Testosterone 101: Everything You Need to Know in 20 Minutes

Summary

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The Tamsen Show

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

Host: Tamsen Fadal
Date: April 13, 2026

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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.

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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.

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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)

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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.

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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

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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.

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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)

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

Transcript

[Tamsen]

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Okay, before we get into today's episode, I have to tell you guys something.

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I did not see that coming when I started this just over a year ago. I built the show for you. That's not something I say lightly. I started it because I was going through my own stuff, and I kept

thinking, where is a show for women like me? Why didn't anyone tell us this? Women who are in the middle of it all and just want real information from real people. I have a team of badass women

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The link is in the show notes.

It will take two minutes, and it means everything. Thank you, thank you, thank you. Let's win this thing together. And now let's get into today's episode. Welcome back to the Tamsen Show. Happy Monday. I am so happy you're back here with us. So I want to start by telling you a sex story. Yes. We are really getting into it today. Christmas 2018. Ira told me all. All he wanted was me wrapped in a bow for Christmas. So on Christmas morning, I stood at the door in nothing but a big red bow. It was like this huge bows. It was just before we got married. And it was this beautiful second chapter of my life. And I wasn't sure I was even ever going to go into a second chapter of my life like this in a relationship, but I was in it completely. The next Christmas, he asked for the same thing, and I looked at him like he had lost his freaking mind. And in one year, I'd become somebody who only wanted to go to bed and watch Netflix. And I genuinely did not understand what had happened to me. It wasn't just the libido that was part of it. Like, my energy had been zapped. My drive was gone. I was going through the motions of my life but not really feeling any of it. My drive was totally gone. I was going through the motions of my life but not feeling any of it. After years, I tried, like, all sorts of different things. Finally, I had a blood test that came back showing I had essentially no testosterone in my body. Like, zero, None. None. And I didn't even know what that meant because I didn't even know I was supposed to have testosterone. But this is when I started going a little bit deeper and trying to understand what was happening. Testosterone's not just for the sex drive, but for so many things. And that clicked everything into place. So today we're talking about testosterone. Sorry if my. My sex story wasn't a very hot one, but that's my story. But this is part of our how to Menopause series, where I take my book and we're going to go even deeper on this podcast. I'm so glad you're here. I'm so glad you found us. The book is out of menopause. It's actually on sale now. It's linked in the show notes, but we're also going through each chapter right here on the podcast so you can understand why I wrote it and maybe what you can get from it. I'm doing this series because when I was going through it, nobody sat me down and explained it to me. I didn't have a big sister. I didn't have a mom to help me through it. And so that's what I want to be here for you. I'm not a doctor. I'm a journalist who has lived with this and has interviewed hundreds of top doctors all around the world for you. So this makes sense. Everything I share comes from them. So I want you to take any of this to your own doctor because your body and your history are yours. And know this going in. Women have been dramatically understudied in medicine, especially around menopause. We weren't even mandated to be part of research until the mid-90s. So when you hear the research is still building, it's very, very true. And it's also because the system never prioritize studying us. So keep that in mind. If you're confused and you ask that question over and over, why didn't anyone tell us this? That's why. So I want to tell you my experience with testosterone because I had been on estrogen and progesterone for about two years, and they were helping, genuinely helping.

My sleep was better.

My mood had stabilized. Hot flashes had calmed down a bit,

but my libido was completely gone.

Like, not low, just. It wasn't even anything I thought about anymore. And there was, like, kind of a flatness to everything. Like somebody had just turned my volume down a little bit. I was showing up for my life. I was going to work every day, but I wasn't really feeling it. My doctor brought up testosterone, and I just was like, not sure. I said Like I'm going on now, I have to do estrogen, progesterone, vaginal estrogen and testosterone seemed like a lot. I found a different doctor though, because I was like, I need a second opinion. And the one that I went to was very confident that what I needed were pellets. And I had no idea what pellets were at the time. The short version, I felt incredible. For two months they like did a little shot in me of these little pellets that went in my butt. Those two months were amazing. I was like attacking higher. I was all over em, like I. I was thinking of sex again. I felt totally normal. And then I crashed hard. Like just, I had in two months, maybe three months, no more interest. And then I was back to how I was feeling before. And here was the mistake that I made. I did not have the right information. I did not know there were different types of testosterone. I did not know what was going on. There were a lot of women out there that do pellets for me that did not work because that was like all at once. And then I would have to go back there again to get it all at once again. And here's what I learned. Our whole lives we have been told testosterone is a male hormone. It's not just a male hormone. That framing leaves so much out, it's basically wrong. Women actually have more testosterone in their bodies then we have estrogen. That blew my mind. I had to make sure that that information was right several times when I was writing this book. If you measured both hormones in the same unit, testosterone would be the higher number. I'm not going to get all technical with you about it because that's not my field. But it is technically our dominant sex hormone, not estrogen. And here's something most people don't know. Your body can't make estrogen without first making testosterone. It's like estrogen is a finished product and testosterone is the ingredient. It starts from. They're connected. Dr. Kelly Casperson, a dear friend of mine, a urologist and a women's sexual health expert, has been on this show several times and has a great way of putting it. We discovered estrogen in ovaries and testosterone in rooster testicles. And we have never gotten more nuanced than that. I'm going to actually link that episode down below too, so you can listen to the whole thing. We just put estrogen in the women column and testosterone in the men column, and then we called it a day. And that one decision has shaped how women have been treated or not treated ever since. Okay, you guys know I talk about this a lot.

