Is He Okay? Seven Subtle Signs of Low Testosterone — And Why You Need to Know This Too

Johanna breaks down seven subtle signs of low testosterone that have nothing to do with libido — and why every woman and man in midlife needs to know them. Drawing on an episode of The Dr. Tyna Show, she walks through the quiet symptoms doctors miss: the emotional flatness, the disappearing muscle, the burnout that never lifts, the joint pain that came from nowhere. Plus — Australia just became the first country in the world to approve a testosterone product made specifically for women. Half of this episode is for the man in your life. The other half? Might be about you

🤩•  The Dr. Tyna Show, Episode 349: drtyna.com / @drtyna

🤩•  AndroFeme 1 (Australia — first women’s testosterone product): lawleypharm.com.au

🤩•  PBS Petition (Australia): change.org — search “Subsidise Testosterone Replacement for Women”

🤩•  Aviva Bio / AVA-291 (US development pipeline): aviva-bio.com

🤩•  Check your US practitioner’s credentials: ama-assn.org/doctor-finder

🤩 • https://www.joinmidi.com

Transcript

SPEAKER_00 0:42

Hi friends and welcome back to Not Your Mother's Midlife. I'm Joanna, and today's episode is a little different because I'm going to start by talking about men. I actually like this one. This is exciting. I want to share this. Um, because it's gonna help all of us. I was listening to uh an episode um recently on the Dr. Tina show, and she breaks down seven subtle signs of low testosterone in men. Okay, we think we all know, but no, you don't. Signs that have nothing to do with libido and erectile dysfunction. See, told you. The ones that most guys aren't even registering as hormonal. And as I was listening, I had two thoughts at the same time. Thought one, every woman in a relationship with a middle-aged man needs to hear this, because we are often the first ones to notice that something is, you know, like kind of off. And thought two, I have when I was listening is hang on, this sounds really familiar because testosterone isn't just a men's health issue. Women's testosterone drops significantly during perimetopause too. So we're gonna talk about both today. But first, let's talk about testosterone. I know we're gonna talk about men, but like first let's talk about testosterone and women because testosterone is not just a male hormone, but we know that because if you've listened to my previous episodes on hormones, you found that out. Where women women produce it too, in the ovaries and the adrenal glands, and it plays a significant role in our energy, mood, brain function, muscle mass, confidence, and yes, our libido. Everyone just thinks testosterone is libido, but it's so much more. Levels start to decline in women from our early 30s, and by the time we hit menopause, testosterone can drop by around half compared to the peak levels that we had when we were younger. And because the decline is gradual, we tend to write the symptoms off as stress getting older or just doing too much. So everything I'm about to walk you through, keep both ears open, one for the man in your life and one for yourself. Okay, let's start with the seven signs that doctors are missing. Let's just deliberately skip the obvious ones, like a bit libido and erectile dysfunction. Okay, we're not just gonna be talking about dicks. Because those are the signs that always get the attention first. But there are earlier, quieter signals, the ones that get dismissed as stress or aging for years before anyone connects to the dots that it's testosterone. Sign one, losing hair where you didn't expect to. Not scalp hair. Shin hair, you heard that right, shin as in below the knees. Testosterone plays a role in regulating body hair, and the lower legs are one of the first places the decline shows up in men. For women, the parallel is thinning hair more broadly, like on the scalp, eyebrows, body hair. But if you notice your man has started to lack hair below the knees, could be a sign. I'm not talking about hair that's just rubbed away by socks, by the wearing socks on hairy legs. Sign two. Muscle is disappearing and belly fat is appearing. Testosterone is critical for maintaining muscle mass, and when it drops, men start losing muscle, particularly in the upper body and gaining fat around the abdomen, even without changing how they eat or move. For women, this is one of the most frustrating experiences of perimenopause. Doing everything right, everything as you always have been doing, and watching your body composition change anyway. So frustrating. Sign three. The drive is gone. Not sex drive. Okay, that happens to not sex drive. That's what everyone is the first thing that everyone always thinks about. The drive to do anything, the ambition, the motivation, the competitive spark. The man who used to love pushing himself, competing, who was always working on something or planning something. Now