In this conversation, Dr. Lucy McBride sits down with New York Times journalist Susan Dominus to discuss her recent article “‘I’m on Fire’: Testosterone Is Giving Women Back Their Sex Drive—and Then Some” on testosterone supplementation in women. With testosterone use surging among midlife women, they explore the gap between recommendations from the medical establishment and the wellness industry, examining why women are turning to testosterone for sexual health, energy, and vitality—and what the limited evidence really tells us about risks and benefits.

Key Concepts

Women Actually Make Testosterone (And More Than Estrogen)

* The common misconception is that testosterone is purely a male hormone

* Most women don’t realize they naturally produce testosterone—and in higher quantities than estrogen

* Women’s bodies produce testosterone from three sources: 25% from ovaries, 25% from adrenal glands, and 50% from peripheral tissues

* Testosterone plays a role in libido, energy, metabolic health, and muscle tone throughout women’s lives, however the role of supplemental testosterone for issues other than low sexual desire remains unclear

The Decline in Testosterone Levels Starts Earlier Than You Think

* Testosterone levels in women begin declining around age 30, dropping to approximately 50% by age 60

* This is a gradual, age-related process, not a sudden menopausal crash

* Menopause doesn’t cause testosterone to plummet; it coincides with the end of a depletion that’s been happening all along

* Women in their mid-40s can feel the effects of low testosterone long before they’re perimenopausal

* Understanding this timeline challenges the narrative that testosterone issues are specifically about menopause

The Testosterone Surge: From UK Trend to US Phenomenon

* Just a few years ago, testosterone therapy for women was primarily a UK conversation; the US medical establishment was dismissive

* In the past six to eight months, testosterone use has exploded across the US

* Women are discussing it on streaming feeds, social networks, and with their friends, indicating a cultural moment

* The treatment has moved from relative obscurity to mainstream conversation at remarkable speed, and the wellness industry is seizing the moment

The Evidence Gap: What We Know and What We Don’t

* The medical establishment has been cautious about testosterone in women due to limited research and because supplemental testosterone is not currently approved by the FDA

* Existing studies support the use of supplemental testosterone in women only for libido and sexual function (i.e., hypoactive sexual desire disorder)

* Anecdotal evidence suggest that testosterone can help women with energy, muscle mass, metabolic health, cognitive “clarity,” and overall wellbeing; however more research is needed to understand where these are true effects versus placebo

* The potential downsides are real (especially if given at high doses): voice changes, irritability, hair loss, hyper-arousal

* Long-term effects remain unknown, particularly regarding cardiovascular health, metabolic changes, and other systemic impacts

* Doctors face the challenge of counseling patients when definitive evidence is lacking, creating tension between patient demand and evidence-based medicine

* This uncertainty leaves both physicians and patients navigating uncharted territory

Navigating the Gray Zone Between Medicine and Wellness

* Women find themselves caught between traditional medical systems that historically have not made space to discuss sexual health and wellness practitioners who proselytize products without adequate evidence

* This dynamic mirrors other areas of women’s health where quality-of-life concerns have been historically undervalued compared to longevity metrics

* The conversation reflects a broader cultural shift toward prioritizing women’s subjective experiences as legitimate healthcare goals

* There’s a growing concern about polypharmacy: using multiple pharmaceutical interventions to address interconnected symptoms, then needing additional treatments for side effects

* The question remains whether people are reaching for pharmaceutical solutions too quickly instead of evidence-based lifestyle interventions like exercise, sleep, and stress management

* Both Dr. McBride and Ms. Dominus stress the importance of seeking care from practitioners who are well versed in medical evidence—for example those who are certified by the Menopause Society—and addressing testosterone levels in context, ruling out other causes for issues like fatigue and brain fog before jumping to testosterone as a quick fix, while acknowledging the lack of access to evidence-based care to address the nuances of patients’ health

Upshot

The conversation about supplemental testosterone represents a pivotal moment in women’s health—where patient demand for quality-of-life improvements collides with limited evidence. This moment underscores the need for nuanced, individualized discussions between patients and providers that honor women’s subjective experiences while acknowledging medical uncertainties, a challenge that extends far beyond testosterone to many aspects of midlife women’s healthcare.

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