Reinvention Is a Permission Slip (Plus Testosterone, Drive & the DHEA Trap)

Midlife reinvention isn’t glossy, curated, or hashtag-friendly. It happens while you’re still paying bills, packing lunches, and doing the work you already know how to do.

In this episode of On the ’Mones, I reflect on standing on stage at a menopause education event in Sydney and asking myself a quiet but clarifying question: How did I get here? Not because I suddenly became more qualified, but because I finally gave myself permission to be visible.

We talk about reinvention as access, privilege, momentum, and integration, not burning everything down, but letting hard-earned skills show up in new places. I unpack what it’s like to hold two truths at once: deep medical experience alongside total digital naïveté, and why learning at midlife is uniquely powerful.

From there, we get properly nerdy. I break down testosterone in women, what it actually does, why it’s not a “male hormone,” how it affects drive, energy, cognition, and libido, and how it fits into hormone replacement as part of a team sport with oestrogen. We talk indications, monitoring, side effects, and how to start a sensible, grounded conversation with your prescriber.

And in Woo of the Week, I take on oral DHEA, the internet’s favourite almost-hormone, explaining why swallowing raw hormonal ingredients and hoping for the best is not biology, it’s wishful thinking.

This episode is about hormones, yes, but it’s also about visibility, work, value, and giving yourself permission to evolve without abandoning who you already are.

Whether you are in perimenopause, approaching menopause, or simply trying to understand your hormones, I've got you.

Read more about this episode at Medication Clarity Clinic, Kate's own medication education and telehealth consulting site: https://medicationclarity.com.au

