; found it effective:
    • "I haven't looked back. I really love it. It's added a lot of value to my life." (11:51)
• Francesca (12:10):
  • Used progesterone cream in the '90s when conventional medicine failed her; inspired by lack of women-specific research and options:
    • "They don't study us. And then they're like, ‘Oh, but don't take matters into your own hands.’" (13:20)
• Emily (20:30):
  • On Estra Test for 30 years; attributes energy, youthful appearance to it:
    • “I love it. People tell me all the time I seem younger than my age.” (21:02)
• Listener Text:
  • Testosterone cream improved muscle weakness and joint pain; paid just $100/year at a local pharmacy (21:13-21:35).

5. Risks, Side Effects & Unintended Consequences

• Libido Rollercoaster: High doses sometimes result in hyper-indulgence or interpersonal issues.
  • “She had insisted her husband pull over... so they could have sex. It became an uncomfortable distraction.” — Susan Dominus (15:41)
• Emotion & Mood: Heightened irritability or anger, sometimes described as "acting like a teenage boy."
• Physical Effects: Some lost up to 40% of head hair after pellet implants; coarse facial hair can be permanent.
  • “There’s no way to stop the process... your hair will kind of forever come back a little darker, a little bit coarser.” (16:51-17:31)
• Financial Burden: Treatments can cost thousands per year, mostly out-of-pocket, particularly with unregulated pellet implants (17:35).
• Unpredictability: Energy can surge then crash; steady low-dose creams tend to be easier to regulate (18:20-18:41).

6. The Gender and Cultural Angle

• Medicine’s Double Standard & Research Gap:
  • FDA required far more rigorous safety data for women than for men, citing cancer and long-term risks.
  • Bias and neglect toward women’s middle-age health persists (13:42).
• Societal Pressures & “Hustle Culture”:
  • Some listeners/viewers push back against the drive to medicate natural aging or expend every effort to feel "young."
    • "I despise how our entire culture is geared towards popping pills to keep up with hustle culture. No thanks, I'll keep my hair and happily do less." — Listener MJ (24:28)
• Sex and Gender Continuum:
  • Witnessing some women (even conservative ones) choosing male-range hormone doses led Dominus to see gender as a spectrum:
    • “I did start to think of gender as a little bit more of a continuum.” (26:15)

7. Long-term Unknowns and Calls for More Research

• Insufficient Data: Even for recommended doses, most research covers only 2–6 year windows.
• Need for Better Studies:
  • “The companies that produce these pellets haven’t really done very long-term randomized control trials… what are the long-term health repercussions? Somebody needs to answer that question.” — Susan Dominus (27:15)

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Notable Quotes & Memorable Moments

• On Social Narratives:
  • “There are, I think, some who didn’t even know women have testosterone in their system.” — Susan Dominus (03:51)
• On FDA Reluctance:
  • "For women ... the FDA really wanted long-term safety data, which I think some people think was excessive, but other people think is completely justified." — Susan Dominus (13:42)
• Candid Energy Shift:
  • “Her daughter said to her, Mom, you’re acting like a teenage boy.” — Susan Dominus (19:23)
• Cultural critique:
  • "We also shouldn’t be shaming women who want to say, like, that was great and now I’m moving on to other things." — Susan Dominus (25:09)

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Timestamps for Key Segments

• 03:33–04:46: Why Dominus investigated testosterone, background trends
• 05:16–06:20: Testosterone’s biological role in women
• 08:15–10:19: Medical guidance, regulatory limitations, dosing controversies
• 10:59–13:20: Callers Cynthia & Francesca share personal experiences
• 13:42–14:33: Medical research bias and regulatory struggles
• 15:39–17:31: Negative and surprising side effects (libido, hair loss, irritability)
• 17:35–18:41: Financial cost and delivery methods
• 18:20–19:23: Anecdotes about increased energy, personality changes
• 20:30–21:35: Callers Emily and text responses, cost/access details
• 22:37–23:33: Prospects for FDA approval, industry efforts
• 24:28–25:09: Cultural criticism: hustle culture & expectations vs. acceptance
• 26:15–27:15: Rethinking gender, need for long-term studies

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Conclusion

The episode highlights the complex landscape around testosterone therapy for women. Although some find real relief for libido, energy, and mood, the science (and the regulatory apparatus) lags behind the large, vocal demand. Risks can be significant, the financial burden is real, and the absence of robust long-term data generates controversy and caution. Yet, the widespread interest also reflects evolving attitudes toward women's health, agency, and the spectrum of gender, leaving open crucial questions for the future.

