Women's Hormone Testing, Treatment, & Q&A

Register for the Live Q&A with Karen Martel taking place TODAY, October 14 at 12p ET / 9a PT, only in Physique University (replay available if you're listening to this later). Use code FREEPLAN to get a free custom nutrition plan when you join at physique.witsandweights.com

Get hormone creams and oils without a prescription at witsandweights.com/karenmartel (use code WITSANDWEIGHTS for 10% off)

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Enjoy this short replay (from Ep 135) with hormone specialist Karen Martel on how women should test testosterone, why SHBG changes your free hormone levels, and how fasting, carbs, and thyroid meds shape results. We share timing tips, key labs, the 5‑alpha pathway, and smarter steps before adding therapy.

And what about intermittent fasting, keto, and carb cycling?

Join us for today's Q&A with Karen Martel at 12pm ET / 9am PT

Chapters

• 0:00 Bonus Replay & Live Q&A Invite
• 0:31 Link Fixes & Discounts
• 1:16 Why Testosterone Testing Matters
• 2:10 When to Test and What to Order
• 3:20 Fasting, Carbs, Protein, and SHBG
• 4:36 Finding the Balance: Insulin and Cortisol
• 5:40 Thyroid Meds Raising SHBG
• 6:40 Beyond Bloodwork: Dutch and Metabolites
• 7:38 The 5-Alpha Pathway and Side Effects
• 8:36 Modulating DHT and Next Steps

Transcript

Philip Pape: 0:00

Hey Wits and Wits of Family. Today is a quick bonus episode. It's a replay of a conversation with hormone specialist Karen Martell about testosterone for women. This was from early 2024, and I'm replaying this because Karen is joining us for a live QA today, exclusively in Physique University. I wanted you guys to get a taste for the kind of specifics that she gets into regarding the mechanisms of our hormones, as well as how to test, how to interpret, what your doctor might be missing, how to treat it, what options are available. So very short, under 10 minute replay today. If you want to ask Karen questions about hormones, perimenopause, menopause, optimizing your health, join us in physique university, go to wits and weights.com slash physique. Use my code FREEPLAN to get a free nutrition plan. And when you sign up today, you can hop on the call at 12 Eastern. If you miss it, there will be a replay. But if you could join live, you'll be able to ask her your questions. I also want to let you know I fixed a broken link in our most recent episode with Karen. There was a link in the show notes to her hormone creams and oils that you can get without a prescription. So that link is fixed in the show notes. It's witsandweights.com slash Karen Martell. And then use code Wits and Waits for 10% off. I'll throw all that stuff in the show notes, but enjoy the replay on testosterone with Karen. Let's go back to testing, right? Because testing's always a point of confusion, especially in the traditional healthcare system where it's like, if you could even get them to give you a test, it's blood work. And usually that's not adequate, but it might be for testosterone. So let's let's break it down. Exactly. That's one thing that makes it easy, right? So how should a woman get access, get tested, and then use the results properly.

Karen Martel: 1:39

So once again, some really shitty man-to-woman things here, which is testosterone's the only one that they'll ever test free and total. Women would they won't do estradiol free and total or progesterone free in total. It's only testosterone, which is a little bit frustrating. But you can't, that's a very accurate way to test your testosterone. And testosterone, we have a little bit of a peak right before we ovulate, I think to give us that drive to go out and have sex and procreate. But pretty much we don't fluctuate like we do with our other hormones throughout the month with testosterone. It stays pretty even keo. We have that little flux on day 12 right before we ovulate on a 28-day cycle. But you know, besides that, you can kind of just test whenever in the cycle. You probably don't want to test on that peak day. Day 21 is what I would recommend because that's where we test the esterdiol and progesterone in fertile women. So might as well do your testosterone then too. And so it is very accurate, but you definitely want to do both free and total in case your SHBG is too high. And then test your DHEA sulfate in blood, test your sex hormone binding globulin. So we see if it's elevated. Because one of the things that's happening right now is that a lot of women are fasting and fasting like hardcore fasting, you know, one meal a day, two meals a day, and they've been doing this for a long time, or they've been eating a really low carb diet, or and when they're fasting and not eating that much, they're also really low in protein. So low protein diets, low carb diets, too much fasting will all raise SHBG because it makes sense. If we were back in hunter-gatherer days and there wasn't a lot of food around, so we're fasting, right? Then the body is being told, don't get pregnant. There's not a lot of food around. And so SHBG naturally would go up because there's a food shortage. So it wants to bind up your testosterone, bind up your estradiol, and so that you can't get pregnant. And so too much of that starts to signal to the system, don't get pregnant, which is that's really the only reason why we're here. So your body's gonna compensate for this, whether you like it or not, where whether you want kids or not, or care about being fertile, this is what happens. So we have to be really careful with that. So testing that's a good idea.

Philip Pape: 4:02

So a couple of things, because I actually just put together a new episode about carbs coming out. And one of the interesting things about a higher carb diet was the increase in testosterone to cortisol ratio that they've seen, not in addition to the increase in IGF one that you talked about. So the fasting and the low carb and the low protein, are you saying that that in general for most women that's not recommended because of this? Or what are you saying there?

