137. Testosterone - Mood, Libido and more

Have you ever wondered if testosterone therapy is just for men—or if it might actually help you with low libido, energy dips, or stubborn vaginal dryness? You’re not alone. So many midlife women are asking questions about testosterone, but getting few clear answers.

In this episode, I sit down with my fabulous nurse practitioner, Monique Willingham, for a down-to-earth conversation about what testosterone therapy really looks like for women. We unpack myths, dive into its surprising benefits, and talk honestly about when it might help—and when it might not.

If you’ve been feeling like something’s “off” but haven’t found the missing puzzle piece yet, this episode might hold the answers you’ve been seeking.

In this episode:

• What testosterone does in a woman’s body (it’s more than just libido!)
• How to tell if your low sex drive is hormonal—or something else entirely
• The surprising role of testosterone in mood, confidence, and brain fog
• Myths debunked: Will testosterone make you bulky or aggressive?
• Why some providers don’t offer testosterone therapy—and what to do instead
• Lifestyle factors that suppress testosterone production (and how to turn things around)
• When testosterone might not be the right fit—and what to consider instead

Connect with me, Dr. Sara Poldmae:

Website: https://risingwomanproject.com

Instagram:  https://www.instagram.com/drsarapoldmae

Transcript

Sara Poldmae: 0:01

Sarah, welcome to menopause. Rise and thrive. I am Dr Sarah pulled May, and this podcast is your go to guide for navigating perimenopause and menopause. If you are feeling a little overwhelmed, trust me, you are in great company. Each week, I'll bring you expert advice, raw, honest conversations and simple tips to help you stay grounded and maybe even find some humor in the process. Let's rise, thrive and tackle this wild ride together. Hey ladies, welcome back today. I've brought Monique, my nurse practitioner, back onto the show. Super excited, because I think this will be a juicy conversation. We get so many questions about testosterone therapy at our clinic, and I thought Monique would be the first person to line up to talk all things testosterone. And the reason why we wanted to bring it onto the show today is because women have so many questions. Would you not agree? Monique, so many questions

Monique Willingham: 1:07

about, is this a hormone that I need to worry about? Is this something that's affecting me now in midlife, testosterone is definitely a hot topic.

Sara Poldmae: 1:16

Yeah, for sure. And so I thought of some of the random questions, and actually jotted them down. Some of the questions that we hear are, will testosterone make me bulky, so like, if I'm working out, will I all of a sudden be like this major muscle woman, or will testosterone Make You hairy or aggressive, or just feel like you're not yourself? Another question I feel like we get a lot is, is testosterone going to make me gain weight or hold on to belly fat? And often, women will also ask us, is it normal to want testosterone mostly for libido, or is that like over simplifying? It like, are there other things that testosterone can help with, and how can testosterone help my mood, my confidence or my motivation. So we wanted to just kind of go through and have an organic conversation about testosterone therapy. Some of the questions we get, how it can help women. When is it maybe not appropriate for women? How do we come to determination of whether to use testosterone therapy in clinic? So let's get started. Okay, let's go all right. Well, one of the good questions that I thought of, that I thought women would benefit from knowing about, is, how does a woman know if her libido or lack of sex drive is a testosterone issue, or is it simply stress, exhaustion or resentment or just maybe, you know, the marriage needs a little bit of a kick in the butt, right? I think that's a great question, and I think that both you and I can answer that together, bringing our different pieces of our experience. But a lot of women do come to both of us saying, you know, my desire is not there, and I do love my husband, but it's just the spark isn't there anymore. And you know, I wish that we could say, oh, here's a magic pill, and everything will be better tonight when you get home. But unfortunately, you know, we have to look at everything, and testosterone definitely will play a piece.

Monique Willingham: 3:24

But the way that Dr, Sarah and I work is we kind of look at layers to that individual that's coming in. And we're looking at, okay, yeah, chronic exhaustion. Like, why are we so exhausted? What's going on? How can we help with that? What else did you say your stress, you're stressed like if you were constantly stressed, I think that's huge. You're not going to feel relaxed enough to go enjoy yourself. I think another piece that comes into the picture is with the desire is a lot of women, as we're aging in midlife, post menopausal, start to have genitourinary symptoms, and so they start having vaginal dryness or vaginal pain with intercourse, and so they start to relate, like, oh my gosh, my desire isn't there because I don't want to be in pain, or I don't even want to think about what that's going to feel like, because it's not the direction I want to go. So I think it's definitely multifactorial and kind of peeling away the layers of, how can we address each thing? And then once we get you into a nice calmness, then we can really think about, hey, is testosterone going to be beneficial?

