Dr Darcy Graham- Testosterone, HRT, And Women’s Wellbeing

Feeling exhausted, foggy, or disconnected from your desire—and being told your labs are “normal”? We get real about what’s actually happening. With women’s health NP Dr. Darcy Graham, we dive into the overlooked role of testosterone in women and how it works alongside estrogen and progesterone to restore energy, sharpen focus, improve sleep, and bring back a responsive, joyful sex life.

We break down the most common midlife symptoms—low motivation, brain fog, hot flashes, painful dryness, and vanishing libido—and explain why they’re so often misread as depression. Then we map out a practical, stepwise HRT approach: start with sleep-saving progesterone, layer estrogen for thermal regulation and mood, and add personalized doses of testosterone to support drive, lean mass, and cognitive clarity. You’ll hear a candid look at what changes in the body and bedroom, why clitoral sensitivity matters more with age, and how open communication can transform intimacy.

Curious about methods? We compare creams and gels (steady and simple), tiny weekly injections (faster onset with peaks), and subcutaneous pellets (3–4 months of convenience that demand careful dosing). We also unpack myths around “bulking up,” facial hair, and voice changes, and when those risks are real versus rare. Expect clear guidance on timelines to feel better, lab monitoring that informs rather than dictates, and lifestyle levers—light strength training, smart nutrition, and cutting back on alcohol—that amplify results.

If you’ve ever been dismissed, this conversation puts the power back in your hands. We share how to find trained menopause providers, what questions to ask, and why treating the person, not just the numbers, is the path to lasting relief. Subscribe, share with a friend who needs this, and leave a review telling us the one symptom you want solved first. Your story may help someone else feel at home in their body again.

Transcript

Welcome And Guest Reintroduction

SPEAKER_02 1:10

Welcome back to Empowered Ease. I'm your host, Jen Ollinger, a holistic nurse coach. And today we're welcoming back a very special guest. I hope you all remember Dr. Darcy Graham. She is a D and owner and founder of Grit and Grace Wellness and has spent more than 25 years in healthcare, serving patients with compassion and expertise. These days she's specializing in women's health, hormone replacement therapy, and medical weight loss. She helps women restore balance, energy, and confidence. She is a mother, a wife, a mother of seven, in fact, a dog mom of three, and she deeply understands the real life demands women base. She's passionate about providing realistic supportive care that actually fits your life. This episode, Darcy Graham is back to dive deeper into testosterone and HRT. What you need to know, what often gets missed in traditional conversations, and how these therapies can be used safely and intentionally to support women's health at every stage. So let's get started. Welcome, Dr. Darcy Graham. So happy to have you back. Well, welcome back, Dr. Darcy Graham. I'm so excited. You're back to talk to us more about testosterone and HRT therapy. How are you doing?

SPEAKER_00 2:29

Good morning. I'm doing great.

SPEAKER_02 2:31

For some of our listeners who may may be new or didn't hear the episode, the last episode, which I think was like two episodes ago. Can you just like briefly reintroduce yourself and what you do and how you work with Women's Hormones?

Why Testosterone Matters For Women

SPEAKER_00 2:43

Absolutely. I am Darcy, Dr. Darcy Graham. I am a nurse practitioner in Alton, Illinois. My primarily, my primary day job is a women's health nurse practitioner. I've been doing that for going on my 12, going in 12 into 12 years now. It's hard to believe it's been that long. And so given that I'm in women's health and in my mid-40s now, I've kind of taken on this role as getting very, very educated in hormone replacement therapy and kind of what women are going through with this perimenopause phase, which has been in a very exciting time, a lot of changes this past year. So it's a hot topic. It is. It is. I would say most of my new patients now in my in the clinic that I work in has just been primarily perimenopause, especially now that my name's getting out, that I'm doing all the certifications in it and getting more educated in it. So yeah, it's it's really exciting. So I do women's health um with focus on menopause and perimenopause right now.

SPEAKER_02 3:41

Yeah, I got I actually scheduled an appointment. It's just just not till March. So I'm so excited to get started to like speak to it as well.

SPEAKER_00 3:48

So absolutely, I'm excited.

SPEAKER_02 3:51

So we decided to do another episode kind of focusing on testosterone because I know we like briefly talked, touched on it before, but I was, I mean, I've been a nurse for 12 years, but I don't remember. I think it was after I graduated nursing school that I found out women also create make testosterone in their body that like everyone makes a little in their brain, and men just make like a lot more of it with organs we don't have. So can you tell us a little bit about like the role of testosterone in women? And yeah, what do we need to know about that?

SPEAKER_00 4:21

Definitely a lot of people don't know that testosterone is is produced by women as well. So that's kind of uh a lot of people like you said, you were in nursing school and and a nurse and didn't quite understand like the role that testosterone plays in women. So we as females are born with a very small percent of uh testosterone produced in our body, not like men that have the beards and the big burly voices, but we need testosterone as well. And like we talked about on the last podcast, as we age, women, as women age, our levels, all of our hormone levels, start to get kind of wacky in our mid to late 30s and then start to kind of take a nosedive. And testosterone is one of them. Testosterone is very, very important for energy, fatigue, brain fog, and most especially libido. So that's one I really like to kind of talk about because a lot of women will come into the clinic in their mid to late 30s, 40s, 50s, and just talk about they don't want to have sex anymore. They have no libido. Well, it's not fair because guys, when they go to their doctor and say, oh, you know, I don't want to have, I can't get an erection anymore. I'm not really like, I want to have sex, but I just can't. They get a little blue pill called Viagra. And they haven't made that for women yet. I'm kind of hoping that maybe someday we will get to have something like that. There's definitely some aids now that are out there for women that kind of will help get them in the mood. But long-term standing, testosterone helps with that. And I think women are pleasantly surprised with that once we get them started on testosterone therapy, that that's one of the things that it helps.