he just sits. He's not depressed exactly. He's he's just flat, just blah. For women, this shows up as a loss of that inner spark, that the thing that made you feel like yourself, the enthusiasm, the curiosity, the sense that you have things you want to do, self-confidence, feeling sexy and attractive even. When testosterone drops, it can take that with it, sadly. Sign four. Strength is declining and recovery is brutal. Not just muscle loss, actual strength loss. Men start noticing they can't lift what they used to. And when they do work out, recovery takes forever. For women, impaired menopause and menopause, this is why resistance training becomes absolutely necessary that we've spoken about in previous episodes. You are fighting the same battle. You just may not have been told that's what it is. Sign five, emotional flatness. This is the one I think is most overlooked. And for women in relationships with men, the most quietly painful. In the show, Dr. Tina describes it as emotional blunting. That makes sense, right? He's not sad, he's not angry, he's just not really there, he's not really present. He used to laugh more, feel more engaged, but now there's a blandness to him. And I'm not saying that in a mean way, like, oh my god, my husband's just got so boring. There's just like something that changed. He's not he's not his usual self. I think if you if you've been in that relationship, you probably know exactly what I'm talking about. Testosterone interacts with serotonin and dopamine. They're neurotransmitters that regulate mood and emotional response. When it drops, it can genuinely flatten effect in a way that looks like depression, but it doesn't respond to antidepressants because the root cause is hormonal. So for women, research on over 500 women treated with testosterone found the three symptoms most likely to improve were loss of interest in most things, crying spells, and then loss of interest in sex. Mood first, libido second. Or libido, libido, libido. Sounds like the beginning of La Verne and Shirley show, if you remember that. Yeah, that's how old I am. Libido, libido. Um, that's not the order we usually hear about, okay? So mood first and libido second. We always think it's libido, but there you go. Sign six, burnout that never lifts. This isn't tired after a hard week. This is the tired that doesn't go away after a holiday, after a long sleep, after taking it easy for a month. The tank just never feels like it's full. Does that sound familiar? This is one of the most common things I hear from women in perimenopause. Bone deep fatigue that rest doesn't fix. That's not a character flaw, that's a hormonal signal. Sign number seven, joint pain and inflammation that seems to come from nowhere. I think we're all starting to feel that. Testosterone has an anti-inflammatory property. And when it drops, the body loses some of that natural protection. Pain that gets written off as old injuries or just getting older, wear and tear, could actually be a downstream effect of low testosterone. And for women, joint pain is one of the most commonly reported and least discussed symptoms of perimenopause. We are not just imagining this joint pain, especially shoulders. A lot of women have that frozen shoulder. Okay, so what does testosterone therapy actually look like? I know so many of you are already thinking, all right, this is interesting, but what are the actual options that I have? What does it even come in? Because it's not just one thing. Testosterone therapy comes in several different forms, and they work quite differently. Let me walk you through the main ones for both men and women. Injections, the most common form for men. Testosterone is injected directly into the muscle, usually the thigh or the butt or the glutes. The word makes me laugh. There's always something that makes me giggle. They're typically given once a week or once every two weeks because it goes straight into the bloodstream and it works fast and levels are predictable. The downside is the peak and trough effect. Feeling great right after the injection, then starting to drop off before you get your next injection. For women, injectable testosterone isn't generally recommended because the doses are much harder to control, and the tiny amounts women actually need and the levels, it can be overshot really easily. Gels and creams. This is how I take my testosterone, the gel. They are applied to the skin, usually the shoulders, upper arms, or inner wrist. You know what? I apply mine to the thigh as I'm already shaving my legs. So if I go a little more fluff there, it's not a big deal. I I don't want a furry teen wolf inner wrist. I don't know. I'll keep it to my legs. I don't want it on my wrist when I'm spraying my perfume and there's a little tuft of hair. Okay, get back to it, Joanna. The advantage is a steadier daily release, which means more consistent