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For more, read Dominus’s article, "I'm On Fire" in The New York Times Magazine.

Transcript

[Susan Dominus]

For 140 years, MultiCare has been in Washington prioritizing long term solutions, partnering with local communities and expanding access to care. Together, we're building a healthier future. Learn [e-mail].

[Alison Stewart]

This is all of it. I'm Alison Stewart live from the WNYC studios in Soho. Thank you for supporting for spending part of your day with us. I'm really grateful that you're here. And congratulations to everyone who participated in the New York City Marathon. Yesterday. We had some members of the New York Public Radio family running, huge applause to them. And we also wanted to shout out actor Jordan Litz who plays Fiyero in Wicked. Why you ask? I'll let Brad Oscar, who plays the wizard in Wicked, explain from here.

[Susan Dominus]

Jordan Lynch, R. Fiero, I want you to know something.

[Alison Stewart]

You already do.

[Susan Dominus]

This man ran the New York City Marathon this morning. He completed it and then he did two shows. He did two shows today. Come on. I give you Superman the musical.

[Alison Stewart]

Hear that? He ran the marathon, then performed in the matinee and then the PM performance. Congratulations to Jordan. And I bet you are really glad the house is dark today. On today's show, we'll speak with the photographer and author Deborah Willis about her groundbreaking book Reflections in Black. And we'll hear excerpts from our recent get lit with all of it book.

[Caller Host / Producer]

Club event featuring author S.A. cosby and musician Yaya Bay.

[Alison Stewart]

That is our plan. So let's get this started with reporter so Susan Dominus. As women hit middle age, many find their energy levels are lower and so are their sex drives. To solve that problem, some women are turning to taking high doses of testosterone, a non FDA approved method of treatment. New York Times Magazine reporter Susan Dominus spoke to women who shared how taking testosterone changed their lives sexually and emotionally. Emotionally. But there are, of course, side effects to taking testosterone and the long term effects aren't yet fully understood. Plus, testosterone treatments, they can be expensive. Susan Dominus spoke to women about their journey with her new piece called I'm on Fire. Testosterone is giving women back their sex drive and then some. She joins me now to discuss. Susan, welcome back to all of it.

[Susan Dominus]

Thank you so much for having me.

[Alison Stewart]

Listeners, we want to hear from you. Have you ever taken testosterone? Are you taking it right now? What made you decide to try it? What have the positive and negative effects been? We want to hear women's experiences with taking testosterone. Our Phone lines are open. 2124-3396-9221-2433 WNYC. You can call in. You can Join us on air or you can text to that Number once again, 2124-3396-9221-2433-WNYC. Why did you get interested in looking at women taking testosterone?

[Susan Dominus]

Well, a couple of years ago, I wrote a story for the New York Times Magazine about menopausal hormone therapy in general, which was mostly estrogen and progesterone. And every once in a while, testosterone would come up, but it didn't seem to be a hormone that was being taken seriously as a supplement in this country as much in the uk.

[Caller Host / Producer]

Yes.

[Susan Dominus]

And then in the past six months, I just started seeing it all over Instagram. It became a really big part of the conversation. And, you know, I think there are some who didn't even know that women have testosterone in their system. So it seemed like an interesting opportunity to explore what women were experiencing.

[Alison Stewart]

I was interested. Is it a new trend or has it been happening for a while?