Symptoms, Misdiagnosis, And Mood

SPEAKER_02 6:02

Yeah, that's a huge piece and like the dynamic of your relationship too, and as you get older. So I think that's probably like a huge, huge concern for people. How do women's testosterone level levels typically well? I guess we kind of talked about it, like change across the life's lifespan. But what are some of the subtle signs that people may notice if their testosterone is starting to like fluctuate or besides libido, I guess?

SPEAKER_00 6:28

Yeah, energy and motivation. Okay. I I guess I should have prefaced this episode with if any of my family members are listening to this, I'm probably going to talk about my sex life. Um probably don't want to hear about that. But so just turn away, or if my mom's listening to it. Right. Earmouth, my daughter, my mother-in-law, I don't know. Most, I mean, like we just said, libido is definitely one of them. Energy, energy is another one. You have to also think in this time frame of our lives. And we talked about this a little bit on the last episode. So if you haven't listened to the last episode, definitely go back. Yeah, it's a great one. We're in a different time in our lives, too, in our late 30s or 40s. We're taking care of children. We might be taking care of parents, kind of going through career changes, maybe, or are advancing in our careers. So, you know, women are always tired. We're just tired. We're mentally tired, like maybe don't have a motivation to go to the gym. We're starting to lose some of that lean muscle mass that we had. We're starting to get that menopausal weight gain, like just exhausted, just don't feel right, not feel right in their skin. We talked about brain fog last time, like just you know, losing words. I still lose words every once in a while.

SPEAKER_02 7:42

Not as bad, but I'm in the hardest, like a the last week of we break word finding word binding has been so hard for me. I feel like I can't communicate.

SPEAKER_00 7:52

So testosterone can be a game changer with some of these symptoms and just kind of all around health when you add them with the estrogen and progesterone as well. But yeah, I I think last time you asked me, one of the the questions was when people come to me, what are the the main complaints that they have? And usually it's estro it's libido, energy, fatigue, and that brain fog. And testosterone really couples nicely with the estrogen progesterone therapy.

SPEAKER_02 8:21

Okay, that was gonna be one of my questions too. So it's like they all kind of play on parts of it and others, because I didn't, you know, every woman's so different too, as I talk to people, like you know, what they're experiencing, so it's hard. And I know in men, well, this is what I've heard, I shouldn't say now, that on their testosterone, it can mimic depression, like a lot for men. So and some of these sound depression would make you depressed.

SPEAKER_00 8:46

And in women, it it kind of mimics depression too, that lack of motivation, just like, yeah, I know I gotta do it. I just don't really want to do it. And a lot of women will go to their dar their primary or even their GYN and say these things, and they'll get sent SSRI or an antidepressant because that's kind of it, it kind of checks the marks. And a lot of providers are not educated or are very uncomfortable talking about hormones, especially testosterone, because testosterone is kind of a newer, I mean, it's been around obviously forever, but testosterone in women is more of an up-and-coming type of thing. It's not been well researched. So it's a very important thing to consider.

SPEAKER_02 9:27

I know last time you were like, I will fight you if you try to take my testosterone. You could take everything but that one.

SPEAKER_00 9:34

Testosterone and progesterone are the two that I swear I will go down swinging in the nursing room if they try to take those away from me.

SPEAKER_02 9:43

Well, as I'm like, we're talking about symptoms, I'm like, this kind of sounds like similarly with the progesterone and the estro estrogen too. Are do they all kind of all the symptoms kind of mix with being low in all of them? So then the treatment also kind of builds together.

SPEAKER_00 9:59

They can. And I like to do baseline labs. And obviously, when you're on testosterone therapy, that is the one that we do need to be monitoring some other labs just due to some side effects. But I always like to get baseline labs. And then again, at three and six months, whenever I put anybody on any of these therapies, but most importantly, labs don't tell us everything in hormone replacement therapy. Um it's changing. I think new research, new protocols, we're gonna get some better clarity over the next couple of years. But I really like to look a little bit at the numbers, but not concentrate on the numbers and treat the symptoms.

SPEAKER_02 10:35

Like Yeah, that's what you said last time. And I loved that because it was like there's a lot of variation, right? And we don't know as much as we could know, it sounds like.

Treat The Person, Not Just Labs

SPEAKER_00 10:43

I feel like in a lot of the testosterone levels that are what they consider normal. So, like I would draw your blood and check your testosterone level, and let's say it says, oh, it's normal at 36. Well, that that fits that normal range. But now that we're learning more about how women are feeling at the higher levels with no side effects, for me specifically, I like my testosterone levels. I can feel a difference between 200 and 250. So that's a, you know, the highest normal level is 50. So whenever a doctor that maybe is not educated in the levels looks at mine and they're like, oh my God, you're at 250, like, holy crap, that's way too high. We gotta get you down, or what that's not necessarily true. I'm not having any side effects of it being that high. And I feel my best when mine levels at that at that level. So um interesting.

SPEAKER_02 11:35

It's that's exactly what happened to me. I went like in my 30s and they were like, everything is totally normal. And then I got an antidepressant, which didn't help. But I knew early, I feel like I've always been like in touch with my body. So I knew things were changing, and I was desperately trying to figure out what it was.