levels and fewer peaks and crashes. For men, products like androgel and testa gel are common. One important heads up. If you're using a gel, you need to be careful about skin-to-skin contact with a partner or children or pets before it dries because the testosterone can transfer, and that's not safe. For women, a low-dose cream or gel applied to a small patch of the skin is actually the preferred delivery method because you can control it. It's easier to control. It's much easier to use tiny doses that women need without overshooting and getting all the side effects. I use the men's version. It's a small packet, probably the length of my pinky finger. For men, they usually use a full one once a day. I cut the top off and I use I I start with a P size and I just felt like I needed more, so I've gone up to a I wouldn't say it was a grape, more like a large blueberry, I guess. I don't know what whenever it comes to women, we're always having to talk about food. When you're pregnant, it's like, oh, your year was the size of an apple, now it's the size of a a watermelon, whatever. And now we're using testosterone and we're still talking about food. So yeah, I use about a large, healthy, plump blueberry-sized dollop on me leg. I after I do my dose, I seal it clothes with a bubby pen until the next dose. Really high tech here. That got off on a little tangent, but yeah, now you know what I what I do? Sharing that intimate information. Next we have patches. Similar concept to the gels, you stick a patch on your skin and it releases a steady, controlled dose over 24 hours. Similar to the um estrogen patches or progesterone patches, the women use. They're non-invasive and straightforward, but some people find them irritating on the skin and they need to be replaced daily. Pellets. This is the set it and forget it option. Small cylinders of testosterone are implanted under the skin, usually near the hip, in a brief in-office procedure. They slowly release testosterone over three to six months. The obvious appeal is there's no daily application, so you never forget a dose. Um, no weekly injections and just steady hormone. But there are drawbacks. Once they're in, you cannot adjust the dose. If your levels get too high, you can't dial them back. And pellets are particularly problematic for women. The doses can easily overshoot into levels far higher than physiologically normal for women, which can cause permanent side effects like voice deepening. I could do with that because I feel like my voice is a little high-pitched, so maybe I do a pellet for three months and fix my voice. Pellets are popular through compounding pharmacies, but are not genuine not generally recommended by menopause specialists for women for exactly this reason that I stated before. Oral testosterone. The newer oral formulations are available for men that bypass the liver more safely than the old pills, so that's great. But for women, oral testosterone is generally avoided, but it can negatively affect cholesterol levels. So transdermal, meaning through the skin versions, is almost always the preferred route for women. The bottom line on delivery. For men, injections and gels are the most common. For women, a low-dose gel or cream is the gold standard. And you should really monitor your blood levels regularly because getting the dose right is everything to make you feel great. Now, here is the news that genuinely got me fired up. Until recently, there was not a single testosterone product anywhere in the world, anywhere in the world that was specifically approved for women. Not one. Men have had dozens of FDA-approved testosterone formulations in the US alone, and when a woman asked her doctor for the same hormone, the doctor had to say, there is no approved dose for you. We'll use a men's product, which I am doing, at about a tenth of the dose, off label, and do our best. Yep, that's what happened to me. And it's not covered by insurance. That has been, which is okay, because the box lasts me a long time, and the pharmacy actually did find a coupon, so it was the price was cut in half, but it is not cheap at all. And yeah, because I'm using smaller doses, the packet lasts me longer. Gosh, I give you the most boring, like private information of mine. Now you know about my insurance and my finances. That has been the reality in the US and everywhere else in the world, except for my home country, Australia. Yay! In November 2020, Australia became the first country in the world to approve a testosterone product specifically formulated for women. It's called Androphem1. It's a 1% testosterone cream made by a Perth-based company called Lawley Pharmaceuticals. The testosterone in it is body-identical, meaning it's the same testosterone the ovaries and adrenal glands would naturally produce. It's applied daily to the skin in a small measured amount using a dosing syringe, and it's