Sara Poldmae: 4:31

Yeah, absolutely, because testosterone can take care of a lot of physical stuff, if it is a deficiency of testosterone. And we'll talk about that a bit more. But there are so many layers, right? We're often playing so many roles as women. I talk about that a lot on the show, and sometimes at the end of the day, honestly, like the last thing you want is more input, more of someone needing you. And I think that that's something to address and and oftentimes, you know, for in law. Term relationships. Sometimes it's just, you know, kind of like, Oh, I've been there and done that for 20 years. Maybe I don't need to do that right now. And so that's another conversation, you know. Sometimes I'll start, you know, if I have a patient that I have that type of rapport with, I can say, well, you know, if there was this really sexy 35 year old expressing interest, would that, like, boost your libido? And I'm not asking that to, like, stir up any problems in a relationship, but it's, you know, sex is a is a big topic, right? And testosterone can get you part of the way there, but it might not get you the whole way there if there's other underlying issues. Exactly, exactly. Agree, I think that testosterone can play a part in those genitourinary symptoms. I think a lot of women are under the impression that correctly, that the first thing we want to do is look at a non hormonal vaginal moisturizer. But the next step through the menopause society would be vaginal estrogen. We take a slightly different take on that in clinic, because testosterone cream can actually help with vaginal dryness and dysfunction.

Monique Willingham: 6:06

Yes, actually, yes, the receptors in the vaginal area. There's a lot of androgen receptors there, so yes, estradiol is helpful first line treatment to vaginal dryness or pain with intercourse. But if that is not working, or if you need to complement that, then testosterone cream can be a something that can be useful, but it's not just any testosterone cream. So the com the testosterone cream that has the green base that's appropriate for the vaginal area, yeah, yeah. So, so how do we know whether a woman might want to explore testosterone therapy. So I think that when we talk about testosterone, it is part of the conversation. When we're talking about hormone balancing and hormonal changes as we are going through perimenopause and menopause, and we want people to feel better. So I think that there's kind of two approaches that we take, and it is definitely symptom control. So when someone shows up and they're telling us, I have terrible fatigue, I my desire isn't there. I have vaginal dryness. I'm losing my muscle mass faster than I thought I could ever those are things off the top of my head that are already working, like, oh, this particular person could benefit maybe from a little bit of testosterone therapy. So it's really based off of the symptoms that they're presenting with, what they've tried in the past, what their lifestyle, what's going on, lifestyle wise. And then we would always, you know, do a baseline lap, check and see where that testosterone level is in relation to their symptoms, and then have another discussion. Okay, great. And so we're talking a bit about physical stuff, but I want to go more towards how testosterone might play a part in brain fog, focus, or even mental stamina, as well as things like confidence and mood. Yeah, yeah. Testosterone can definitely play a part with our moods. It can help decrease anxiety. It can help help women become a little bit more confident and happier. And honestly, I kind of compare hormones to cars, and so testosterone is like the big truck, the f1 50, the big guy on the road, that's, you know, driving around. He's got, to me, strong, confident, big. That's what testosterone can help improve in women who are maybe not feeling that way, or they're just not feeling like themselves. Okay.

Sara Poldmae: 8:47

Okay, great. What about I started the show talking about some of the questions that women have, and so I'm gonna tie this into kind of a two part question. The first part of the question is, what does safe testosterone therapy for women actually look like? And then the second part of the question is, because a lot of women have concerns over whether testosterone make them bulky or hairy or aggressive, gain weight, etc, I have a feeling that those two things are tied in, like, is there a way to make sure that testosterone therapy is saved, so that some of those side effects don't pop up? Because we do hear of women maybe getting too much testosterone and becoming a