SPEAKER_00 11:52

So I love that you say that. And just because mine is I feel my best at 250 doesn't mean that you know, you might come in and and we start you on this and you feel great at 100. And you're like, I want to stay in this range, or somebody might want 300 and 350, you know. And it also depends on their lifestyle. Are they do they work out and lift weights every day because they're gonna burden a testosterone more? Do they have a lot of lean muscle mass? So there's a lot of play to it. It's not a one size fits all. None of these hormones are a one-size-fits-all game playing field.

SPEAKER_02 12:25

So, at what point do you think women should consider getting these, getting labs drawn and checked, like the beginning of like I guess late 30s, like we're talking about?

SPEAKER_00 12:35

I see a lot of women coming in between that 38 and 42 level right now, or 38, 42 age range. I think that's a great time to start maybe kind of exploring, like maybe this is why I'm feeling this way. Now, of course, a lot of uh other comorbidities kind of develop in our later 30s, early 40s. Some autoimmune disorders might show up during this time. So you need to do your hopefully your provider's doing their due diligence. And if I come to you and I say, Oh, I'm so fatigued, I just don't feel like doing anything, we rule out it's not depression, anxiety. Hopefully, your provider is at least during some other labs for arthritis or autoimmune disorders, before they jump the gun and start on hormone replacement therapy, just because I feel that's important to kind of point out. Hormones aren't the answer to all our ailments. But mid mid to late 30s, 40s, I'd see that that age range, early, early 40s, probably definitely people start kind of filtering in to start getting a knowledge base on how they're they're feeling.

SPEAKER_02 13:43

With testosterone, is it one that like so I guess not just testosterone, but HRT in general? Is there like a pattern of how you usually start people, or is it like like you know, or is it just symptoms-based? Like you usually start people with some progesterone and then testosterone is what you add last, or is it like everybody's different?

SPEAKER_00 14:01

Everybody's different. I do like so everybody wants a quick fix. And unfortunately, this is not a quick fix. For me personally, it took about seven to eight months before I got my levels, my estrogen, progesterone, and testosterone where I wanted them to be. So, and it's case-specific. Some patients, if they already have been on hormones, we kind of know where to start. I like to start people usually on the progesterone pill that they take at night. I feel like that one makes the is probably the most beneficial and it is the fastest working. So they feel like, oh, this is like a huge difference. I just had two patients in the last two weeks message me after I started them on progesterone, and they're like, I noticed a difference immediately. I'm sleeping better, I feel better, like sleep is better.

SPEAKER_02 14:47

Well, then just all the effects sleeping better has on your life, too.

How And When To Start HRT

SPEAKER_00 14:50

Like that one thing, right? Yeah. If you can fix that. So I usually like to start out with progesterone. Now, if they're coming to me and they're not sleeping and they're having like a million hot flashes and some different things, we might start the progesterone and estrogen together. And then I always usually add testosterone in about three months after I start. Not always. Sometimes if they're like, if their testosterone is literally below zero, like you get that like under three level, we might throw in a little bit of testosterone just to kind of see how they react. The one thing I don't like to do is throw a bunch of new stuff at somebody because you, if they have a side effect or something's not working, we don't really know which one to adjust.

SPEAKER_02 15:31

Oh, yeah. And then you don't know what's safe. That's a great point. Yeah.

SPEAKER_00 15:35

It is, I just tell everybody low and slow. Everybody's different. Their treatment plan's gonna be a little bit different. So just because I start you on all three right at the beginning, my, you know, your friend that comes to see me, I might say because of their their symptoms or their background, like, let's do one at a time. Let's do, let's try this or do two first and then kind of play it by ear.

SPEAKER_02 15:55

Now, so I was talking to one of my coworkers. I work with a lot of women in this age gap, and I work with a nurse, so it's like we're gabby women all the time about what we're what's going on in our lives. But so, like for me personally and her, I feel like my sex drive has actually done the opposite. I feel all the other side effects, but I feel like my sex drive is like uh hyperactive, like like it would be yeah, I know it's I'm not not trying to show off, but then I was wondering, am I still having testosterone problems? And she said the same thing. She's like, I actually feel the opposite. I was like, me too, and I don't want to like brag about that because I'm not but but I don't feel that way, but I do feel the other stuff. So is that part of is that normal?

SPEAKER_00 16:34

Yeah, absolutely. I was gonna say, congratulations, because you're like one of the very few that don't have that problem. Dang, good for you. Um but you still could have some lower levels, especially so estrogen and testosterone can kind of balance each other out sometimes. One can make one higher, one can make one lower, and and probably don't want to get into the all of the chemistry of all of that. But yeah, so you can still have some lower testosterone levels and still need help with the sleep and motivation and kind of things. So we we depending on your level, we probably wouldn't you start we probably wouldn't start you off straight away on the testosterone. We would look at the estrogen progesterone first, start those, kind of see how you feel, and then maybe start a very low dose of testosterone to kind of maintain.

SPEAKER_02 17:20

Okay. What are some of the biggest myths or fears that you hear with women in testosterone? I mean, I've heard some, but like I don't know, like you know, hair growth is the biggest one I've heard people complain about. But what are some of the others?