[Susan Dominus]

It's been happening for a while, but I think because there is all this new excitement and awareness about the needs of menopausal, postmenopausal, perimenopausal women, testosterone has really entered the conversation. I think women also, maybe to the detriment of their own care, some doctors think, have really come in strong to their doctor's offices, you know, sort of demanding that they get their hormones. And so women do feel empowered, which is obviously great, and they're asking more questions. I think doctors sometimes feel like they're not getting great information and they're coming in, you know, asking for things that the hormones might not even deliver.

[Caller Host / Producer]

Let's start at the beginning.

[Alison Stewart]

What is the function of testosterone in general?

[Susan Dominus]

Well, to be honest, its function in women is not that well understood in men. We do know that it is a hormone that is associated with aggression and also aggression and also sexuality and sex drive. And it exists in women, but it drops over time much more in women than it does in men. So that by the time a woman is 60, her testosterone levels are about half of what they were when she was maybe 18, 19.

[Alison Stewart]

Why is testosterone important for women?

[Susan Dominus]

Well, as I said, we're not exactly even sure. All we know is that when you do replace testosterone in women, whose levels have really dropped, often they do report that they have more of a sex drive and, you know, they get stronger, they look more ripped if they're taking it at very high levels, which doctors don't generally recommend. So it's obviously, you know, has a connection to bone health, mental health, but we don't know, when what doses are, you know, at what point are women sort of surpassing levels that are also known to be safe?

[Alison Stewart]

And what is its relationship to menopause testosterone?

[Susan Dominus]

That is a great question. So it's actually not a hormone that plummets during menopause the way that estrogen and progesterone do. It's just that the lowest point that women experience testosterone is something that coincides with menopause. So it, you know, just as you're losing your estrogen and your progesterone, you are also really at like, the nadir of your levels of testosterone.

[Alison Stewart]

As you were talking to women, what explanations did they give you for why they wanted to be on testosterone?

[Susan Dominus]

Well, a lot of them were hearing about it from their friends or they were seeing influencers talking about it. And I think it made sense to them. You know, we do associate testosterone in men with sexual drive. And I think for women whose libidos have really dropped, it makes sense that they would want to try that if that's something available to them. And also, you know, on social media, you do see people talking about how it gave them energy. It was the final piece in the puzzle, some experts say, of their hormone replacement that it's just this thing clicks. They feel more like some women report feeling, quote, unquote, more like themselves.

[Caller Host / Producer]

You talked about. There are many people on social media speaking about it.

[Alison Stewart]

Let's listen to this clip and we.

[Caller Host / Producer]

Can talk about it on the other side.

[Testimonial Speaker]

Do you have it, ladies? You're not lazy. You may have low testosterone. You may not have just a lack of motivation. You may have low testosterone. Your struggle to stay organized, low testosterone, low libido, brain fog, depression, anxiety, low testosterone. I've struggled with these for years and explains why I depended on caffeine in the morning and throughout the day just to feel normal. And why when I quit caffeine, that certain supplements, I relied on those to make me feel normal. And then I also have to keep my diet pretty strict. Now, of course, some of that does have to do with the chronic illness and autoimmune symptoms that I've been keeping in remission as well. I have to do all those things to keep those in check as well. But I just did a Dutch test with a functional medicine practitioner, and they found that my testosterone was low. And it makes so much sense.

[Caller Host / Producer]

All right, first of all, what expectations do influencers have or what do they set about testosterone? And are those expectations somewhat unrealistic?

[Susan Dominus]