Karen Martel: 4:26

It's it's a fine line, is what I'm saying, because we also become more insulin resistance resistant because of the drop in hormones as we age, which means intermittent fasting can be a really, really important tool to start implementing because we will we need help being insulin sensitive. It's that women are taking it too far, they get results, and then they're like, oh my God. And then they stop getting results and they think, I better do it harder longer. Right? Like, I better, oh, if I'm eating two meals a day, I better eat one meal a day. Oh, I should be doing a 36-hour fast or a five-day fast. And you you hear this from a lot of like of the big practitioners that are out there on social media saying, like, you, you know, do five-day fast once a month, you know, do one 36-hour fast every single week. And I'm like, no, most women can't handle that, especially in menopause. It stresses the system out too much. So you have to find that balance. You have to know where your cortisol levels are, you have to know where your insulin's at. So testing, of course, is super important. We don't, we don't want to guess what's happening in the body. So some women that are insulin resistant, their cortisol's okay, or let's say it's high, then I would probably say, you know what, you need to be intermittent fasting more, but you still want to make sure you're getting in the protein because if not, then that SHBG will go up and it'll bind up those hormones. The other thing that will raise it is thyroid hormones. So if somebody's on thyroid medication, which a lot of women are, they don't realize that that's actually binding up their hormones and sending them into menopause early, which is something that happened to myself and nobody told me. And I was like, what? What's going on? My total levels of estradiol and testosterone are great, but yet I'm missing a period, I'm getting hot flashes, low libido. And then I finally heard Peter Atia on who's huge, he was on Huberman Lab podcast, and he was talking about thyroid medication raising SHBG. And I'm like, what the frick? Why isn't anybody talking about this? Like, how many women are on thyroid hormones? So many.

Philip Pape: 6:30

A lot of yeah, it's this is why women are so frustrated, right? And because it's I could just imagine like a piano of keys, and every single key is like a different hormone. And as soon as you press one, the other one goes up or down, and they're all so interrelated, right? Yeah. Um, and even the thing about energy availability, which shameless plug, that's what we talk about on your podcast when my episode comes out, energy availability, is that you you need the energy there to support your hormones, but you don't want so much energy that you're gaining a ton of weight, right? And that's where it's like this balance for women to find out.

Karen Martel: 7:04

Like we can't be, we got to get away from this one size fits all because even though we know that we're still doing it. The majority of women are still going, what's the next best diet out there and trying it? And oh, everybody's doing keto. Well, I'm gonna do keto. And it's like, but is that a good fit for you? Like, where's your thyroid at? Where's your adrenal system at? Where are your hormones? Like, you gotta look at this full picture and then decide, okay, I'm you know, inflamed, I've got PCOS, I'm insulin resistant. Then yeah, keto could be great and it could reverse all of those things, but then you want to, you know, start carb cycling, and you know, there's there's a lot of nuances to it, and everybody has to find what's gonna work for them.

Philip Pape: 7:48

So going back to the blood work, uh, free and total testosterone, DHA sulfite, SPG, what else?

Karen Martel: 7:54

S HPG, yep. And then of course you want to test your acidion progesterone as well, because there is some some evidence that shows that women should actually be like if you're gonna replace your hormones in perimenopause and menopause, there is some research that shows it's actually better to replace estrogen and progesterone first for three months, then put in the testosterone. So I always want to see that full picture. The other way that I I want people to test is through urine metabolite testing. Now, oddly enough, testosterone is actually the least accurate on urine metabolite testing. So you think, okay, well, then why are you saying that we should do this, Karen? Well, in the a Dutch test, which is dried urine hormone testing, we have testosterone on there. We've got the DHEA sulfate on there. But if you have a genetic SNP where you're missing these enzymes called the UGT enzymes, you won't pee out that testosterone. So it looks like you have none when you actually have plenty. So I always want women to do blood work on the same day or the next day so that we can compare the two just in case it's more common in Asian backgrounds. So if you're you've got, you know, if you're Asian yourself or you've got Asian in in your family history, then you may not have that enzyme. I don't have it, so I always look like I have test low testosterone. But the other piece of the puzzle that we want to see on a urine metabolite test that blood work won't show is something called five alpha reductase enzyme. And so there's a fan gauge on the Dutch test, and there's five beta and there's five alpha. If you are leaning towards a five alpha pathway, so the on the fan gauge, if you're way over to the five alpha, it means you convert your testosterone at a higher rate to what's called dihydrotestosterone, which is the most androgenic out of all the androgens. And so that's where we'll see women, if they go on testosterone replacements, then they if that goes up, the DHT goes up, they start having the hair loss, the greasy skin, the acne. And so that's not that's not pleasant. Women can get whispers, have, you know, can start growing the clitinous, as I call it. So your your P your clitoris can actually start to get longer. And you Yeah. Which is not fine. And I've heard of women this happening to them, their voice cracking, and just from being on testosterone replacement.

Philip Pape: 10:36

And that's if you lean more toward the alpha side, you said? Correct.

Karen Martel: 10:39

Yeah.

Philip Pape: 10:39

And does that mean you shouldn't be taking therapy if that's the case, or do you just have to modulate it and be more careful with the dosage?

Karen Martel: 10:45

Exactly. And you have to possibly take something that's going to stop that conversion. So it blocks the five-alpha reductus pathway. There's herbals that do it. There's also medication, uh, finasteride and doasteride that will block that conversion. So a lot of women will take the medication so that they can get the benefits of testosterone without having the masculine features. But there's lots of that, like saw palm meadows, really good for it, pumpkin seed. There's a bunch of different things, ink, that can help.

Philip Pape: 11:17

That's it for today's replay. If you want the full conversation with Karen, including natural supplementation strategies, treatment options, you can go back and listen to the full episode 135. And remember, join us for today's live QA with Karen in Physique University. Go to witsandweights.comslash physique. Use my code FREPLAN again, witsandweights.comslash physique. And I will see you tomorrow for the next full episode.