Podcast Summary

Podcast Title: BETTER! Muscle, Mobility, Metabolism & (Peri) Menopause with Dr. Stephanie
Episode: Saving Marriages & Bedroom Comebacks: Midlife Women on Testosterone with Shalin Shah
Host: Dr. Stephanie Estima
Guest: Shalin Shah, CEO of Marius Pharmaceuticals
Release Date: January 12, 2026

Episode Overview

This episode dives deep into the science, misconceptions, and emerging applications of testosterone therapy for women—particularly those navigating menopause and perimenopause. Host Dr. Stephanie Estima and guest Shalin Shah break down current research, clinical experiences, diagnostic strategies, delivery formats, and the cultural shift beginning to bring testosterone for women into mainstream health care. The discussion is aimed at demystifying hormone replacement for women, empowering listeners with actionable insights, and paving the way for more equitable aging for all genders.

Key Discussion Points & Insights

1. Misunderstandings About Testosterone in Women vs. Men

[00:00–07:00]

Testosterone is often pigeonholed as a “male hormone,” with focus on muscle mass and libido, but women have more testosterone than estrogen (albeit much lower than men).
There are androgen (testosterone) receptors in every major organ system: brain, heart, bones, muscles, mitochondria.
The role of testosterone in women is largely analogous to men in areas of body composition, cognition, energy, and cellular health.

Notable Quote:

"Testosterone has a role all across your body. It is not a single category."
—Shalin Shah, [05:11]

2. Clinical Signs & Symptoms of Low Testosterone in Women

[07:00–12:00]

Early indicators: fatigue, afternoon energy crashes, body composition changes (fat gain, muscle loss), reduced libido, sleep difficulties, and cognitive decline.
Many women report “doing what I did at 35, but I’m 45 and it’s not working anymore,” especially with respect to body composition and new-onset insomnia.

Notable Quote:

"I'm doing literally the same thing I was doing when I was 35, and now I'm 45 and my waist is disappearing. I'm accumulating belly fat at a rate that I'm unhappy with... and I can't sleep."
—Dr. Stephanie Estima, [09:16]

3. Diagnostics & Lab Interpretation: Why Test and What to Look For?

[12:00–20:00]

Regular blood panels rarely include testosterone for women, despite its value as a biomarker for inflammation, metabolism, and cardiovascular health.
Important labs: total testosterone, free testosterone, and SHBG (sex hormone binding globulin)—especially since women often have high SHBG from historic birth control use.
There is a need to focus on "optimal" levels for the individual, not just the lab “normal” ranges, which are often based on population averages that have trended downward over decades.

Notable Quote:

"Normal has been sort of decimated if you think about it... what’s optimal for them? That’s why testing is important earlier and earlier."
—Shalin Shah, [17:24]

4. Testosterone Access & The Gender Healthcare Gap

[13:40–18:00]

As of the episode, only Australia and the UK have approved testosterone products for women; in North America, it’s off-label, with the only official indication being “hyposexual desire disorder.”
Major ramifications for couples: men have broad access to TRT (Testosterone Replacement Therapy), while their partners do not, often leading to intimacy and relational mismatches in midlife.

Notable Quote:

"You can’t just treat the penis and ignore the vagina. We want to be thinking about both the male and the female."
—Dr. Stephanie Estima, [64:02]

5. Declining Testosterone Trends & Underlying Causes

[20:30–25:00]

Testosterone levels have been declining predictably, attributed to sedentary lifestyles, environmental toxins (microplastics, endocrine disruptors in lotions, food and water), and altered sleep/screen patterns.
This is not easily reversed by “willpower” alone; environmental factors play an increasing role.

Notable Quote:

"Sleep and screens have become so embedded in our culture... our bodies don’t know how to handle that. I think that is massively affecting our hormone production."
—Shalin Shah, [22:06]

6. Lifestyle vs. Pharmacology: Building a Virtuous Cycle

[25:38–28:20]

Modest lifestyle changes can mildly boost testosterone, but may not restore optimal levels—especially if low energy is the barrier.
Medication can help “break inertia,” making lifestyle changes sustainable and reinforcing, especially when combined with exercise and protein-rich diets.

Notable Quote:

"You need to get into a virtuous cycle... use the tools in the toolbox to get there."
—Shalin Shah, [27:10]

7. Risks, Side Effects, & Dosing—Especially for Women

[30:29–41:14]

Virilization Risks (deepened voice, body/facial hair, jaw/mandible prominence, clitoral enlargement) are largely dose-related.
- Most cases arise from super-physiologic dosing, especially with long-acting pellets.
- Physiologic dosing (approx. 1/10th male levels) shows little evidence for significant risks.
Delivery formats: injectables (in men), gels (with transference risks), pellets (super-physiologic & hard to titrate), and newer oral forms like Kaisertrex (designed for lymphatic absorption, not hepatotoxic).
Monitoring: symptom relief trumps isolated lab values; monitor for physical/behavioral signs of overdose, plus specific labs (see below).