So I'm really glad you asked that, because so as we know testosterone in any dosage is not approved by the FDA for use in women. However, a body of very well respected medical societies got together in 2019 and issued a consensus statement saying, you know, we think in the short term, like two years to six years or so, 5 milligrams of testosterone a day for women seems to be safe and something that restores their testosterone levels back to where they were in their 30s. The only thing those doctors and those societies will tell you that it is likely to do is improve women's libido. They'll say it's a modest but meaningful effect. They tell women, look, if you're not feeling an effect in six months, just go off of it. But this is the only thing they will tell women that testosterone at that dose will do libido. And they also don't think it's necessarily something anyone would want to take at higher doses than that because it really hasn't been studied well. So this is where like the buck stops. Five milligrams. Maybe it'll help your libido. Give it a try. There are women who are going to wellness spas, aesthetic centers, even some obgyns who are taking testosterone in levels that bring their testosterone levels three or four times higher than it ever was when they were in their 20s or even 18 years old. So they're experiencing testosterone at a level that is kind of unprecedented for women. It's, you know, some women are starting to take it even at the levels that are the low levels that people take who are transitioning. So those women do report, you know, bursts of real sex drive and energy. They also report sometimes feeling incredibly irritable and frustrated and angry or like over aroused in a way that's uncomfortable. So not only do you not know what your particular response is gonna be, but we really don't know what the safety profile. And there are obviously, you know, doctors do have real concerns.

[Alison Stewart]

We're talking about the rising popularity of women taking testosterone. My guest is New York Times magazine staff writer Susan Dominus. Her new piece is titled I'm on Fire. Testosterone is giving women back their sex drive and then some listeners. We want to hear from you. Are you a woman who has taken testosterone for energy or sex Dr. Drive benefits? Have you thought about it before? We want to hear your experiences with taking testosterone. Our number is 2124-3396-9221-2433. WNYC. We've got Cynthia who is calling in from Manhattan. Hi, Cynthia, thank you for making the time to call all of it.

[Cynthia (Caller)]

Hi. Thank you. Yeah, I started taking a very low dose of testosterone a little over a year ago and maybe like a year and a half ago. And it's just like a topical, like a clear little gel. I put very little on my thigh. And I originally got it because I went to my gynecologist because I was feeling, I'm 47 now, and I was just starting to feel at that time, like some changes in energy, in my mood, especially also in my sex drive. So I knew, like, this is related to menopause. My gynecologist suggested a very low dose of testosterone to start. And I was a little apprehensive at first, but I, you know, I took home the prescription, I started to do some research and I thought, why not let me just try it. And I haven't looked back. I really love it. It's added a lot of value to my life.

[Alison Stewart]

Cynthia, thank you so much for sharing your story. Let's talk to Francesca, who is calling.

[Caller Host / Producer]

In from the Bronx.

[Alison Stewart]

Francesca, you are on the air. Hi.

[Francesca (Caller)]

So I have not yet tried it, although I would like to. I don't have the cash to lay out for that. But when I was in my 20s, back in the 90s, I was taking a progesterone cream, like a topical cream. Nobody knew about this at the time. I happened to be living in Minnesota. There was this product Melinda Bonk made with a doctor Wise essentials. They still make it. The doctors were not helping me. I had debilitating, you know, had debilitating periods. It was cramping, bleeding like, mood. It was horrible. It was a nightmare. And the doctors were not helping me. They were giving me a synthetic hormones making it worse. And I was desperate casting about and I. And I found this. And it was life changing. And all I remember is the doctors telling me, I mean, it was incredible. You know, it cut it down from 10 days to 5. Bleeding became mostly normal. You know, the painkillers I had to use were severely reduced. You know, the Advil is, you know, very bad for you to take too much, all of that, the moods, everything. And they were like, oh, but this isn't studied. Like, you shouldn't be taking this. This is, you know, and I get it on the one hand, but on the other hand, it's like they don't study us. They don't study us. And then they're like, oh, but don't take matters into your own hands. We don't have anything for you.

[Alison Stewart]

I want gu in here real quick.

[Caller Host / Producer]

Because you made a really interesting point, Francesca. They don't study us. How much of this has to do with the bias against women in medicine, bottom line?

[Susan Dominus]

Well, I think specifically when you speak about testosterone, it's hard to separate out, you know, the way that women are indeed under research, particularly middle aged women, but also this particular hormone. It's just the standard was much higher, the safety standard that the FDA put in place, like when testosterone was approved for men. Basically they just needed to find that it did indeed restore men's testosterone levels to where they were for women because there are, you know, real and valid concerns about breast cancer. They didn't just want to see that it restored women's testosterone to where it was. They want, the FDA really wanted long term safety data, which I think some people think was excessive, but other people think is completely justified. It's one of those questions that you can get different answers about. So I think testosterone in particular kicks up a lot of uncomfortable feelings for people when they think about women taking it.