SPEAKER_00 17:33

People are really worried about looking like waking up and looking like Arnold Schwarzenegger. You're like, that is a good word for men. Yeah, like I just tell you, like probably that's not gonna happen. But yeah, about like, you know, bulking up. Now I will say women that are into weightlifting, it definitely helps with the muscle development. But I think that I would, for me personally, I would not be prescribing a high enough dose that you're gonna be like roided out, you know, in that power building type of body style. The facial hair growth is always a big concern. Women do need to keep in mind as we get older, we naturally will start to grow more facial hair because of the hormone changes. Sometimes that's not helped by hormone replacement therapy. Sometimes it actually can increase a little bit with testosterone therapy. I've been on testosterone now for over a year. I don't have a beard. Um I I don't get the black crazy hairs yet. I mean, I might still develop that in my 60s. Who knows? Again, I don't use the high enough doses where they're they're rapidly gonna develop some problems. Now, would I say that I feel like I have like that like fuzzy hair a little bit more? Yeah, and that's that's true with aging as well. I love total side note, but I love that my daughter showed me that spray. Have you seen that for derma planing? No. Oh my gosh, it's on Amazon. It's this is just a fun thing you can do. And it's love it. Yeah, if anybody does this, you have to record yourself doing it or take a picture. So you get this spray, it's for derma planing, and it it makes you look like Santa Claus. Like you spray it on your face and it outlines every little fine hair that you have for you to use the little derma planing tools to oh wow. And so my daughter showed me this, and I I'm not kidding. Like the first time I did it, I was like, I was mortified. I'm like, oh my gosh, I had that much hair on my face, and I didn't realize it.

SPEAKER_02 19:21

Yeah, so the first time I did it too. I'm like, but I think if it's normal, I just didn't notice that that's what I tell myself. But I've been I come from a pretty like hairy family, and I have had like their hair removal from like my armpits down, but I'll tell you that always like regardless, I got like a hair on my chin in my 20s, and now I don't have more than that. It comes and goes like literally that hair that I got in my 20s, and as that same one doesn't pop up anymore, so I really do feel like it's hormonal because some periods I'll have like three black hairs pop up somewhere, and then other ones I won't see it for like six months. So, and that's been my whole life. So uh well, I can comment after I if I ever started after I do the therapy about the hair growth. So we'll have to revisit this question.

Sex, Orgasm, And Changing Bodies

SPEAKER_00 20:02

Yeah, absolutely. The other thing people get really worried about is the low voice, like they're gonna change. I didn't even think about that. That is very, very possible with high doses. So one of the things that we'll talk about probably later on in this this discussion is about the testosterone pellets. And not to go too much into them right now, but I have had a couple of patients that I had those at at other clinics and got their testosterone like super, super high and their voice did drop a little bit. Oh wow. So, and then the other, the other thing that people will will comment about or question about is the clitoris. So it can make the clitoris down in the vaginal area a little bit larger. It's more sensitive. So orgasms are stronger. We're not talking like it's gonna get like most women don't take enough testosterone in in this traditional therapy type of setting to make the clitoris so enlarged that it's like protruding or makes a difference. But that is some that's a concern that people will, you know, they've read about it or seen about it and seen something about it and they they questioned it.

SPEAKER_02 21:07

Is that related to blood flow to the area? Because then that's usually what feels good, right? So I do have another question. I'm so glad you brought that up because I heard this. I don't know if it was on a podcast or what someone was saying, and I was like, well, that's one of the perimenopause menopause things I had not heard yet, which that your clitoris can actually shrink as you get older. And so I was like, bring on the test, like that women sometimes have harder times achieving orgasms, like when they've been with the same partner for years, because all of a sudden they're they're they're they have less stuff going on.

SPEAKER_00 21:39

Yeah, so sensitivity changes down there because of blood flow. And then I don't remember if we talked last night about estrogen in the vagina. We did. So estrogen, as and it's totally sex related. A lot, one of the biggest complaints that I get from women that are post-menopausal or even just pre-menopausal or posthysterectomy is their vagina is very, very dry.

SPEAKER_02 22:01

You've heard that, yeah.

SPEAKER_00 22:03

Sex hurts.

SPEAKER_02 22:04

Oh, yeah. I've heard this one too.

SPEAKER_00 22:05

They're like, it feels like like razor blades, like whenever we have sex and I'm using water-based lubricant, like I don't understand, like, so we go through everything, like water-based lubricant, like what are you using? And it's estrogen. So estrogen decreases and it shrinks everything up. And so replacing the estrogen in the vagina specifically, so using an estrogen suppository at night before bedtime, usually just a couple of times a week, helps kind of plump up those, those tissues down there. And it helps the clitoris to keep that with testosterone, especially, kind of helps that from shrinking and kind of pulling back up inside the vagina. Another very, very common side effect, I guess, of perimenopause, menopause is women will will say, I used to never get urinary tract infections. And now I'm getting them every month, and I don't understand it because I'm peeing before and after we have sex, I'm drinking plenty of fluids, I haven't changed my diet. Like all of a sudden, I'm getting these recurrent things. And it's because everything is kind of shriveling up and it's And bacteria is being trapped, and it's the it's the decrease of estrogen.

SPEAKER_02 23:13

So interesting. That is so true. Okay, this might be a little off topic, but this is a common woman issue. I know some women just in general have trouble achieving orgasm. Like it can be difficult. So can hormone, I mean, maybe like uh take the perimenopause out of there just in general. Can hormone replacement therapy help with the help those women? Is that another thing? Absolutely. Oh my god, right through everyone listening. I'm like, what?