approved for post-menopausal women experience what's called HSDD. It's hypoactive sexual desire disorder. But you know, you just go in and pretend you've got it and get the testosterone. That's what I would do to say, oh, I've got HSTD and info and have sex. Oh, here you go. It's some medication. They don't know if you've got it or not, because it's all in your your own body. Anyway, that's what I'd do. I'd trick them. This is not medical advice from Joanna, but that's just what I would do. If I was one of you ladies in Australia, go and just get it. Okay, so the um HSTD, the hypoactive sexual desire disorder, it's the clinical name for persistently low libido. That can cause genuine distress for both women and the men in your life too. He's probably thinking it's his fault. Anyway, the oh gosh, I go off. The founder of LOLLEAC called it a global milestone in gender equity. The first time a regulatory agency anywhere in the world had approved a treatment for sexual dysfunction specifically for women. And it really is significant. This is not a men's product reproduced. It's a cream designed from the ground up for female at the right concentration for women's bodies. Women using endroferm report improvement, not just in libido, but in energy, motivation, brain fog, joint pain, and exercise performance, which hello is everything we just talked about in the seven signs. Same hormone, same symptoms. But here is where it gets frustrating. Even in Australia, the fight isn't over. Androphim is approved and available by prescription, but it is not subsidized on the pharmaceutical benefits scheme, the PBS, which is Australia's equivalent of insurance coverage for medications. So without BPS listing, women pay full price out of pocket, around 107 to 140 per tube. And while nine testosterone products for men are PBS subsidized, there are zero for women. In December 2025, the Pharmaceutical Benefits Advisory Committee declined to recommend Androferm for PBS listing. Lowly has now taken the decision to the federal court, and there are petitions circulating with thousands of signatures. The argument is simple and hard to argue against. Women are currently paying up to 14 to 16 times more than men pay for treatment of equivalent conditions. That's a gender gap in healthcare access, full stop. Australia created this product. Australia is the only country in the world that manufactures a testosterone cream specifically for women, and Australian women are still fighting to afford it. That tells you everything you need to know about how slowly this system moves when it comes to women's hormonal health. And for us in the US, where do we stand? Well, right now there is no FDA-approved testosterone product for women in the United States. Zero. The FDA rejected a transdermal testosterone patch back in twenty back in 2004, citing concerns about long-term safety data. Testosterone gel trial failed at the efficiency phase in 2011, and since then, crickets, nothing made it through. So what US doctors do is prescribe, like we talked about before, they describe off-label using men's products at roughly one-tenth of the Maldose trying to hit the tiny physiological range that's appropriate for women. Some doctors are really skilled at this, others aren't familiar enough with it to feel confident. I know for a fact my doctor and also the pharmacy, when I got picked it up, they're like, okay, just do one tube every other day. That should be that should be good. And I was like, uh, no, because I'd done my homework and I knew. And so I told my doctor that. I'm like, that is not correct. And he's like, oh gosh, okay, thank you. And I actually had to inform my GP, don't be telling other women to do that. Just start them off in a P size and maybe move them up to a blueberry. And he didn't know that because these GPs, they don't learn about this. They probably spend like half an hour about women's hormones in school. So sometimes you've got to help your doctor, and thank God I've got a gorgeous doctor who's open to that sort of a conversation. Maybe yours wouldn't be as welcoming to that. But mine, my wonderful doctor was very thankful that I told him that. And some doctors just aren't um familiar or confident enough to even prescribe testosterone. So you might need to shop around. Sounds terrible, shop around doctors or get on to MIDI Health. They are great. I will put them in the show notes again. I've listed them in almost every one, but they are a great company to get onto and to talk to a specialist who specializes in hormones. That's how I found out a lot of the information about it. But she couldn't prescribe it for me because she had to be in Texas to prescribe it because some states are funny like that. And I was talking to her and she's in Georgia, so I had to go to my GP. So luckily he's a great one, and he prescribed it and listened to her recommendations that she