[Alison Stewart]

We're talking to Susan Dominus about her piece about women taking testosterone. Listeners, we want to hear from you. Are you a woman who has taken testosterone for energy or sex drive benefits? Have you thought about it before? We'd like to hear your experiences with taking testosterone. Our number is 2124-3396-9221-2433 wnyc. We'll be right back. You're listening to all of it on wnyc. I'm Alison Stewart. My guest in studio is Susan Dominus. She's a writer for the New York Times Magazine and she's written a piece called I'm on Fire. Testosterone is giving women back their sex drive and then some. We've talked about an increase sex drive when taking testosterone. What did William tell, what did women tell you about the potential downside of an increased libido?

[Susan Dominus]

Oh, that was super fascinating, I have to say. I mean, one of the foremost researchers in the field told me about a woman who came to her and had been taking very high doses of testosterone. This is a middle aged woman who had basically injured her back because she had insisted that her husband pull over by the side of the road while they were driving so that they could stop and have sex. You know, it became this kind of uncomfortable distraction. One woman who was on high dose testosterone told me that she definitely felt more, you know, eager for sex, but that the hormone also seemed to be making her so irritable and annoyed with everybody that she couldn't bring herself to have sex with her husband because he was, she was so mad at him all the time, even though she was really interested in sex at the same time, you know, and then so there were kind of these emotional side effects for some women, but other women also told me that they had really been uninformed about really common side effects like hair loss. So one woman went on high doses of testosterone, you know, many times the level she'd ever have, kind of naturally. And she said she lost within the first three months of taking a form of testosterone that you can't stop halfway through. It's a pellet that gets this tiny grain of rice that gets inserted under your skin and releases testosterone. Over three months, you know, she lost up to 40% of her hair and there was no way to, you know, stop the process. So that was really challenging. And I think that a lot of the places that are offering these high doses are very high profit driven kinds of places. And maybe women are signing the paperwork that informs them of the risks, but they're not really being talked through the reality. Like, look, you really could lose your hair. You could start growing facial hair in ways that are irreversible, you know, that your hair will kind of forever come back a little darker, a little bit coarser, that kind of thing on your face.

[Caller Host / Producer]

What kind of expense are we talking about?

[Susan Dominus]

Oh, I mean, it could be upwards of thousands of dollars a year because each pellet, for example, lasts three or four months. And I think each one is about $400. Yeah, it depends where you go. They also often are pushing on women these supplemental shots, you know, $100 a pop here and there. It's just, there's a lot of churn and a lot. You know, these places will tell you that they are really trying to individualize it to women, but at the same time, they're taking it much higher than these, you know, established medical societies recommend.

[Caller Host / Producer]

I wanted to ask you about this idea of increased energy that some women talk about.

[Alison Stewart]

I mean, what does that mean? Is that what's different than getting a.

[Caller Host / Producer]

Good night's sleep gives you increased energy? What do they say about the kind of energy that they are experiencing?

[Susan Dominus]

Well, you know, it's a steroid, right? It's like, it definitely gives. It's like, it's like a steroid. It is gonna give you that, like, burst at these very, very high levels, that kind of pop of energy. You know, some women found when they take these pellets that they have a burst of energy and libido in the beginning, but then they kind of crash, like It's a little bit uneven. Whereas, you know, the.

[Testimonial Speaker]

The.

[Susan Dominus]

The daily cream that women take at that standard dose that's endorsed by the medical societies that's a little more steady. You can, you know, regulate it yourself a little bit. But, I mean, I did have two different women tell me that they, you know, were. They had so much energy that they went on to get their advanced degrees that they wouldn't have thought they had time or energy to pursue before. So it is a real thing. It's just you're kind of rolling the dice because we don't have great safety data about it. And you don't know if you're gonna be the woman who loses half your hair, and you don't know if it's gonna give you good energy or bad energy.