SPEAKER_00 23:37

That's awesome. So this is one of the topics that I talk about sex, you know, 30 plus times a day at work usually. And again, it's important. If anyone that knows me, my husband or family or family members are listening, like please close your but yeah, like it has made such a testosterone, specifically has made such a difference in our sex life. Because yeah, I think as we decrease the estrogen testosterone hormones in general as we age, things feel different down there. Sex definitely changes. Our vaginal area changes just in the way that things are are felt. Our things change. So yeah, we we take the we do these sort of these therapies and it kind of like rejuvenates everything, right? And like I hate to say it, but like, you know, my husband and I like we'd have sex once or twice a week, and I'd kind of be like, oh yeah, I'd enjoy it. Like it was great. But now it's like really great. And it's like going back to your 20s, you know, when you're like a hormonal teenager and you just want to have sex all the time or make out with your boyfriend. And it's kind of like, okay, like I'm the one initiating it way more than what I used to initiate it.

SPEAKER_01 24:47

So their husband's like, yeah, yeah, I have a weight for this.

SPEAKER_00 24:51

So like he, I've heard him at some of our friends' parties, like the topic always, you know, somebody's always gonna ask me questions about it, and he's always like, Yep, gotta do it. Like telling the husband, like, yep, definitely get her on it.

SPEAKER_02 25:04

Like, it's well, isn't that the truth though? Is that like it is such a relevant issue for so many people across your for women, especially across like your whole lifespan, really. There's not a lot of people you can talk to about it. And even when you go to a medical professional, I can't, I don't think a lot of people know enough about it to even find the information if you're looking. So it's great that like somebody finds somebody like you, they're like, oh my God, just while I've got you here.

Myths, Fears, And Side Effects

SPEAKER_00 25:29

And so I'm always I'm like I'm a lifelong learner. Like, I I plan on I'm always taking classes and I am right now I'm in the middle of another menopause certification. But my next one, actually, I want to get certified in sex therapy or like not necessarily like sex therapy, but like more in the sexual aspect of it because people don't want to talk about it, they're embarrassed to talk about it, they don't know the right questions to ask. And it's cute because my patients know me and I'm very open. Like, I'll tell you, like whatever you want to know, you know, like I'll explain it to you. But we we need to know that like everything down there does change, and especially like you said, those nerve endings, like our orgasms usually, as you get older, your orgasm, a female's orgasm, is more clitoral-based, so clitoral stimulation and not penetration-based because of the changing of everything down there. And so a lot of women might feel really awkward like talking to their partner about like I ending things up, yeah. Yeah, like maybe for what you need. Yeah. Absolutely. Like, I don't think Kyle's surprised about anything that I ask anymore. I'm like, you know, let's try this, or you know, like because I read that this works, and then I'm like, yeah, that definitely worked. Like, we're gonna do that again. But yeah, our nerve endings change, things that feel good now didn't maybe when we were in our 20s, or vice versa. So that's very, very important. And I think the testosterone, when you add that back in, as everything's kind of decreasing along with the estrogen, really is a game changer for relationships because you always hear about midlife crisis and for both. For both. Yeah, absolutely. For partners kind of growing apart. Well, intimacy is a huge part of that. Like you don't want to lose that because you want to be connected to your partner and and touch feels different and that emotional connection that's all menopause related.

SPEAKER_02 27:19

Yeah, and I've heard, I don't know if this is true, but this is why I've read is that like for men, sex is a really important part of intimacy for them to feel connected. So, like knowing that you want to be able to provide that for the person you care about. And if you're not feeling it, that's an awful feeling.

SPEAKER_00 27:35

Yeah, and and I think it needs to be now. Like, I hope some guys maybe or maybe women will show this to their husbands or significant others. Like women feel connected usually by like acts of service, like them just randomly texting, I love you, doing something in the kitchen, like doing the dishes or taking care of the kids for the night, kind of taking something off of their plate every once in a while. And then just that touch, like holding hands, touching of the back, a kiss on the neck, like just that, like that's gonna make your woman like more like that's that's kind of how women get their sensitivity of like, oh, like okay, like let's do that tonight.

SPEAKER_02 28:11

Not feeling taken care of in that way, how we feel intimately connected to someone.

SPEAKER_00 28:15

Yeah, yeah. It's a pull, you know, push-pull type of thing. So it's like if you want one thing, you need to do some things for me too.

SPEAKER_02 28:22

That's right. I love it. That's great. Um, so what forms can people take testosterone? I know you mentioned the pellets, and I didn't know this, but pellets are apparently a hot topic because when I was like researching this episode, it was like pellets are a hot topic right now. It's like oh, absolutely. So tell tell us about how we can we can take testosterone or how we should or could.

