I think that is pretty typical. The doses are so small for women that you can get away with using gels, creams, pellets, injection, patches, etc
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This is an absolutely brilliant podcast episode IMO. Attia asking some nice awkward questions, but her answers are great, and I think she makes a lot of extremely valid points. Very valuable listening for those in long-term relationships (i.e. after the bang-each-others-brains-out honeymoon phase), those struggling to balance work, home life and personal lives, and especially women in the perimenopause age.
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Just stumbled upon this related podcast, perhaps of interest to people, on this topic…
Testosterone for Women: Myths, Truths, and Real Benefits | Rachel Rubin, M.D.
AI Summary
The Role of Testosterone in Women’s Health
- Testosterone is often overlooked in discussions about women’s health, despite its crucial role in sexual health and overall well-being.
- The decline of testosterone levels begins in a woman’s 30s, and this decline is age-related rather than solely linked to menopause.
- Women produce both testosterone and estrogen, and there is a common misconception that testosterone is exclusively a male hormone.
- When comparing hormone levels, women have significantly higher amounts of testosterone than estradiol, which is often surprising to many.
- Testosterone plays a vital role in libido and sexual function, with levels peaking around ovulation, which enhances sexual desire.
- The lack of awareness among healthcare professionals, especially OBGYNs, about the importance of testosterone in women’s health contributes to inadequate treatment options for women experiencing low libido.
- Women are frequently told that regular menstrual cycles indicate normal hormone levels, which can lead to misdiagnosis of hormone-related issues.
Impact of Birth Control on Testosterone Levels
- Birth control pills are a form of hormone therapy that can significantly affect a woman’s hormonal balance by suppressing natural hormone production.
- While birth control provides synthetic estrogen and progesterone, it does not replenish testosterone levels, which can lead to long-term hormonal imbalances.
- Women who have never taken birth control may experience a more noticeable decline in testosterone as they age, leading to various health issues.
- The decline in testosterone can result in increased risks of urinary tract infections, pelvic pain, and potentially heightened levels of anxiety and depression.
Global Consensus and Attitudes Toward Testosterone Therapy
- There is a growing global consensus on the efficacy of testosterone therapy for treating low libido in women, particularly in postmenopausal women.
- Despite the evidence supporting testosterone therapy, societal attitudes often create stigma and fear surrounding its use.
- Currently, there are limited FDA-approved testosterone products for women, which complicates access to treatment.
- Many women hesitate to start testosterone therapy due to fears of side effects, despite the fact that clinical experience often shows manageable risks.
- Common side effects of testosterone therapy may include acne and increased hair growth, but these are generally mild and manageable.
- The conversation around testosterone therapy is evolving, with public figures discussing their positive experiences, which may help reduce stigma.
The Importance of Balanced Hormone Therapy
- Integrating testosterone with estrogen and progesterone can lead to significant improvements in women’s health and quality of life.
- Patients often report feeling revitalized and more like themselves after receiving testosterone therapy, highlighting its importance in hormone replacement therapy.
- The combination of these hormones can address a wide range of symptoms, making it a vital aspect of comprehensive hormone therapy for women.
- Healthcare providers are encouraged to consider testosterone as a necessary component of hormone therapy to enhance women’s health outcomes.
Conclusion and Call to Action
- The discussion around women’s hormonal health, particularly testosterone, needs to be expanded and normalized within medical practice and society.
- Women should be empowered to seek information and treatment options for hormonal imbalances, including testosterone therapy.
- As awareness grows, it is crucial for healthcare providers to stay informed and offer comprehensive care that includes all relevant hormones.
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A Pill for Women’s Libido Meets a Cultural Moment
Ms. Eckert is the co-founder and chief executive of Sprout Pharmaceuticals, the maker of the women’s libido drug Addyi, which treats the condition known as hypoactive sexual desire disorder, or H.S.D.D., in premenopausal women. Sometimes erroneously referred to as “female Viagra” — Addyi targets neurotransmitters, not blood flow — its proper name is flibanserin, and in 2015, Ms. Eckert won a knock-down, drag-out battle to get it approved by the Food and Drug Administration.
Naturally, she has embraced the name “little pink pill.”
In Ms. Eckert’s fight with the government agency, critics accused Sprout of trying to medicalize the natural ebbs and flows of women’s sexual desire. They also saw Ms. Eckert’s colorful style as a sleight of hand to distract from the scientific debates about her product. When, one day after winning F.D.A. approval, Ms. Eckert sold Sprout for $1 billion to a company that soon hiked the price and effectively shelved Addyi, it was all the more proof for her detractors that she didn’t have patients’ best interest at heart.
