The Tamsen Show

Episode: Testosterone 101: Everything You Need to Know in 20 Minutes

Host: Tamsen Fadal
Date: April 13, 2026

Episode Overview

In this episode of The Tamsen Show, host Tamsen Fadal dives deep into the often-overlooked topic of testosterone and its critical role in women's health, particularly during perimenopause and menopause. Sharing her personal experience, she offers a real-talk, practical roadmap for women struggling with unexplained loss of energy, libido, motivation, and joy. Tamsen blends lived experience with insights from medical experts and provides actionable advice for asking the right questions and advocating for better care around hormone health.

Key Discussion Points & Insights

1. Tamsen’s Personal Story: Libido and Motivation Loss

• Tamsen kicks off with a candid story about her unexpected loss of libido and zest for life following a period of feeling invigorated and happy in a new relationship.
• After checking her bloodwork, she discovered her testosterone was “essentially zero”—a result she didn’t even know was possible for women.
• “I didn’t even know I was supposed to have testosterone.” (04:32)

2. Testosterone Myths & Scientific Background

• Testosterone is not “just a male hormone”—in fact, women have more testosterone than estrogen if measured in the same units.
• “It is technically our dominant sex hormone, not estrogen.” (07:12)
• Your body can’t make estrogen without first making testosterone; these hormones are closely linked.

3. The Medical System’s Blind Spot

• Women have been drastically understudied in medicine—especially regarding menopause and hormone health.
• Clinical trials involving women weren’t even required until the mid-1990s.
• “If you’re confused and you ask that question over and over, ‘Why didn’t anyone tell us this?’ That’s why.” (05:50)

4. Types of Testosterone Therapy & Tamsen’s Experience

• Pellets:
  • Tamsen describes trying testosterone pellets, which gave a short burst of improvement followed by a crash.
  • “Those two months were amazing… and then I crashed hard.” (06:54)
  • Pellets deliver a heavy dose upfront, can’t be easily adjusted, and are generally not recommended by most specialists.
• Transdermal Gels and Creams:
  • Using 1/10th of a male dose of testosterone gel is common and effective.
  • “You take about the size of a pea… behind your calf or on your inner arm… rub it in and let it dry.” (18:01)
• Compounded Creams:
  • Alternative options from compounding pharmacies are available and affordable.
• Medical Guidance:
  • Most doctors who specialize in menopause recommend establishing stable estrogen/progesterone therapy before adding testosterone.

5. What Testosterone Actually Does for Women

• Energy & Motivation:
  • The main change Tamsen noticed on appropriate therapy was improved energy and drive.
  • “It was amazing getting through things without running on empty—that was such a big deal for me.” (11:27)
• Muscle Maintenance:
  • Testosterone is key for building and maintaining muscle; loss can lead to muscle breakdown and plateaued results at the gym.
• Mood and Desire:
  • It impacts desire—not just sexual but general motivation and joy in life.
  • Low testosterone can be mistaken for depression and often leads to inappropriate antidepressant prescriptions.
• Research and Recommendations:
  • Medical organizations worldwide agree testosterone improves libido after menopause and acknowledge evidence for energy, muscle, and cognitive benefits, but withholds official endorsement pending more research.

6. The Testing and Diagnosis Process

• Testing Challenges:
  • Standard blood tests often can't detect the lower testosterone levels typical for women.
  • “Be really specific about this because a standard version could miss it.” (17:58)
• Symptoms vs. Numbers:
  • Diagnosis should focus on symptoms, not just lab values.
  • “There’s no magic number that tells you whether you need it or not. This is about symptoms.” (18:13)
• How to Talk to Your Doctor:
  • Always request a testosterone test designed for women.
  • If your provider is unfamiliar or dismissive, seek out a specialist.

7. Barriers and Advocacy

• FDA Approval:
  • No FDA-approved testosterone therapy for women in the US; all prescriptions are off-label.
  • Australia approved a women’s formula in 2020.
  • Male testosterone therapies are fast-tracked, highlighting a double standard in medical research and approval processes.

8. Practical Application: How Tamsen Uses Testosterone

• Gel Application Demo:
  • “This is what the tube looks like… don’t confuse it with your travel-size toothpaste!” (18:22)
  • Apply a pea-sized amount behind your calf or on your inner arm; alternate sites, let it dry, and continue with your day.
• Safety and Side Effects:
  • Concerns about unwanted effects (voice change, increased hair, excess muscle) are rare and dose-dependent.
  • Adjustments should be made promptly if side effects appear, with routine blood work for safety.

Notable Quotes & Memorable Moments

• On the psychological impact:
  • “You can have a perfectly good life on paper and then just kind of feel nothing…” (12:07)
• On medical bias:
  • “We discovered estrogen in ovaries and testosterone in rooster testicles. And we never got more nuanced than that.” (07:29, referencing Dr. Kelly Casperson)
• On acting as your own advocate:
  • “Ask your doctor for a testosterone test that measures at women’s levels… If your doctor doesn’t know how to have that conversation or doesn’t want to have it, you need to find one who does.” (21:45)

Actionable Takeaways

• Ask for a testosterone test designed for women if you’re experiencing unexplained drop in motivation, energy, or libido.
• Focus treatment and diagnosis on how you feel, not just on numbers.
• Testosterone therapy for women is off-label in the US—but evidence and global practice support its benefits for postmenopausal libido and potentially for energy, muscle, and cognitive function.
• Routinely monitor levels and symptoms; hormonal care is not “one and done.”
• Thomasen offers links and resources—including a provider search and her menopause-focused book—in the episode show notes.

Key Timestamps

• [03:17] Start of main content: Tamsen’s personal libido story
• [05:50] Medical research bias against women explained
• [06:26] Experience with estrogen & progesterone therapy vs. need for testosterone
• [06:54] Trying testosterone pellets—short burst, then crash
• [07:12] Key science: Women have more testosterone than estrogen
• [11:12] Non-reproductive effects: Energy, mood, and pleasure
• [13:25] Medical acknowledgment of testosterone for female libido
• [14:00] Why most doctors don’t bring up testosterone and FDA context
• [17:58] How to ask for proper bloodwork
• [18:01] Application demo and therapy options
• [21:45] Advocacy: What to do if your doctor resists

Final Thoughts from Tamsen

• “It took me a long time and some wrong turns to find my way back… You don’t have to do any of that.” (21:20)
• Reach out with your stories or questions, and stay tuned for more chapters broken down in future episodes.

Resources

• Dr. Kelly Casperson’s previous episode (linked in show notes)
• Tamsen Fadal’s book Out of Menopause
• Provider search and other tools (see show notes)

For more information and ongoing conversation, follow @thetamsenshow on social media.