Transcript

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You're listening to On the Moons, where we have conversations about hormones, midlife, and the moments that make us wonder Is it just me? I'm Kate. I'm a 48-year-old pharmacist and newly minted perimenopausal oversharer. This is where we talk openly about the changes we aren't prepared for, so we never have to feel alone in them again. I acknowledge the Camaragle people of the Iora Nation, the traditional custodians of the land which I am recording today. I pay my respects to elders past and present, and I extend that respect to all Aboriginal and Torres Strait Islander peoples listening. Always was, always will be, Aboriginal land. Hello friends. Thank you for tuning in from around the world. A special welcome to our new friends joining us from Montclair, New Jersey, Ottawa, Ontario, and Washington, Louisiana. Different hemispheres, different accents, same weird midlife biology. I'm going to answer the questions you didn't even know you had about testosterone, how it fits into the broader hormone replacement picture, what it can do, what it can't do, and how to start a sensible, grounded conversation with your prescriber about whether it's right for you. That will take us beautifully onward into Woo of the Week where we're talking about oral DHEA supplements, the internet's favorite almost hormone, and why biology has some strong opinions about it. But before we get into hormones, pathways, and prescriptions, I want to spend a little bit of time on something that isn't a medicine, a guideline, or a lab result, but it is very much part of midlife health, and that is reinvention. Not the glossy Instagram version, the real one, the kind that happens whilst you're still paying the bills and packing the lunches and doing the work you already know how to do. Because last week I had one of those moments that made me stop and take stock. Picture this. I'm standing on stage at the Manly Pavilion. It was one of those perfect Sydney summer days that feels almost staged. Blue blue water beyond the windows, boats bobbing lazily in the harbour, the spit to manly walkers drifting past outside all lycra and purpose, and across the water the soft curve of Rose Bay sitting quietly in the distance. Inside the room was full in that very particular way that only happens when women gather intentionally. Linen dresses, colour, ease, confidence. It was also unmistakably a Northern Beach's Sydney crowd, predominantly white, slim, well dressed, self-possessed. Tickets were two hundred and twenty dollars and it was a Friday, and that alone shaped who could be there, who could take the day off, afford the ticket, linger with a drink and a conversation. That doesn't make it wrong, it does make it specific. And it reminded me that access to reinvention, to education, to health conversations, to time and space isn't evenly distributed. Some women are given the microphone earlier, others are still carrying the load that makes attendance impossible. The space itself was beautiful and intimate, low ceilings and dim lights, flowers everywhere, bowls of fruit cut in halves and arranged with just enough cheek to not so subtly musquerade as vaginas. Think guava, fig, pink grapefruit, you get the picture. Booths lined the walls, bespoke skin care, vibrators displayed without apology, a pelvic floor chair promising to do your keegles for you, breast checks by breast screen Australia, a bone mineral density scanner humming away in the corner. A DJ, a middle aged woman, of course, set the tone while the staff, tastefully dressed in white and beige, expertly navigated the room with champagne and cold drinks and plates of genuinely good food. Barbecue garlic prawns, little arangini balls, and bowls of seafood paella. Yum. At one end, a small stage with chairs drawn close, big screens projecting to the back of the room, designed not for performance but for conversation, the kind that feels safe, generous, and powerful in a space shaped by comfort and access. It's a female health immersion, still so hot right now, a menopause education event. And there are health experts being interviewed on panels, Dr. Carrie Cashel on hormones, Michelle Bridges on Strength in Midlife, Lane Beechley on breath work and self-actualization, Georgina Wheelan, a clinical psychologist and sex therapist, and little old me. So I'm on stage, microphone in hand, room full of women, champagne flowing, all leaning in to hear me talk about testosterone. And I had this thought. Not in a panicky way. I was the right amount of nervous where you can get your groove on. I had had ten milligrams of propranolol, so maybe that helped. And not in an I don't belong here kind of way, although the imposter thoughts were lurking, always lurking, just beneath. More in a hmm kind of way. Like when you look back at an old photograph of yourself wearing your mum's Ken Donne collots with more hairspray in your fringe than your lungs can realistically be expected to handle, how you were and what you thought at the time and realize you couldn't have predicted any of it. But somehow it all still makes perfect sense. I've spent twenty five years in hospital pharmacy, and if you know that world, you know it shapes you in very particular ways. You learn to be precise, you learn to be careful, you learn to speak when needed and stay quiet when not, and you learn that the work matters more than the recognition. And that is not a criticism. Hospital pharmacy is very good work. Medicines are still the way we treat the majority of illnesses, and medication misadventure is real and harmful, so the role of the hospital pharmacist is crucial to patient safety. But hospitals don't reward loudness, they reward reliability and procedure. So for most of my career I was very comfortable being behind