[Caller Host / Producer]

Yeah. One woman in your piece talked about having the energy of, like, a teenage boy. She was kind of argumentative.

[Alison Stewart]

Yes.

[Susan Dominus]

And very insistent on her opinions. And her daughter said to her mom, you're acting like a teenage boy. And she had kind of the levels of hormone in her, this hormone that, like, teenage boys actually have. And another woman said to me, you know, I feel like I'm a little bit, like, a little bit more matter of fact, you know, like, maybe she meant a little bit even less empathetic. And she said, but, you know, that's great, cause I don't have time for all that stuff anyway.

[Caller Host / Producer]

Did you talk to anyone who truly regretted taking testosterone?

[Susan Dominus]

Yes, I think there were men. I did talk to women who felt that the irritability of it made them uncomfortable and that they, you know, and that some of them felt like they're. They're. That they were spotting afterwards and that their mood was screwed up for a little while. I did hear from one woman who took it years ago and is still dealing with unwanted coarse facial hair, you know, that she feels like it's such a, like, chronic problem for her. And I do think she regretted it.

[Caller Host / Producer]

Yeah. Let's talk to Emily, who's calling in from Atlantic Highlands, New Jersey. Hi, Emily. Thank you so much for making the time to call, all of it.

[Emily (Caller)]

Oh, it's my pleasure. Thank you.

[Caller Host / Producer]

And you're on the air.

[Emily (Caller)]

So I was simply calling to give my experience of having taken a pharmaceutical called Estra test, which is like a big, big pharma version of testosterone. And I've been doing it for 30 years, and I love it. I feel great. People tell me all the time that I seem so much younger than my age. So I thought I'd let you know.

[Caller Host / Producer]

Emily, thank you so much for calling in. This text says my perimenopause symptoms included muscle weakness and joint pain. And taking testosterone has been a game changer. I apply a small amount on my inner thigh daily and the cost is nominal. Not going through insurance. A whole box of packets of testosterone that lasts a year cost me $100 for my local pharmacy pickup. Is that how most people take it?

[Susan Dominus]

Yeah. Well, how most people take it, we don't know. Right. Because they're not. It's not. Insurance isn't covering it, so we don't have great records. But if you go to a reputable OBGYN and say, I would like the standard dose, many of them may figure out how to get it through the pharmacy in just that.

[Caller Host / Producer]

Yeah.

[Susan Dominus]

And it doesn't have to be that expensive. Other people find it easier. But the problem with taking it from, you know, a sort of standard pharmacy is that you're usually getting a packet that is intended for men. Like, men will use the whole packet and rub it on their legs. And if you're a woman, you take a tenth of what men take. So you kind of have to estimate what a tenth of the packet is. And that's a little bit of a guessing game. Other people will prescribe it through a compounding pharmacy. And, you know, there's like a dispenser. You turn it, it clicks and it'll give you this, this, you know, sort of standard dose, this 5 milligram dose. And the only problem with that is that compounding pharmacies, their medications are also not regulated as carefully by the fda. So, you know, it's a little bit less quality controlled, basically. So again, you're rolling the dice a little bit more than if you take it through a standard pharmacy.

[Alison Stewart]

So when is the FDA going to get on this?

[Susan Dominus]

We do not know. I mean, there is a pharmaceutical company that has. So it used to be that people could take testosterone via a pill. Men took it in a pill, but it was causing liver problems. And now a pharmaceutical company has a product on the market that bypasses the liver. So this pill is very easy to take.

[WNYC Announcer]

And they.

[Susan Dominus]

That company is in discussions with the FDA about getting some studies going of a female appropriate dose of the same kind of approach to testosterone delivery. So that, you know, these things take a very long time. But it's been a really long time so far, as I know before, because it's. Because it's been a long time since a pharmaceutical company has even come to the FDA with a product because they've Gone to the FDA twice before and failed. You know, and after something like that happens, it's very expensive to run these trials. Once two different pharmaceutical companies have failed, it's very hard to get something back on the market. But here we are, there is this company, Marius Pharmaceuticals, that is approaching them once again.