Notable Quote:

"At physiological doses, you are not going to see anywhere close to the side effect profiles that you do regarding pellets."
—Shalin Shah, [33:01]

8. Dosing, Monitoring, and Formulation Innovations

[41:15–53:06]

Dosing in clinical practice: men take two oral doses (300–400mg BID); developing safe options for women (aiming for 20–60mg daily in future clinical trials).
Monitoring for men: hematocrit (red cell count), LH/FSH, PSA (prostate health).
Monitoring for women: symptom improvement, watch for virilization; labs should inform but not dictate therapy.
Daily oral dosing is favored for compliance—more intricate cyclic dosing may be possible but is less practical.
Baseline testing in early adulthood is ideal for future “optimal” tracking.

9. Dispelling Myths: Cardiovascular & Cancer Concerns

[43:05–47:19]

Cardiovascular disease: Recent large RCT (TRAVERSE) found no increased CV risk with TRT; may even improve endothelial function.
Cancer: Testosterone does not cause prostate cancer (men) or breast cancer (women). The original concern came from flawed, tiny studies.

Notable Quote:

"Testosterone therapy does not increase the risk of cardiovascular events, period."
—Shalin Shah, [44:13]

10. Access: How to Find Providers and The Future of Testosterone for Women

[59:06–64:41]

Current US access: Kaisertrex oral testosterone, with both telehealth and brick-and-mortar providers. Approval pending in Canada, UK, other markets.
Female product: Clinical trials expected to finish by 2027; off-label, low-dose use is common for women under physician guidance.
**Telehealth is expanding options for patients unable to find supportive local providers.

Memorable Moments & Notable Quotes

Saving Marriages:

"There's so much divorce that happens in midlife, and part of it ... can be traced back to the mismatch that we're describing."
—Dr. Stephanie Estima, [16:10]
Optimizing, Not Just Normalizing:

"Normal people need to understand what's that, you know, optimal for them."
—Shalin Shah, [17:24]
On Compliance:

"What's the best therapy? It's something you can be compliant and consistent with."
—Shalin Shah, [39:00]
Testing Early:

"If you are a young person... encourage them in their 20s to have some kind of baseline..."
—Dr. Stephanie Estima, [20:17]
On Therapeutic Inertia:

"If you don't have the energy, it's going to be difficult for you to be less sedentary..."
—Shalin Shah, [27:10]

Timestamps for Important Segments

Intro & Context: [00:33–04:43]
Testosterone in Female vs. Male Health: [05:18–09:46]
Diagnostics, Labs, and “Normal” Ranges Discussion: [12:01–20:03]
Gender Disparity in Hormone Therapy Access / Relationship Impact: [14:09–16:56]
Declining Testosterone—Lifestyle & Environment: [21:12–23:04]
Raising T: Lifestyle + Medical Approaches: [25:38–28:10]
Pharmacology, Compliance, & New Oral Formulations: [33:09–40:53]
Rhythms & Dosing Paradigms by Sex: [36:15–41:14]
Monitoring, Adjustments, & Individualization: [48:03–53:06]
Guidelines, Myths, & Medical Bureaucracy: [43:23–47:19]
Access, Provider-Patient Dialogue, Telehealth: [57:17–64:18]
Closing: What’s Next for Women’s Testosterone Therapy: [62:23–64:41]
Host Reflections & Takeaways: [64:46–71:00]

Episode Takeaways

Testosterone is not just a male hormone; its systemic roles in women are profound and underrecognized, affecting everything from mitochondria to mood.
Symptoms—not just labs—should guide diagnosis and therapy in women, as lab “normals” may be misleadingly broad.
The healthcare system is behind the science: lack of FDA-approved options for women is a historical artifact and perpetuates disparities.
The best use of hormone therapy is individualized, physiological, and paired with lifestyle change—not viewed as a shortcut, but as one lever among many for thriving post-40.
A renaissance is underway: new oral testosterone products are being developed for women, with trials aiming for 2027 completion; telehealth is accelerating access where local expertise is lacking.
Educated conversations with clinicians—and sometimes seeking out functional/telehealth providers—are key for women seeking equity in aging and wellness.