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[Tamsen]

Here's what you should know. Testosterone also works in your brain, not just your reproductive system. So when it drops, the effects are everywhere. Down below where you might expect. When I finally got on testosterone that actually worked, the first thing I noticed was my energy. It was amazing getting through things without running on empty that was such a big deal for me. Testosterone plays a real role, though, in that drive and motivation that a lot of us start losing. And then we say, like, oh, I'm so stressed out. Oh, I'm getting older. Sometimes it's just the hormones. The second thing I noticed was at the gym. I'd been working out consistently for years, and somewhere in my mid-40s, the results that I was getting without any hormones or anything had just stopped. Same workouts, totally different body. Testosterone is a big part of your ability to build and maintain muscle. And when it drops, that process gets a lot harder. Testosterone is connected to the part of your brain that makes you want things, not just the sex, but, like, things in general. So when it drops, that whole system gets quieter. You stop looking forward to stuff. You stop feeling motivated. You can have a perfectly good life on paper and then just kind of feel nothing. The truth is, is all the. That I've read is really more about that muscle and low libido. But this feeling in me totally. I totally felt a difference. That Christmas of 2019, I was telling you about the year after the Red Bow story. I felt nothing. I wanted nothing. And I'm convinced it was partly the hormones. Around 60% of women going through menopause say they do not feel like themselves anymore. That is documented. That is in data and in research. And it can look a lot like depression from the outside, which is why so many of us end up on antidepressants. Like, we're thrown antidepressants. But what we actually needed was a hormone conversation. Not to say you don't need antidepressants, but you've got to have that hormone conversation, too. Now let's talk about libido, specifically. The major medical organizations that focus on menopause have looked at all the research and said, yes, testosterone helps with sexual desire in women after menopause. The evidence is strong enough that there's actual agreement on this across the globe, which is good news, which Dr. Kelly Casperson told me is rare. She said, we don't agree globally on just about anything. So on that specific thing, it's solid. Everything else that we're talking about, the energy I mentioned, the muscle, mood, brain fog, bone health, the research, it looks good, and the doctors who work in this space say they see it every day. But right now, major organizations haven't officially put their stamp on those benefits yet. And given how long women have been understudied, you can draw your own conclusions as to why that might be. You might be saying to me, okay, Tamsen, but my doctor never brought that up. My doctor brought up estrogen, progesterone, maybe vaginal estrogen, if you've had painful sex, or UTIs.

I had been on hormone therapy for

two years before testosterone ever came up. And it turns out that's really common. When doctors say you can't take hormones, they almost always mean estrogen. Testosterone is a completely separate conversation. Here's something I need you to know so you're not surprised by this. There's no FDA approved testosterone products specifically for women in the U.S. none at all. In Australia, there's been one approved for Women specifically since 2020. So in the US when your doctor prescribes it, they're doing it off label. That's legal and it happens all the time. But you should know that going in a testosterone patch for women was actually studied. The data showed it worked. The FDA still said no. And meanwhile, testosterone for men got approved within six months, six months of safety data. And the doctors in this space know exactly what that reflects. So we will keep working at it. If any of what I've described sounds like you, here's where to start. You need to get the right blood test first. And this part matters. Women have about 10% of the testosterone that men have, which means a lot of the standard blood tests are not built to pick up that level. You can go in, get tested, get told your levels are, quote, normal. And that test may have literally not been measuring in the right range. I know this can be really frustrating, but when you get a doctor who understands this and can talk you through this and does things specifically for you, you're going to feel so much better about it. Are you over 35 and confused about

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See Terms for details. You need to ask your doctor specifically for a testosterone test designed to measure women's levels. Be really specific about this because a standard version could miss it. Not always, but could. There's no magic number that tells you

whether you need it or not.