[Alison Stewart]

There are nearly 1300 comments on your piece. What was a response that either surprised you or brought up an issue that you hadn't thought of before?

[Susan Dominus]

A lot of the comments were actually about the illustration that we, that we ran with the piece, which was kind of wacky. You know, there are, I heard from all kinds of women, some women, you know, one woman was convinced that, you know, testosterone, which she had been taking for many, many years, was causing non cancerous tumors there. You know, I think people do have real concerns about the long term health effects, but just in general, I think there's a sense that, you know, women deserve more information and they certainly deserve a female appropriate dose of a medication as long as their doctors are telling them exactly what we do know and what we don't know. You know, it's true that we don't really know that much about long term use of testosterone, even in these standard doses.

[Alison Stewart]

This comment was from a reader named MJ. They said, I mean, if you're running around for 18 hours a day, of course you're tired. You don't need testosterone or cocaine. You probably need to rest. I despise how our entire culture is geared towards popping pills to keep up with hustle culture. No thanks, I'll keep my hair and happily do less.

[Susan Dominus]

I love that.

[Alison Stewart]

Yeah, I know what you think about this idea of hustle culture or the idea that this is supposed to happen to women as they get older, they lose testosterone, or we like just diving in and changing our humanity and our, the way we're supposed to age.

[Susan Dominus]

It's a really profound and important question. And you know, I wish I'd been able to quote in the piece one of the really wise sex therapists I spoke to who said, you know, some women want to be done with sex in their 50s and 60s and we can normalize that too. Just as there shouldn't be shame around being in your 50s and 60s and wanting to have sex and wanting to feel that, you know, red hot desire. We also shouldn't be shaming women who want to say, like, that was great and now I'm moving on to other things, you know, and some of the women who were taking it for energy, like these are women who have lots of kids and they have lots of jobs and they're really juggling so much. And I did sometimes think it, you know, we do know that like the labor of child rearing still falls to women. And in large part, and it does seem like I did sometimes think it shouldn't be this hard just to get through the day, that you need to take these really high doses at a level that has never really been experienced, you know, in past centuries, certainly by women at all.

[Caller Host / Producer]

We've got a question here that says.

[Alison Stewart]

How did working on this piece make you think differently about sex and gender?

[Susan Dominus]

Oh, that's a really good question. Let me think about that. I actually thought it was really interesting to think about gender, you know, to the extent that some of the things that we associate, you know, for better or for worse with certain gendered behaviors. Just having more of a sense of how much testosterone women do have, which is of course much less than men, but just the fact that we do have it, and of course women have it in different levels. You know, I did start to think of gender as a little bit more of a continuum, you know, and then when you think about the fact that some women are taking testosterone at levels that approach the low levels that people take who are transitioning, some of these women, by the way, so far as I could tell, quite politically conservative or religiously conservative, you just realize that increasingly people, whether they realize, realize it or not, or playing around with that spectrum and deciding where they want to be on it.

[Caller Host / Producer]

What are some of the big questions that you still have after working on this piece?

[Susan Dominus]

I would like to have more safety data, to be honest, because it's the best safety data we have, even on the standard doses really only goes out like two to six years. And I think a lot of people, once they start on a hormone, it's really hard for them to walk away from it. And so for women's sake, I would like better long term safety data. And I think we should have, you know, one of the women I, one of the doctors I quoted in my articles, Rachel Rubin, this really outspoken and smart urologist. The companies that produce these pellets haven't really done very long term randomized control trials. We don't really know what's going to happen to women who are taking these very high doses. We know what the side effects are going to be, but forget the side effects. What are the long term health repercussions? Somebody needs to, to answer that question.

[Caller Host / Producer]

The name of the piece is I'm on fire. Testosterone is giving women their sex drive and then some. Giving back their sex drive and then some. It is by my guest Susan Dominus.

[Alison Stewart]

Thank you for coming to the studio.

[Susan Dominus]

It's always a pleasure. Thanks so much for having me.

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