Delivery Methods: Creams, Shots, Pellets

SPEAKER_00 28:43

Yeah. So there's there's several different forms, and I want to profess this, preface this with none of these are FDA approved yet because it's considered still very controversial. Like I said, I think this is all gonna change over the next couple of years. So there's the creams and gels. So they would come from a compounding pharmacy, you'd meet with your provider, they would do your laps, talk about symptoms, and then say, okay, I think you would benefit from a cream or a gel. This is kind of usually the entry-level form of testosterone. And why I say that is you can just stop taking it, right? So it's a cream or gel you put on every day. And it's the the kind that I prescribe from the pharmacy that I use. It looks like, I wish I had some here. Um, it looks like a deodorant stick. It's a little container. You pop the top off. Your dose is how many clicks. So, like most women would start out at five or four clicks. So every morning before you leave for work while you're getting ready, you would click it. So four clicks comes out like a deodorant. You put it on the inside of your arm, the inside of your thigh, and you'd alternate every morning. So I always alternated from arm to arm and then thigh to thigh. And then it takes about 30 seconds a minute to dry. I would during that time, I wouldn't get dressed yet. I'd brush my teeth, wash my face, kind of start my morning routine. Um, you'd let that dry because it's important you don't want to touch anybody while it's dry, like your kids or you know, um the transference of it. But you let that dry, it slowly absorbs. It does take a little bit longer to get built up because it's a different delivery method that's a little bit slower using that cream for absorption. But a lot of people really like that. And most people are very, very happy with that. Once we kind of get them built up, you know, you're putting deodorant on every morning, I hope, right? Most of us are. So it's just kind of an easy, easy thing to do. Really, no side effects with that one. We're going very uh low and slow with that one. I've had one person complain she had very sensitive skin of some skin irritation on the inner arm. Once she moved it through her inner thigh, she didn't have that issue. But that's the gel and the cream. And then uh the gels, you could also put those on the back of your shoulders. That was another delivery delivery pace. Most people don't like to do the shoulders just. I'm like, that'd be hard to reach. Yeah. Um, but that's another place you could put it. The injections, again, it's it's an injection you'd have to give yourself, uh, subcutaneous. So just a little tiny little needle once a week in the stomach. There's some difference, not to go into great detail, but some providers want women to do them twice a week. Some want them to do it once a week. It just kind of depends on who your provider is, what they're comfortable with. But super tiny, it does raise your doses a little bit higher faster because it's being injected directly into the body. The one complaint that I get about those is they raise you really high or higher for that. Like, let's say you do it on Sunday. Your your level is probably like Monday, Tuesday, Wednesday. You feel great and all this energy. And then maybe the last two or three days, you're kind of like, eh, it's okay. Like, so there's kind of that peak and trough of it. So it's not a consistent level. And then you have the pellets. So the pellets are plant-based. You can get them from different med spas. Usually I do pellets, I do pellet insertions um in Godfrey, Illinois at the BioID clinic, uh separate from my other office, but it is a medical procedure. So another another thing, I guess, to talk about between all of them is cost. So the gels and the creams and the injections are usually anywhere from like$40 to$80 a month, depending on the dose and the pharmacy and where you get them. Sometimes a little bit more money. The pellets are a little bit more expensive. They're anywhere from four to five hundred dollars. However, you don't have to come and get them as often. So three to four months. So you're coming in three to four times a year. Um, it is an outpatient medical procedure kind of thing. Very, I say outpatient, it makes it sound really like a surgery. It's it's not. We have you come in after labs and consultation. You we put them in like the upper butt cheek area. I numb the area up with liaine. And then I use a little instrument that kind of inserts the pellets underneath the skin and where they dissolve over the next three to four months. The pellets are about the size of TikToks, tic-tacks, um, tick tock.

SPEAKER_02 33:05

Pellets more popular now, right?

SPEAKER_00 33:07

So they're they're super little. You can't really feel them under the skin. They dissolve pretty quickly. Um, there's always the risk factor of infection because we're putting something under the skin. I've had one patient where their body just naturally kind of expelled them. Oh, yeah, I've seen that. So kind of pushed them out. That doesn't happen very often. And I've never had anybody really have like a reaction, like a medical reaction from them. I'm sure there's cases of them, but me specifically have not had any patients say anything about that. Patients seem to love them. Usually their testosterone gets really high over the first four to eight weeks. Great reaction to libido energy motivation. They do usually feel like the last four weeks is before they're getting ready to get due for the next injection or the next uh insertion. They do start to feel that downward. Like it's not a I and when I say downward, I don't want to I don't mean it to sound like all of a sudden that testosterone stops and they're like, I'm exhausted, like I hate everybody. It's not if they can just feel a difference from whenever they first like the tapering off and starting to notice.

SPEAKER_02 34:12

Now you said something earlier about someone getting a deep voice.

SPEAKER_00 34:15

Was that was that like it was it was with the pellets. Okay. And the the particular physician that put those in at this clinic that she went to, like we do a lower dose and then work patients up and kind of make sure they're not having side effects or they like the dose that they're at, that are getting the desired effect, they're lasting as long as we can get that three to four month window. This particular provider went, in my opinion, after looking at her doses and her side effects, just went like almost triple what we would normally do. They said that that was their standard practice. So everybody's a little different. I just feel like for her, after looking at her labs, the side effects and what the doses she was on, it was just it was way too much for her. Her voice did get better, it did recover. Um it does. It it took her a little while. And of course, she was scared to death to to start on pellets again. So now she doesn't mean she's more comfortable with the cream, she's satisfied, you know, she's satisfied with that. Um but it was kind of scary for her for a minute. I don't want this voice problem. I don't want so yeah, like I I think everybody, everybody's provider is a little different on that. But I just felt like for her, after looking through everything, I was like, ugh, that probably wasn't the best, best option for her.

SPEAKER_02 35:37

Right. So what can people expect? Because we talked a little bit earlier about some of the side, well, we talked about the side effects of like maybe being low, like you know, just like the changes in our muscle, like our body, the fatigue, the brain. What things can we expect to see an improvement? And because personally, one of the things I was again laughing at work about is I was like, I went to sit down, it was probably like four months ago. And my inner thighs actually like slapped and it what it's not they're smaller than they've ever been, I feel like in that area. It's the consistency of my fat or skin down there, it's just different. It's like a it it will slap now, and before it was like thicker and it wouldn't. So, like, are those things that are possible to see a change in? Is it just the emotional things?