Resources & More Information

Learn more about Kaisertrex and providers: kaisertrex.com
For US listeners, search the Kaisertrex website for both telehealth and in-person providers.
Clinical trial timelines for a women’s product: aiming for completion by 2027.
For up-to-date resources, refer to Dr. Stephanie’s show notes and community.

“Aging well isn’t about being perfect—it’s about being better. And that includes access to all tools available to us, no matter our sex.”
—Dr. Stephanie Estima

Podcast Summary

Episode Overview

Key Discussion Points & Insights

1. Misunderstandings About Testosterone in Women vs. Men

[00:00–07:00]

Testosterone is often pigeonholed as a “male hormone,” with focus on muscle mass and libido, but women have more testosterone than estrogen (albeit much lower than men).
There are androgen (testosterone) receptors in every major organ system: brain, heart, bones, muscles, mitochondria.
The role of testosterone in women is largely analogous to men in areas of body composition, cognition, energy, and cellular health.

Notable Quote:

"Testosterone has a role all across your body. It is not a single category."
—Shalin Shah, [05:11]

2. Clinical Signs & Symptoms of Low Testosterone in Women

[07:00–12:00]

Early indicators: fatigue, afternoon energy crashes, body composition changes (fat gain, muscle loss), reduced libido, sleep difficulties, and cognitive decline.
Many women report “doing what I did at 35, but I’m 45 and it’s not working anymore,” especially with respect to body composition and new-onset insomnia.

Notable Quote:

"I'm doing literally the same thing I was doing when I was 35, and now I'm 45 and my waist is disappearing. I'm accumulating belly fat at a rate that I'm unhappy with... and I can't sleep."
—Dr. Stephanie Estima, [09:16]

3. Diagnostics & Lab Interpretation: Why Test and What to Look For?

[12:00–20:00]

Regular blood panels rarely include testosterone for women, despite its value as a biomarker for inflammation, metabolism, and cardiovascular health.
Important labs: total testosterone, free testosterone, and SHBG (sex hormone binding globulin)—especially since women often have high SHBG from historic birth control use.
There is a need to focus on "optimal" levels for the individual, not just the lab “normal” ranges, which are often based on population averages that have trended downward over decades.

Notable Quote:

"Normal has been sort of decimated if you think about it... what’s optimal for them? That’s why testing is important earlier and earlier."
—Shalin Shah, [17:24]

4. Testosterone Access & The Gender Healthcare Gap

[13:40–18:00]

As of the episode, only Australia and the UK have approved testosterone products for women; in North America, it’s off-label, with the only official indication being “hyposexual desire disorder.”
Major ramifications for couples: men have broad access to TRT (Testosterone Replacement Therapy), while their partners do not, often leading to intimacy and relational mismatches in midlife.

Notable Quote:

"You can’t just treat the penis and ignore the vagina. We want to be thinking about both the male and the female."
—Dr. Stephanie Estima, [64:02]

5. Declining Testosterone Trends & Underlying Causes

[20:30–25:00]

Testosterone levels have been declining predictably, attributed to sedentary lifestyles, environmental toxins (microplastics, endocrine disruptors in lotions, food and water), and altered sleep/screen patterns.
This is not easily reversed by “willpower” alone; environmental factors play an increasing role.

Notable Quote:

"Sleep and screens have become so embedded in our culture... our bodies don’t know how to handle that. I think that is massively affecting our hormone production."
—Shalin Shah, [22:06]

6. Lifestyle vs. Pharmacology: Building a Virtuous Cycle

[25:38–28:20]

Modest lifestyle changes can mildly boost testosterone, but may not restore optimal levels—especially if low energy is the barrier.
Medication can help “break inertia,” making lifestyle changes sustainable and reinforcing, especially when combined with exercise and protein-rich diets.

Notable Quote:

"You need to get into a virtuous cycle... use the tools in the toolbox to get there."
—Shalin Shah, [27:10]

7. Risks, Side Effects, & Dosing—Especially for Women

[30:29–41:14]

Virilization Risks (deepened voice, body/facial hair, jaw/mandible prominence, clitoral enlargement) are largely dose-related.
- Most cases arise from super-physiologic dosing, especially with long-acting pellets.
- Physiologic dosing (approx. 1/10th male levels) shows little evidence for significant risks.
Delivery formats: injectables (in men), gels (with transference risks), pellets (super-physiologic & hard to titrate), and newer oral forms like Kaisertrex (designed for lymphatic absorption, not hepatotoxic).
Monitoring: symptom relief trumps isolated lab values; monitor for physical/behavioral signs of overdose, plus specific labs (see below).

