Sep 8, 2026 · 1h 22m
Women’s testosterone care remains stuck between evidence and regulation
The Testosterone Myth Women Have Been Lied To About │ Dr. Susan Hardwick-Smith
The episode examines how declining testosterone may affect women’s health while inconsistent testing, limited products, and dosing risks complicate treatment.
- 1Testosterone supports women’s sexual function, mood, cognition, energy, muscle, and bone health, especially during the menopausal transition.
- 2Women lack FDA-approved testosterone products partly because regulatory and commercial incentives have not aligned around a naturally occurring hormone.
- 3Delivery methods, laboratory assays, and dosing can produce undertreatment or excessive exposure, making individualized monitoring essential.
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Hardwick-Smith warns that the early dramatic response to testosterone can fade naturally, making dose escalation a dangerous attempt to recreate it.
The brief
Susan Hardwick-Smith explains why testosterone is not exclusively a male hormone, linking it to women’s sexual function, mood, cognition, energy, muscle, and bone health.
The regulatory gap is central: women have no FDA-approved testosterone product, while the failed Intrinsa patch and weak commercial incentives helped leave care dependent on off-label prescribing.
Hardwick-Smith compares gels, creams, injections, and pellets, showing why administered doses do not translate cleanly across delivery systems and why absorption can vary sharply.
The safety debate turns on exposure: serious problems are associated with excessive or prolonged dosing, while oral testosterone raises distinct liver and lipid concerns.
The episode’s sharpest warning is against chasing the initial treatment effect; symptom improvement can settle into a normal baseline, not justify escalating toward supraphysiologic levels.
The closing case is for individualized menopause care that accounts for testing limits, medications that lower testosterone, lifestyle constraints, and women’s long-term physical and sexual function.
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