Results, Body Composition, And Fitness

SPEAKER_00 36:23

It's a little bit of both. Like your body composition definitely changes, as everybody knows. It was traumatizing if you can't tell. Yeah, except since you're like, oh, this happened. I mean, body composition, everything changes, or we especially women, we start to learn that lose my mind, my brain's not working. We start to lose that lean muscle mass. And estrogen and testosterone can definitely help with that. Testosterone, especially if you add in, and we're not saying go bodybuild and you know, go to the gym seven days a week and do these, just light weights, you know, getting, I have I'm looking at my three, five, and eight-pound weights over here. I have some 15 pounds. I don't use the 15 pounds very often. But even just the three to five pound, you know, and just doing some mild exercises will help keep that muscle mass where it needs to be. Unfortunately, though, you know, there are some genetic issues or age-related changes that we can't reverse. But I've seen some of some women that I guess kind of going, you know, noticing these midlife changes. I've noticed some friends of mine that are now in their 50s that are signed up now to run their first marathon. They were never runners before. And they're like, Yeah, I wanted to change my body mass. So I started lifting weights or doing yoga. And then it one thing kind of led to led to another. I have one testosterone patient right now who she's a bicycle, like she does the bicycling like hundreds and hundreds of miles. And I'm like, she's like, Yeah, I never did this when I was younger. And now I like I want to do this, like I have that motivation. So was it her, you know, just her mind changing the way she thought, or was it the hormones that giving her that medic, you know, that motivation to change? Yeah, it's really hard to say. Now I will say personally, I want to work out more than I do. And I know that I need to work out more than I do, but I'm probably the busiest that I've ever been in my life. So the hormone replacement therapy has definitely been a good, oh it's been very complementary to my current life of being a busy mom, working. You know, my my my business is is booming for this education stuff, which I absolutely love. So I probably could work on my lean muscle mass a little bit more, but the hormones have given me that motivation and that energy and that drive to do this. So you love it. Yeah, I mean, you might not be a person to exercise. I don't like exercising at all, but it'll help in other ways as well.

SPEAKER_02 38:50

Well, it's hard to do that stuff when you're tired, when you're fog, because then everything starts building up. I mean, you start spiraling when you don't feel good. It's like the things that are possible when you start clearing things off your plate can be very surprising.

unknown 39:01

Yeah.

SPEAKER_02 39:01

So what what's a realistic timeline for women to start this kind of therapy and one, start feeling the benefits, two, like get to a place where they feel somewhat stable.

SPEAKER_00 39:16

I have a couple of women in their their early 30s getting testosterone replacement therapy. A couple of them are doing pellets, a couple of them are doing creams. The main thing with that when you're still in childbearing years is we don't want to get pregnant when we're on testosterone. And we don't really know know the effects. So they need to be on birth control, tube, you know, tube tied, whatever they they need to do for that. Because I'd be very hesitant to start it on someone who's still planning on having more children. Um just because of the research, we really don't have a ton of long-term research on all these therapies. But for getting started on like feeling different, usually you feel different within the first three months, depending on uh what form you pick. The the gel takes a little bit longer, the the injections are are a little bit quicker, and the pellets are almost immediately after the first four weeks or so. So yeah, any age starting at age range, I think the youngest person I had inquire was 27. We opted not to start the testosterone with her because they still wanted to have another child or two. But yeah, so time frame is really a little on benefits, it's a little bit different on everybody.

SPEAKER_02 40:25

Yeah. So is there anything we can do? Like we've talked about weightlifting, and this is one of the examples that I have a question about. Is there anything we do that would help us do build testosterone in ourselves? Do those activities actually help, or are they just better supportive?

SPEAKER_00 40:41

Better supportive, definitely. But there's a lot of diet. There's I don't have it in front of me, and I wish I could blow it up in my brain. There are a lot of diet therapies and exercise regimens that will help naturally increase testosterone, more so in men, because they naturally produce testosterone. Dr. Shearer, uh, Jacob Shearer is one of the chiropractors that I work with that I do pellets with. If you go to his business page, I think it's his personal Facebook page, but it's private because he or he's public because he talks about his journey with different things. He naturally increased his testosterone by doing some diet changes, some uh weightlifting changes. I can't speak to 100% how it's affected for women because our, we don't have the sex glands that naturally will produce the higher levels. But I know that there's a lot of natural supplements that claim to, but I'm not really well versed on those. But yeah, definitely the exercise is a big proponent. You know, exercise affects hormones all around on many different levels.

SPEAKER_02 41:44

That's good to know. Is there anything that we may be doing that would unintentionally lower or be work against us with hormones at this age that we could be doing? Like, is there any diet things? I mean, everyone always says like avoid sugar, but is there anything that we have that works against us with hormones?

SPEAKER_00 42:02

Alcohol, alcohol consumption in diet, you know, the alcohol sugars and glutens really processed foods. The same ones that, you know, they I feel like that it's a we beat this to death, like on preaching about decrease your sugar, decrease your processed foods.

SPEAKER_02 42:22

It's the same stuff every time, but it still was good for you.

SPEAKER_00 42:25

Absolutely. Like it's still, it still is very relevant, especially when talking to talking about hormones. Yeah, that makes sense. Yeah, because if you look at a lot of our younger patients that are just starting their menstrual cycles, usually we have a lot of women who will come to me that are overweight that aren't having regular menstrual cycles, and it's because of their diet. So it's all it's all still related as we get older. It just kind of affects us in different ways.