the scenes, fixing things, translating complex information quickly and efficiently, and making sure the right medication made it at the right time to the right patient, even if no one noticed. I never imagined myself on stage publicly talking about libido or testosterone in women. I will add here that when I was the chief pharmacist, my team and I did one of those personality profiling things, like Amyas Briggs, you know the ones. I think HR had decided all the hospital teams could benefit from knowing how to communicate with each other. Probably a noble thought, but I'm pretty sure we all just reverted back to our way of doing things immediately after. Anyway, it was telling because I was in one quadrant of the scale, top right, and every single other member of my team was in the diagonally opposite quadrant. As in, my personality was expressive with a low degree of attention to detail, and everyone else's was procedural with a high degree of attention to detail. Now I would say that you would want your pharmacist to have a high degree of attention to detail, and I know that that is something I need to put active effort into when I'm working. My attention to detail is so low I can't be bothered concentrating long enough to fill out a form. When we go overseas, my husband does the immigration form because I just cannot be asked reading the whole thing. And over the years I have developed my own set of coping strategies such that I can execute my job accurately and efficiently. But I much prefer the chat with the patient, with the clinician, with the MDT. I like the collab. So here I am now on stage. Same knowledge, same training, same values, different expression. What changed wasn't competence, it was permission. I think this is an important point. I didn't suddenly become more knowledgeable, I didn't suddenly become more qualified. What changed was that I gave myself a permission to use my experience differently. And midlife has a funny way of doing that. Because as hormones shift, so does your tolerance for shrinking yourself. You start to feel quite viscerally that time matters. Not in an urgent way, not yet at least, but in a clarifying way. And when I started speaking publicly, online, on the podcast, at events, what surprised me most was not the fear, although hearing and seeing yourself back is very confronting. It was how many people were already there waiting. I will say this, this reinvention period has been overwhelmingly positive. Yes, it's uncertain at times. Yes, it's messy around the edges, but I've met some of the most generous, encouraging, supportive people through this process. People who open doors, offer advice without gatekeeping, share their own missteps honestly, say you should be here instead of who do you think you are? That has been one of the greatest gifts of this phase. There is a network of women and men who genuinely want others to succeed. And once you start moving, you start finding them. They start finding you. That's not luck, that's momentum. I do want to talk about the practical side because optimism without realism isn't helpful. It's not all champagne and flowers and the sisterhood cheering you on at the shores of Sydney Harbour. I'm still working in palliative care. I still work in community pharmacy, and alongside that I'm building this other strand of work. Health communication, education, speaking, media. And yes, I am actively working out how to make that paid work. Not because it's frivolous, because it's valuable. There is a strange cultural expectation, especially for women, that meaningful work should be done for free, or that it is dirty to expect payment for your time and knowledge. But expertise takes time, communication takes skill, responsibility takes energy, respect, and trust. Wanting that to be sustainable is not greed, it's respect for your own labour. And the truth is, most transitions aren't a clean break. They're a bridge, and not a very sturdy one at that. You have to walk across whilst holding on to the shore behind you. One of the strangest parts of this phase is holding two truths at once. I am deeply experienced in medicine, I am deeply inexperienced in digital media. I can explain complex pharmacology confidently and still feel unsure, nay, befuddled about how the algorithm works. I can speak on stage and still feel awkward filming in my own house. That doesn't mean I'm doing anything wrong, it means I'm learning. And learning at midlife is powerful because you're not trying to become someone else, you're expanding who you already are. I don't think midlife is about burning everything down, I think it's about integration, taking the skills you've already earned, the ones you've paid for with years of effort, and letting them show up in new places. You don't lose your credibility when you change format, you don't lose your seriousness when you become visible. If anything, you gain reach, and that's what I've come to understand. This work, this talking, teaching, explaining, is an extension of what I've always done. It just happens to be in public now. So if you're standing on your own edge, if you're listening and you feel that familiar midlife restlessness, if something that used to fit no longer does, if you feel a quiet pull towards something new but you're not sure how it becomes real, I want you to hear this. You don't have to leap, you don't have to quit everything, and you don't have to be fearless, you just have to start moving. Talk to people, share what you know, say yes when something feels slightly uncomfortable but aligned. The rest builds from there. I'm not finished, goodness, I've barely begun. I'm not solved, but I am grateful. I am lucky, and I am deeply aware that this has been a privilege to explore, to speak, and to be supported. In the words of the amazing LM