Copyright The New York Times
‘I’m on fire’: The promise and peril of testosterone I read everything Susan Dominus writes. Two years ago, she wrote an influential piece about how women had been misled about menopause; how the increased risk of breast cancer that comes with replacing declining hormones like estrogen and progesterone was often vastly overstated; and how many women who could have treated debilitating symptoms like hot flashes and insomnia suffered through them instead. That has radically changed, thanks in part to articles like Susan’s and a confluence of social media influencers and doctors who have started talking openly about the benefits of menopausal hormone therapy. Today, things have gone so far in the other direction that not only are more women leaning into conventional hormone therapy, they’re experimenting with testosterone. Lots of it, in some cases. What got you interested in testosterone? I started hearing all these stories from friends about women who were taking testosterone in really high doses, totally transforming their sex lives in their 50s. Women who hadn’t wanted sex with their husbands in years were suddenly having it six times a week. Others said they had orgasms for the first time in years. The effects of testosterone in women have really only been well-studied at doses that replace the levels that a woman would have had in her late 30s. That’s very different from what I was hearing about, which was women taking doses much higher than they ever had naturally, at any stage. Regulators in the U.S., which is where most of my reporting focused, have not approved the use of testosterone for women at all. Doctors have to prescribe it off-label. And yet these massive doses have become a cultural phenomenon. And a lot of women are having extreme reactions. What kind of reactions beyond the increased sex drive? I heard of one woman who had a terrible reaction after taking testosterone via a pellet — a little grain-of-rice-type object that is inserted beneath your skin and dissolves over three or four months. Once it’s in, you can’t take it out. It made her very aggressive and very angry. And everybody had to ride it out, and afterward she had to go back and apologize to her family. Another woman told me her pellet gave her so much energy that she enrolled in a Ph.D. program even though she was raising four children and helping run three small businesses. But she also lost 40 percent of her hair. You just don’t know how you’re going to respond. Are you going to be the person who feels positive and in love with her husband? Or is it going to make you the person who’s hyper-aroused but furious with her husband? Or isn’t even hyper-aroused — but is just angry all the time? And are there any health risks? The risks are not well understood at this point. Doctors have concerns about the possible increase in hormone-related cancers and cardiac issues that could be associated with high doses over time. But even the data on the risks of low-dose testosterone is limited. There is research on women who take it for two years that shows it’s quite safe. There’s been some research on women who’ve taken it for up to six years that’s also reassuring, but isn’t as good as the two-year research. There’s just not a lot of long-term data. Have you read “All Fours” by Miranda July, by any chance? Yes, I loved it! So did I! In part because it got at something that your story also highlights — this idea that female sexuality doesn’t have to be linked to fertility. Yes. Previously, as a menopausal woman, not only were you not considered a sexual being, but the notion that you might be a sexual being was the subject of jokes. What I love about “All Fours” is that it really normalizes this idea that many women in their 50s and beyond not only want to have sex, but, you know, deserve help with that if it’s something they want. But equally, if someone in their 50s is done with sex, we want to normalize that too, right? Our readers are from all over the world. Is there a country that is pioneering this culture change? I think Britain has been leading the charge on making classic hormone therapy — estrogen and progesterone — accessible and affordable and safe, and countries like Australia, New Zealand and South Africa are doing the same, specifically with testosterone. In America, which is a very puritanical and conservative country in many ways, things are moving relatively slowly — which might be why so many women have gone rogue.
