What we've learned lately about the big T
With a nod to Austrian logician Kurt Gödel’s scientific incompleteness theorem
Well, that was embarrassing. I launched a 20 percent discount for subscribers – that’s FOREVER, by the way – and thank goodness for Perla, an angel who reached out to me via my website to say she was trying to subscribe but could not. How’s this for a menopause moment? I launched a subscription drive only to find out no one could pay because Stripe needed new documents. Embarrasssinggggg. Anyhoo, the deal is on until Wednesday because I’m a silly goose and you can get it here. Thank you all (but especially Perla). AMx
I sought out Prof Susan Davis for the Hotflash inc podcast specifically to speak about testosterone, because what we are hearing about it on social media and in the media is pretty wild.
Professor Davis is a clinician researcher, consulting endocrinologist and head of the Monash University Women’s Health Research Program in Melbourne. I wanted to speak to her because she is the exact opposite of all that. She is one of those doctors and scientists who doesn’t have any time or inclination to be on social media. She’s definitely not chasing fame, just her work, and her research – research she’s been doing for decades now.
The thing that made my jaw drop was this: there is no research on testosterone in perimenopause. None. She also pointed out that there is barely any research on perimenopause and hormone therapy at all, and there isn’t. There are only 6,416 studies on perimenopause in the PubMed data base at last check, about a third of them involving hormone therapy.
As Prof Davis tells me, most of what people say and practice is based in studies on menopausal woman. Not only do we know they are very different things – fertile vs non-fertile, for starters – as a woman who has been through both now, I am confident in saying that they feel very different, too.
If you listen to the episode, you will hear Prof Davis talk about the placebo effect in testosterone, and about the limits of what the evidence has shown (so far) that it’s good for: low desire that bothers a woman.
Nothing about cognition, muscle mass, energy, fatigue or anything else.
She absolutely rips apart a recent article published in The Times (behind a paywall) about testosterone, for quoting an old, small study using a type of testosterone that’s not even on the market anymore.
“People are just cherry picking the data, misquoting the publications,” she says. “I could debate any side of this story and cherry pick-the data, but what you've got to do is give women the truth. And some people don't want to hear the truth. We don't have the data.”
Prof Davis confirms what I’ve heard from a number of doctors: we don’t even really know how to test for testosterone, and most of the testing that’s done in any doctor’s office on testosterone levels is inaccurate. Most. And that’s because what needs to be tested is not in the blood, it’s at cellular level, and it involves cellular sensitivity.
You don’t get that level of nuance on Instagram, do you?
On the other hand, if you listen to Arizona-based Dr Angela DeRosa speak about it on the Hotflash inc podcast, a doctor of osteopathy, integrative physician, hormone specialist and testosterone expert in practice, you will get a completely different story.
And as Prof Davis spoke about all this, I couldn’t help but think of the women I’ve seen speaking passionately about how it changed their lives. Marcella Hill, for example, who has amassed a Wake Her Up army in the US.
“It eliminated all my aches and pains,” she writes in the caption.
”It allows me to sleep. It brought me back to life. It stopped the itching!”
I believe Marcella. I believe everyone else too. And it feels patronizing to suggest that the impact is from a placebo effect, even as I think the placebo effect is awesome and not minimizing in any way. If you believe it’s working, it will work, a lot of the time.
Except. We don’t know is what the long-term impact of testosterone supplementation on women is. We are a giant experiment.
And that’s probably why the British Menopause Society warned in July about all the attention – and media articles by ‘lay people’ – on testosterone. It spoke to the acknowledged placebo response, misinformation in the media and on social media, and the dangers of medicalizing a normal life stage.
Pretty recent history provides clear examples why all of this is concerning. Hotflash inc podcast guest Tania Elfarsy, coach, speaker and author, summed all this up well in a recent post on her The Wiser Woman blog:
When estrogen-only therapy started to be aggressively marketed to all menopausal and post-menopausal women in the mid 1960’s, it took a decade until research was published on the increased risk of endometrial cancer found in women who were taking estrogen-only therapy but had not undergone a hysterectomy.
Similarly, when estrogen was combined with progestin (the latter to protect the uterus from endometrial cancer) and was aggressively marketed as combined HRT in the 1980s, it would be over a decade until research revealed the increased risks of heart disease, breast cancer, stroke, blood clots, and urinary incontinence that came with long-term use of combined HRT, particularly in women who are more than 10 years post menopause.
Is the current aggressive marketing of testosterone to menopausal women, without data on long-term safety, going to repeat these unfortunate patterns of harm that we’ve seen throughout the history of hormone therapy?
A lot of this boils down to the problem (and beauty) of science. I spent my drives to and from work last week listening to the American cognitive psychologist Donald Hoffman speaking about consciousness on the Know Thyself Podcast. He explained that there has been a growing acceptance in the last 10 years in the physics and math community that the space-time continuum is insufficient – and that opens the door to realities that no one could have even been able to imagine. Space-time is not all there is people!
It reminded me of how 10 years ago people would have looked at you sideways if you talked about healing leaky gut or reversing pre-diabetes, but here we are in 2024, and people are doing those things all around us.
Hoffman also explained the Austrian logician Kurt Gödel’s scientific incompleteness theorem, which states that in any reasonable mathematical system, there will always be truths that no one can prove. I like to call them “future truths”.
“Truth transcends any scientific theory,” Hoffman explained.
As the BMS acknowledged in their alert: “Ongoing research may provide evidence for other indications for use of testosterone by women, and we all agree that more research is needed.”
Translation? We don’t know what we don’t know. Only future truth – and time – will tell. As for the meantime, that’s up to you and me. Eyes open is all.
I just love reading your Substack; I'm sure I've said this before, but I always learn something new. Each week, you always dig a little deeper than everyone else and share details no one else is talking about. I had no idea that testosterone isn't accurately detected through blood work or that it hasn't perhaps hasn't been tested sufficiently on perimenopausal women. Just last week, my doctor drew blood, told me my testosterone was low, and offered pills, creams or pellets. I declined after reading about the side effects. After reading your article, I know I don't want to be a guinea pig. Thank you for your work- invaluable as always. <3