Square. If this season of life is nudging you too gently, persistently, or in my case loudly and rudely, I hope this is your sign that you're allowed to follow it. Hey, let's talk about the hormone that makes people lean in, lower their voices, and whisper like we're discussing a secret affair. Testosterone. And I genuinely don't understand why testosterone is still so misunderstood when it comes to women. Women have and need testosterone. The biggest misconception I hear is that testosterone is either a male hormone or it's only about libido. And in women, it's really neither of those things in isolation. In women, testosterone is much more about drive, mental drive, physical drive, emotional drive. Women don't necessarily say my libido is gone. They say things like, I feel flat, I've lost my spark, I don't feel like myself anymore. And libido is often downstream of that. That's because testosterone doesn't just work in your genitals, it works in your brain. Well, actually it works everywhere, but it works in your brain. It acts on areas involved in motivation, reward, and interest. It lowers the amount of effort required to engage in life, including sex. So when we talk about testosterone replacement, this is not about turning someone into a different person. It's about restoring baseline energy and interest where it's been genuinely lost. And just to reassure everyone listening, taking testosterone does not mean you'll wake up sounding like Barry White with a sudden urge to buy a motorbike. Although, if that is your thing, I'm not here to yuck your yum. Desire in women is not a simple on-off switch. It's contextual, it's relational, it's psychological, and physical, all happening at the same time. Testosterone plays a role in interest and responsiveness, it increases sexual thoughts, responsiveness to cues, and lowers the activation energy required to feel desire. So instead of sex feeling like, ugh, maybe later I'll add it to the list right after I take out the recycling, it could feel more like, oh, that popped into my head and it's not such a bad idea. But, and this is critical, testosterone does not create desire out of thin air, which is where estrogen matters so much. Topical vaginal estrogen improves the physical environment, it increases blood flow, thickens and strengthens the tissue, improves lubrication, elasticity, and sensation. Less dryness, less pain, more comfort, more feedback. And when sex feels better, desire has somewhere to land. Hormones play a team sport. Estrogen improves comfort and tentation, testosterone improves interest and responsiveness. That's why the testosterone conversation should really be happening in a woman who is already well estrogenized. Neither hormone fixes everything on its own, but together in the right person they can completely change the experience. There's also emerging evidence that combination therapy matters beyond sex. Studies have shown that estrogen plus testosterone can be more beneficial than estrogen alone for things like bone mineral density. And more recently, there is published data showing that women on HRT plus T do better than those on HRT alone in areas like cognition and energy. And it doesn't take a huge leap of imagination to see how improved energy and cognition might flow onto improved libido. So who is testosterone actually for? From a regulatory point of view, there is one recognized indication for testosterone in women, hypoactive sexual desire disorder or HSD. That's defined as persistent low desire that causes personal distress and isn't better explained by pain, mood, medications, or relationship factors. But in real life, the conversation is often broader than that. Women have three sexy hormones, estrogen, progesterone, and testosterone. If you replace estrogen and progesterone, but forget testosterone, then two out of the three hormones are restored and one is left behind. And we're talking about restoring physiological levels, not turning anyone into a 22-year-old man, and certainly not making anybody into a gym bro. Because testosterone acts in the brain, low testosterone can sometimes look like depression or even a low thyroid state, low energy, low motivation, low engagement with life. Midlife women often present these symptoms and are prescribed antidepressants, medications that can further lower libido, delay orgasm, and flatten emotional range. And we know that tapering antidepressants is difficult. Many women say the withdrawal from antidepressants is worse than the original symptoms. Now I'm not anti antidepressants. They are life-saving medications for many people. But if a woman's symptoms are hormonally driven and we don't address the hormones, then we're not treating the root cause. There's some deprescribing data that suggests women on hormone replacement therapy, after estrogen and progesterone have been optimized, are sometimes able to reduce or come off antidepressants, and that number increases by 40% if you add testosterone. So why are we very comfortable prescribing SSRIs for depression, anxiety, and off-label for hot flushes while simultaneously clutching at our pearls at the idea of testosterone? Physiologically, that makes no sense. How can women raise this conversation with their doctor? I suggest instead of asking for the drug, start with the symptoms. Something like, I don't feel like myself anymore, my interest and responsiveness are gone and it's bothering me. Is testosterone appropriate for my symptoms? If so, how do we monitor and what does success look like in real life? Because this is not about chasing numbers. Hormone levels fluctuate hour to hour, day to day, and the blood tests aren't especially accurate at the low doses that women use. A baseline androgen level can be helpful, not because the number means much in isolation, but to check