Monique Willingham: 9:32

masculine so every so when we talk about medication, generally speaking, we are going to individualize it, so every person will have a different blood level, every person will have a different past medical history of what's going on in their bodies. So I think we have to take into account what's going on initially, and then when we're thinking about prescribing test. Gastrointest. There's different forms out there, there's creams, there's pills, there's injections, there's pellets, and they all are aiming for the same goal at the end, but they are all metabolized differently, and they all affect your blood levels differently, so you would have to have very high dosing of testosterone for prolonged periods of time, for you to really see those negative side effects when we're talking about a deeper boy, boys sword like really bad hair growth, so always starting with the lowest dose of any medication and slowly titrating up is going to be at least the way that we would work. So starting with a low dose and then monitoring side effects. So if someone comes to me and it's like, Monique, oh my gosh, I'm starting to break out, or I'm starting to notice maybe a little bit more hair on my chin, and it's more than it was three months ago, then we're going to stop it and rediscuss. You know, what dose Are we at and what do we need to do moving forward? But I, I wouldn't be nervous about it, and I would say that the probability of negative things happening is very low if you're working with the right provider, absolutely. And so why do you think, then that so many women get dismissed or told that they that, you know, the doctor's offices that they're currently go going to? Why are they told we don't do that here? I think you know, as a clinician, as a provider, if you don't feel comfortable prescribing something. They're not even going to act like, you know, they're just not going to do it. So I think that the comfort level of a lot of providers aren't it's not there, and if it's not in their wheelhouse, or if they're not interested in learning more about something, they're not going there and they're going to refer you elsewhere. I think that's number one. Number two is testosterone for women is like a hot topic. It's coming out. We need more research on it. It's not FDA approved for women, so it's off label use. So I think there's a lot of it's a controlled substance, so there's a lot of layers on prescribing it, and monitoring labs. So I think that's a big piece of why some providers are like, Nope, we don't do that here. That makes sense. And again, like, like you said, if it's not within their wheelhouse, I mean it, it's not something that's been used for women for a long time in mass numbers. And if you're not going to take the time to study and learn about something like testosterone, it makes sense to just shy away from it. So it's not that women are being dismissed, but it's for good reason, because if you don't want a doctor to be prescribing stuff that they're not comfortable, that's not that's not the goal, right? You want to work with people that are comfortable with what they're doing? Yes, exactly. And I mean, and from the women perspective, or being a patient in an office that the word dismissed, it feels like that because to that person, because they are wanting or desiring something, and they're not getting the result, or when they're told I don't do that, or that's not part of what I do, they're not offering another suggestion, right? And that, and that's the problem with the dismissing type of tone that women tend to feel, is that they're not being offered other options. So it's like, just deal with it. I think is, is more the problem? It's not, it's not we. We don't do that here. It's more, you just have to suck it off, right, right, yeah, yeah. And maybe this is something more that I could talk about for lifestyle factors, because I think we're talking about, what if you take testosterone? What? Ha, like, why do we lose the testosterone? Like, it's a normal prospect. How do women really tanking their testosterone? And then I think that's something that's really important to hit upon in this conversation. Chronic stress really can suppress androgen receptor. So you were talking about androgen receptor in the vaginal area. And I think that that's important, like we have to make our own testosterone, right? And if you are chronically stressed, if your cortisol levels are always elevated, that can actually suppress your body's ability to take testosterone, to make testosterone and make it go where it needs to go. Not only does stress impact testosterone, but poor and inconsistent sleep can help really block testosterone. Under eating and over restricting are not good for your hormones, blood sugar swings, exercising, too much alcohol. I mean, there's just so many things in our lifestyle that matter as far as not only hormone production, but and utilization. So I think it would be remiss now. Not to mention those things while we're talking

Sara Poldmae: 15:02

about it, right? Absolutely. I mean, again, that's kind of going full circle to how we started of looking at your lifestyle, looking at the measures that we can try to optimize, to balance those hormones as best as we can naturally, by by these different measures, I'm really digging deep on what can we control and how can we improve things, and then reassess, okay, how is my desire? How is my energy? Yeah, exactly, and the mind body stuff and making sure your emotional needs are met. When we meet with women in our concierge clinic, we really try and assess these lifestyle factors, because certain things, like, if you are early, your perimenopausal process and and stress and sleep can often be those main drivers behind why your hormones are going so bonkers, or why you're feeling just so depleted. If we catch things early enough and stop maybe over exercising and maybe start fueling our bodies in the right way and making sure that we're not going on this wild blood sugar roller coaster ride every day with too many sweetened Starbucks drinks. And you know, if we really start to learn to nourish our bodies, our bodies can actually make the most of a healthy lifestyle, and maybe we won't need to go towards hormone replacement therapy, or maybe we need, we can go about it in a slightly different way, if you are later in the process, later in perimenopause or post menopausal, if you've gone through surgical menopause, if you have long standing dysregulation of your nervous system and are really burnt out, then maybe we, maybe we need to use the guns right away. But there's definitely there. There are time periods where we could work on reversing some of these lifestyle things, or nourishing ourselves in a different way that could help us to not need to rely so heavily on HRT, Yep, I agree. And then are certain people that wouldn't benefit from testosterone, or certain people that testosterone might not be the right

Monique Willingham: 17:09

thing for them, I would say, I really, I mean, it really all depends on the person there. I would say I would have to have a good conversation if that person has a lot of chronic comorbidities, and I'm going to say something like congestive heart failure, if they have swelling throughout their body, if they that's the only thing that's popping up in the top of my head right now. But I think it's definitely worth a discussion. It's it's fairly it's a cream the way that I prescribe it, and it's very useful. I mean, I don't really have any contraindications. Off the top of my head, everyone responds differently. So I could say that there's no contraindications, but they could start it and maybe emotionally, it's not right fit for them, or maybe compliance wise, they're like, I don't like creams and I don't like where you want me to put it. But I think it's worth trialing if it's an appropriate case, yeah. And obviously we want to test too. We want to make sure you within safe numbers and all that good stuff, right, right? I mean, if they have a high testosterone in the first place, then replacing it is not going to be helpful at the time, right? Exactly, and that, and that's the idea between behind hormone replacement therapy. We call it replacement for a reason. We want to make sure that we're not taking you to levels that would not be optimal from where the starting point was. The idea is to replace or replenish, and I think that's an important

Sara Poldmae: 18:44

piece of a puzzle. Absolutely for jumping on anybody has any questions and wants to reach out, know where to find us, and we look forward to talking with you soon. Yay. All right, see you later. You