had told me, like how much to take. So that's what just goes to show you some doctors who are very well versed in hormonal treatment, and your GP might not be the one. Even your gynecologist or your obstetrician might not be the right one to talk to. So you if you come up against walls like that, get on to MIDI Health. Go back and listen to my previous episode and I'll explain that more. But yeah, I'll put them in the show notes. And because it because this is off-label, insurance almost never covers it. I know mine doesn't. And meanwhile, over 30 FDA-approved testosterone formulations exist for men. Lucky them. Women, zero. But there is a movement, and I want you to know about it. In July 2025, a formal submission was made to the FDA specifically advocating for an approved testosterone product for women, citing the Australian data and over four years of real-world safety evidence from AndraFirm. The submission noted that in Australia, with over over five years of use, only two adverse events had been reported to the database for the product. Two. In January 2026, Aviva received formal FDA guidance on the development pathway for that drug. And in November 2025, the FDA removed the black box warning from all estrogen-containing hormone replacement therapy products for menopausal symptoms. Yeah, go back to my hormone replacement and I explain that in more detail what that was all about. That was like fantastic. So Momentum is genuinely building. The science has been there for years, and Australia has done the hard work of proving it can be done safely. And I really truly hope the US gets there soon. Because use a man's product at a fraction of the dose and hope it's the best. It's not good enough for women whose symptoms are real, documented, and treatable. Okay, now we've talked about the actual testosterone treatment. But before you even have to go there, there are actual real lifestyle changes worth knowing about that could boost your testosterone. So try these first before diving into the testosterone replacement. Resistance training. Lifting heavy is one of the most well-documented ways to support testosterone production. Compound movements like squats, deadlifts, rows, not just cardio. Sleep. The majority of testosterone production in men happens during sleep, and poor sleep actively suppresses it. Seven to nine hours is not optional. It's hormonal maintenance. Managing chronic stress. Chronically elevated cortisol directly suppresses testosterone production. So if you are stressed and overworking, that could be causing your testosterone to drop. Something that also helps is infrared sauna for hormonal health and inflammation and your body composition. Excess body fat, particularly around the middle, converts testosterone to estrogen through a process called aromatization. Carrying extra weight actively works against your testosterone levels. So maybe just having a few lifestyle changes and you'll feel like your your mood and your body, everything improves. So maybe try that if we get into the therapy. Whatever, do whatever you want. I'm just giving you the information. Anyway, when I listen to the podcast, she ends the episode talking directly to women. We are often the ones who notice first. We're the ones who are more sensitive to changes in those around us. It's just how our brain works. So if you're thinking about someone in your life, a partner, a dad, a brother, a friend, who seems like just a little dimmer version in themselves, this might be the door to open. And don't go up to them and say, hey, I think your testosterone's low. It wouldn't be received very well. Just maybe say, hey, I've been learning about how hormones shift for men and women as we age. Maybe we should both go and get some blood work done to test our levels. That's it. It's enough to open up that conversation. Finally, we are just starting to have loud enough conversations that people are listening to us and doing something about it. It's not your personality that's changing. It's not aging gracefully or otherwise. It's a hormone and it deserves the same attention that we've started giving to estrogen and progesterone. I'll link the Dr. Tina Show episode in the show notes and everything else I've spoken about, so just scroll down and take a look and click. The episode is under 45 minutes. It's really well done and worth listen worth listening to and sending directly to the man in your life. Or just play it when he's around and listening over your shoulder or in the car. Sneaky. As always, nothing in this episode is medical advice because I'm not a doctor. Take the question your questions to a professional who knows their stuff. If this was useful, please share it. Send it to group chat or share it on your social media because I guarantee someone out there needs to hear this. And until next week, I'm Joanna and this is Not Your Mother's Midlife. Bye bye.