Age, Safety, And Timelines

SPEAKER_02 42:51

Oh, yeah, we've all heard of that when you were really young. I remember like there were some really active, very small girls that would delay their period. Like I know like professional athletes, if they were very intense, their periods get delayed sometimes, even into their 20s from that. Yeah. Interesting. I never like obviously you would think that that would connect, like, oh, but it's all the house. Yeah, of course. So if women are listening to this and or let's say they go to get it checked out and they feel dismissed by whatever provider, or like they're just or they're told like everything is normal, and they're like, wait, but it's not. One, what advice would you have? And two, are there things they can ask or say to their provider that would help them understand whether that provider has like a good understanding of hormones and they should move on or not?

SPEAKER_00 43:35

Yes. So I've I'm a big proponent. If you feel dismissed by your doctor for any concern, find another doctor.

SPEAKER_01 43:43

Me too. You need to be heard, you need to trust them.

SPEAKER_00 43:46

I hope that I have never made any of my patients in the last 12 years feel that way because that to me is like right there. If you don't feel comfortable or something is said that you're just like, I that doesn't set well, find another doctor. There's plenty of other providers out there. For hormone replacement therapy, menopause, perimenopause specifically, there the menopause society has a website. I don't have it in front of me, but it's it's if you search the menopause society, it is a a group, tons of questions to ask your doctors, tons of educational information. It also lists the prior providers in your area by zip code that are going through the classes, that are getting the certifications, that have knowledge that are not going to turn you away if you bring up the big, you know, HRT and they're not gonna shut down immediately. So make sure that your provider, or if you're looking for a provider and you're not feeling comfortable with who you're with, go to that website. And that is it's amazing. You can order books on it, reading material. They have free educational material on there. They have material material for providers and to patients about the what you should be feeling, what you shouldn't be feeling, how to fix it, lifestyle changes that will help. So it it's a it's a big resource.

SPEAKER_02 45:07

Great resource. I think you might have mentioned that last time about being able to find the providers and I forgot. But I wish there was that kind of database for everything. Like that's awesome. I love that. Okay. Well, so I la I always ask everyone what their go-to self-care is, but we've already done that. But is there more anything you would like to say, I guess, to women who would like are in this stage of life right now? Like, would is there anything you you would like a message that they need to know?

SPEAKER_00 45:38

Don't suffer. Like I feel like so many people, so many women are going through this. They don't really, maybe they don't have the friend group or them or the sister to kind of talk to them about all of these changes. My mom specifically, like in the 90s, had a hysterectomy. She doesn't, you know, like she can't relate to a lot of these, these things that I was kind of going through. And that's why I kind of took it upon myself when I realized that, oh, I'm in my early 30s or early 40s, and I have women that are coming to me asking me these questions, and now I'm experiencing the same thing. That's why I kind of set out the last couple of years to learn all of this for education purposes. But yeah, ask the questions, don't suffer, and and find, I think we talked about this, find your girlfriend group.

SPEAKER_02 46:26

Find that I love this. Find your people. I love this.

SPEAKER_00 46:31

Because I I couldn't do everything that I'm doing without my supportive husband and family and my group. Like without my friend group, oh my gosh, I'd be totally just lost. And it doesn't have to be a big friend group, you know, just finding that one or two people that you can confide in. So find your people and find your voice. Like so many good resources, resources.

Lifestyle, Diet, And What To Avoid

SPEAKER_02 46:51

Great, great advice. I love that because if I think back to my when my mom started this, and I think she started in her late 30s and raw, and now she's like full blown in like the ends of it. Like she still has a period, but like she's feeling the mass, you know, she's in the tail end of it. But I think for her, it started quite early. And I can remember so much shame. I just remember like my friend cut her hair and was like, you know, I got some hair thinning. Like, and she was like, not another word, like dust stare. My friend calls me up, like, oh my god, I said this to your mom. Like, I just remember it was so not talked about. And you know, like people just suffered in silence and didn't know you don't know what you don't know, you know.

SPEAKER_00 47:29

Yeah, and I think we're in a really exciting time for women right now. Like, I feel like we're getting seen now in healthcare a little bit more than what we were. I think podcasts like yours, especially like highlighting women in different fields and in different topics, and we have access to more information now. So people maybe aren't feeling as kind of alone in these situations. It's just it's kind of exciting and it's fascinating. And I'm glad I'm so excited to be part of like kind of this new like journey for us. I don't want my daughter, I only have one girl out of seven kids. We just have the one girl. And I don't want her to have to. I mean, she she trust me when I say we're very open. She tells me everything and probably more than I want to know sometimes, but I don't want her to feel uncomfortable going to her doctor when this kind of stuff happens. Yeah, or her friends. Her girlfriends call me all the time and you know, will ask me questions. Is this normal? So I I want that to be more than norm. I want, you know, sex to be talked about a little bit more without it being so taboo still. Um I want the changes.

SPEAKER_02 48:35

Talk about the right parts of sex and not you know, that's there's a lot to talk about.

SPEAKER_00 48:41

Absolutely. Like, yeah, it's it's good. Like, you know, like we need to embrace that. There's it's it's necessary. Yeah, I just want I'm the voice just be heard. I love it.

SPEAKER_02 48:54

Well, thank you so much for being an advocate for all this positive change and coming and teaching us, and then again, and good luck to you. And if I you start, if you go back for sex therapy, I would love for you to come teach them too.

SPEAKER_00 49:07

I just started looking up those certification classes about a week or so ago. I'm like, that's that's I have a list, like my bucket list. Oh, my two certifications and that that went on there. So, yes, it'll be coming definitely.

SPEAKER_02 49:20

I love that. I love that. Well, thank you so much. It's been an absolute pleasure.

SPEAKER_00 49:24

Absolutely.