This is about symptoms, and what matters is whether something has shifted in the way that you're feeling right now versus how you've always been. The test, though, gives you a useful starting point, which is what is so important. But the conversation with your doctor should be about how you feel, not just about a number. My test came back at zero and that was finally the answer I'd been looking for. So I brought a prop to explain this. If you are listening, you can also see this episode on YouTube. But I kind of wanted to show you what this was because anytime I show you this on social media, I get a lot of questions about it. And so I want it to make sense and I'll also describe it for anybody who is listening. Since there's no FDA approved product for women in the US your doctor has a few off label options. So let me walk you through some of them. The most common is taking a male testosterone gel and using 110 of the male dose. It's a small amount, it's absorbed through the skin, relatively affordable. And this is what I use. So this is what the tube looks like. Do not confuse it with your, you know, travel size toothpaste please, because I've done that before without my readers on. But it's just a little bit of tube and you're just going to pop it open here and you're going to take about the size of a pea. If you're listening to this and then if you're looking at this, this is what it looks like. And then I put this behind my calf every morning. Alternating legs. You can also do your inner arm if you want. It would basically be a place that you wouldn't be growing hair or want to grow hair, not that you're going to grow hair. So don't panic. But that's what you will be doing. You can alternate back and forth and, and the difference in how I feel to where I was is so real. So again, pea size. Take it and I'll do it on my arm just because it'll be easier. And you're just going to rub it in your arm. It's a gel, let it dry and then go on with your day. Like don't throw your shirt on immediately. And then you're going to alternate that back and forth every other day. The fears women have about testosterone, myself included, I was like, I don't want my voice to change. I don't want more muscle. Well, I actually do want muscle, but, you know, not too much muscle. I don't want unwanted hair. Those side effects are real, but they happen when your levels get too high and at the right dose. Those things are rare according to doctors. If you're experiencing any of those, that's a signal. You've got to talk to your doctor and adjust because dose is everything. There's also an option of a compounded cream that I've also used from a compounding pharmacy. It's about $60 for a 90 day supply, same application. And then there are the pellets. I'm going to keep this one short. But I went to a doctor in New York City, she was like, cost a lot of money. Inserted a pellet without much of an exam. I felt incredible for those two months and then I didn't want anything to do with Aira or sex after that. The pellets give a really high dose up front and then the level falls off. And because they're not removable, you can't adjust if something is off. You just have to wait it out. So most doctors who specialize do not recommend them. Dr. Kelly Casperson said you would have to earn your pellet meaning knowing that you can tolerate those hormones in lower doses before ever going on that higher dose, that non removable option. So for me, I'm not doing that. I skip that. That's not what I want to do. So this is what I do every day. One more thing. Most doctors recommend getting stable on estrogen and progesterone first and then adding on testosterone separately. If you decide that's what you want to do and then once you're on it, you just can't, like, okay, I'm on testosterone. That's just the way it's going to be. You have to get your blood work done regularly to make sure your levels are where they should be. Quick, easy blood test. It's to keep you safe. And it means that your doctors have that information so they can adjust your dose if something's off. So it's not a one and done conversation. In fact, nothing about hormones is a one and done conversation. You have to continue getting checked to make sure you know what's right for you. And a lot of that's also going to be based on your symptoms. So I think a lot about that version of me From Christmas of 2018, the red bow. It took me a long time and some wrong turns to find my way back to that person. I saw a lot of the doctors that were not right for me. I went quiet for longer than I should have. I was really frustrated. I felt like crap. You don't have to do any of that. Ask your doctor for a testosterone test that measures at women's levels. Ask about testosterone specifically, not just, just hormones in general. Ask about testosterone if you are interested in that. 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. I'm also going to link a provider search that's in the show notes as well, so that can help you out. If you have more questions about this, send them to me. DM me, find me on social. Come to one of my live events. I want to hear what you're going through. We try to have these conversations as much as possible so you get all the most current new information, because this is the exact kind of conversation I built this show for, and I'm not done having it. We're going to keep breaking down all of it here on the Tamsen show, chapter by chapter. If this episode or the book helped you, please let me know, because that's what this is all about. And we'll talk soon.

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