But a decade later, after winning back her company in a 2018 legal battle, Ms. Eckert’s critics have quieted. Some have even been converted.
Thanks to the loosening of F.D.A. guidelines surrounding Addyi and a wider, ongoing reckoning with women’s health care, there are now more than 30,000 doctors prescribing Addyi and more than half a million prescriptions on the market. As women binge-read copies of Miranda July’s best seller about a perimenopausal mother’s sexual awakening, or devour stories about Gen X women having the best sex ever, women of all ages are prioritizing their own sex lives. And Ms. Eckert’s drug — and other treatments for women struggling with their libido — are reaping the benefits.
“We played the long game,” Ms. Eckert said. “Culture caught up.”
Full story: A Pill for Women’s Libido Meets a Cultural Moment (NYT)
Prompt to CGPT5:
What is the clinical evidence on the effectiveness (and effect size) of Addyi from Sprout Pharmaceuticals?
CGPT5.1 Response:
Across the best data we have, Addyi (flibanserin) produces small average improvements in sexual desire and satisfying sexual events, with a non-trivial adverse-event burden. The effect is real but modest; whether it’s “worth it” is very patient- and context-dependent.
Full response:
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The Economist gets into the story…
Do women need testosterone supplements?
As concerns about the use of hrt have fallen away, however, women have started reconsidering testosterone, says Caroline Messer, a doctor at Fifth Avenue Endocrinology, a clinic in New York. Since 2019 the hormone has been offered for low libido, now called hypoactive sexual desire disorder (hsdd). In America, between 2013 and 2023, prescriptions increased by almost 50%; in Britain they rose ten-fold between 2015 and 2022.
Testosterone peaks in a woman’s 20s; by menopause, blood levels are about a quarter of the peak. The goal of therapy for hsdd is to get women roughly to their pre-menopausal levels, using products applied to the skin. Dr Messer avoids injectable pellets—she says that women can get too much testosterone this way. Too much hormone comes with side-effects including acne, excess body hair, mood swings or a permanent deepening of a woman’s voice.
Testosterone may also be useful during menopause for reasons other than sexual dysfunction. Women in menopause frequently complain of “brain fog”—with symptoms including fatigue, difficulty concentrating, poor memory, reduced verbal fluency and reduced ability to multitask. Enone McKenzie, a consultant psychiatrist specialising in women’s hormonal mental health at The Soke, a clinic in London, says peri-menopausal women who have been prescribed testosterone for low libido report improvements in mood and say they remember things better and have less decision fatigue. A few studies also suggest improvements in mood and cognition in post-menopausal women treated with testosterone.
Read the full story: Do women need testosterone supplements?
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Addyi (flibanserin) is also used off-label by many men who have the same problem with Neurotransmitters. Serotonin, in particular, can get elevated permanently by long-term SSRI (ab)use and result in a state where Orgasm is very hard to achieve. For some guys, the long time they can last with this condition, can seem like a benefit, but the novelty soon wears off. Many men with this condition report that Addyi seems to help.
Addyi CANNOT be taken with either SSRI (at any time) or alcohol (without 2 hours of the daily pill), which can seem a problem if you are suffering from depression. Fortunately, Addyi was originally developed as an antidepressant (by elevating Dopamine and Norepinephrine), but it also lowers Serotonin levels, which is believed to be responsible for the sexual benefits. Costs around $300/month in USA, but Indiamart merchants have it for $30/month.
Another newer prescription drug, Vyleesi (bremelanotide), is an injectable that is taken 45 minutes before sex (up to 8 times per month). It is an melanocortin receptor agonist, which raises Dopamine levels, amongst other effects in the brain, but the exact mechanism of helping with sexual arousal is not known. Unlike Addyi, it does NOT significantly increase the number of Orgasms in women, but it improves sexual arousal. Unlike Addyi it can be combined with alcohol.
Just as men are taking Addyi off-label and reporting benefits, many women report benefits from taking Viagra. Unlike in men (where physical symptoms of NO deficiency are very “visible”) it may not be obvious to a women if they need a NO-donor (like Viagra or Cialis) so using it on a trial basis, is the easiest way to tell.
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To my knowledge, it is similar to melanotan, which bodybuilders have been using for ages, and is well known to make you horny (and tanned). Thus, it is nicknamed the “barbie” drug haha.
Problem is, the strongest, most common side effect is nausea, which may not be compatible with great sex.
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Also, Vyleesi costs $290 per dose (injector) in USA and they are sold in 4 packs for $1160, so only worth it as a last resort.