Notable Quote:

"At physiological doses, you are not going to see anywhere close to the side effect profiles that you do regarding pellets."
—Shalin Shah, [33:01]

8. Dosing, Monitoring, and Formulation Innovations

[41:15–53:06]

Dosing in clinical practice: men take two oral doses (300–400mg BID); developing safe options for women (aiming for 20–60mg daily in future clinical trials).
Monitoring for men: hematocrit (red cell count), LH/FSH, PSA (prostate health).
Monitoring for women: symptom improvement, watch for virilization; labs should inform but not dictate therapy.
Daily oral dosing is favored for compliance—more intricate cyclic dosing may be possible but is less practical.
Baseline testing in early adulthood is ideal for future “optimal” tracking.

9. Dispelling Myths: Cardiovascular & Cancer Concerns

[43:05–47:19]

Cardiovascular disease: Recent large RCT (TRAVERSE) found no increased CV risk with TRT; may even improve endothelial function.
Cancer: Testosterone does not cause prostate cancer (men) or breast cancer (women). The original concern came from flawed, tiny studies.

Notable Quote:

"Testosterone therapy does not increase the risk of cardiovascular events, period."
—Shalin Shah, [44:13]

10. Access: How to Find Providers and The Future of Testosterone for Women

[59:06–64:41]

Current US access: Kaisertrex oral testosterone, with both telehealth and brick-and-mortar providers. Approval pending in Canada, UK, other markets.
Female product: Clinical trials expected to finish by 2027; off-label, low-dose use is common for women under physician guidance.
**Telehealth is expanding options for patients unable to find supportive local providers.

Memorable Moments & Notable Quotes

Saving Marriages:

"There's so much divorce that happens in midlife, and part of it ... can be traced back to the mismatch that we're describing."
—Dr. Stephanie Estima, [16:10]
Optimizing, Not Just Normalizing:

"Normal people need to understand what's that, you know, optimal for them."
—Shalin Shah, [17:24]
On Compliance:

"What's the best therapy? It's something you can be compliant and consistent with."
—Shalin Shah, [39:00]
Testing Early:

"If you are a young person... encourage them in their 20s to have some kind of baseline..."
—Dr. Stephanie Estima, [20:17]
On Therapeutic Inertia:

"If you don't have the energy, it's going to be difficult for you to be less sedentary..."
—Shalin Shah, [27:10]

Timestamps for Important Segments

Intro & Context: [00:33–04:43]
Testosterone in Female vs. Male Health: [05:18–09:46]
Diagnostics, Labs, and “Normal” Ranges Discussion: [12:01–20:03]
Gender Disparity in Hormone Therapy Access / Relationship Impact: [14:09–16:56]
Declining Testosterone—Lifestyle & Environment: [21:12–23:04]
Raising T: Lifestyle + Medical Approaches: [25:38–28:10]
Pharmacology, Compliance, & New Oral Formulations: [33:09–40:53]
Rhythms & Dosing Paradigms by Sex: [36:15–41:14]
Monitoring, Adjustments, & Individualization: [48:03–53:06]
Guidelines, Myths, & Medical Bureaucracy: [43:23–47:19]
Access, Provider-Patient Dialogue, Telehealth: [57:17–64:18]
Closing: What’s Next for Women’s Testosterone Therapy: [62:23–64:41]
Host Reflections & Takeaways: [64:46–71:00]

Episode Takeaways

Testosterone is not just a male hormone; its systemic roles in women are profound and underrecognized, affecting everything from mitochondria to mood.
Symptoms—not just labs—should guide diagnosis and therapy in women, as lab “normals” may be misleadingly broad.
The healthcare system is behind the science: lack of FDA-approved options for women is a historical artifact and perpetuates disparities.
The best use of hormone therapy is individualized, physiological, and paired with lifestyle change—not viewed as a shortcut, but as one lever among many for thriving post-40.
A renaissance is underway: new oral testosterone products are being developed for women, with trials aiming for 2027 completion; telehealth is accelerating access where local expertise is lacking.
Educated conversations with clinicians—and sometimes seeking out functional/telehealth providers—are key for women seeking equity in aging and wellness.

Resources & More Information

Learn more about Kaisertrex and providers: kaisertrex.com
For US listeners, search the Kaisertrex website for both telehealth and in-person providers.
Clinical trial timelines for a women’s product: aiming for completion by 2027.
For up-to-date resources, refer to Dr. Stephanie’s show notes and community.

“Aging well isn’t about being perfect—it’s about being better. And that includes access to all tools available to us, no matter our sex.”
—Dr. Stephanie Estima