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

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.

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)

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)

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

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.

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