absorption after a few months of treatment. Testosterone should always be a trial, time limited, monitored, and reviewed. It works for around 50 to 60% of women, which honestly in medicine is pretty decent. If I told you you had a 60% chance of winning the lottery, you'd probably buy a ticket, right? And because it is a drug with the potential for an effect, it also has the potential for a side effect. At physiological doses, they are usually mild and reversible. Acne, oily skin, some hair growth. More serious side effects like voice changes or clitoral enlargement are rare but also irreversible. So if you sing soprano for the Australian opera, then that is a real consideration for you because you don't want to have to show up the next day and audition for the baritone part. And one other thing that doesn't get talked about enough, in my opinion, is that relationships do not happen in isolation. If we are willing to prescribe medications that change the sexual capacity in one partner, like the PDE 5 inhibitors, sildenophil and tadalophil, i.e. Viagra and Cialis, then we need also to have conversations about expectations, pressure, timing, and intimacy within the relationship. It makes no sense to have one partner on a medication that increases capacity and the other on a medication that potentially decreases it without ever talking about how that lands for both people. We know that couples that have sex have stronger relationships. We know that having sex is good for you mentally and cardiovascularly. In fact, your sex life is a good indicator of your overall health. I will say this too: testosterone is not a panacea. It's not a personality transplant, it won't fix exhaustion, it won't make you fancy someone you don't like, and it won't fix your relationship if it's a bin fire. But in the right person with the right expectations, it can help you feel more like yourself again, and that is a very reasonable goal. Friends, you know I like to imagine each episode of On the Moans the way I might prepare for a romantic night in with my hottie. The hors d'oeuvres are plated with symmetry and balance, nothing chaotic, nothing unhinged. The wine is at the correct temperature, decanted for optimal oxygenation because we respect process. The room is lit by lamps and candlelight, not to hide the imperfections, but to highlight the evidence. Mood music is on, curated, peer reviewed. But sometimes I'm in my quantum business class pajamas, which I was gifted by someone who flies business class, barefoot, braless, re-watching season one of the Dallas Cowboys Cheerleaders, trying to assemble a meal out of half a serve of bolognese, leftover Thai, a lemon, and something in the fridge drawer that has emotionally moved on. I'm drinking a non-alcoholic beer, pretending I enjoy it, and creating the slap shod midweek dinner that is my segment, Woo of the Week. This is where a wellness supplement presents itself like a perfectly curated romantic date, candles, promises, big eye contact. But by the time year three sips in you realize you're not being wooed, you're being catfished. If you've ever googled testosterone replacement therapy, then you will have been bombarded with advertisements for oral DHEA supplements claiming to fix your immunity, your heart, your cognition, your sex life, basically your entire existence. Biologically, the top of the hormone food chain is cholesterol. From cholesterol, the body makes DHEA, dehydroepandros. Testosterone. Think of it as the raw ingredient, the flour in the cupboard. With flour, you can make cake, biscuits, or bread depending on what you'd said you'd bring to the barbecue. From DHEA, your body can make testosterone, estrogen, or progesterone. Which one you end up with depends on what your body needs at the time, where the hormone is being made, and what enzymes are available. Especially aromatase, which converts testosterone into estrogen. That's why oral DHEA supplements are unpredictable. When you swallow DHEA, you don't get to choose what it turns into. You're essentially putting raw ingredients back in the cupboard and hoping the right baked good comes out without a recipe and without telling the chef. That unpredictability can lead to acne, hair growth, mood changes, and stimulation of hormone-sensitive tissues, otherwise called sore boobs and spotting. It's also really important to say that oral DHEA and topical vaginal DHEA are completely different. Vaginal DHEA, drug named Prasterone, works locally in vaginal tissue, improves tissue health and hydration, and largely stays in its lane. Oral DHEA gets on the motorway and goes wherever it likes. Topical vaginal DHEA is a TGA registered, prescription only product in Australia. Oral DHEA, on the other hand, isn't a TGA listed product at all, yet you can still buy it easily online, which should really tell you something. So before you start playing fast and loose with your hormones, remember this. Your body follows biology and physiology, not persuasive marketing copy. Hormones don't care if something is labelled as natural, they respond to pathways, enzymes, and dose. Taking oral DHEA and hoping it neatly boosts the hormone you want makes about as much sense as raw dogging a capsule of cholesterol and trusting it to behave itself rather than to lodge itself in your coronary arteries. Your body doesn't read wellness websites, it reads chemistry, and chemistry doesn't care how good the brandy is. So lovely friends, as we wrap this one up, I want to leave you with this. Midlife isn't a detour or a decline, it's a recalibration. A moment where the volume comes up on what matters and the tolerance drops on what no longer fits. Whether you're renegotiating hormones, work, identity, visibility, or all of the above, none of it needs to be dramatic to be real. You are allowed to evolve quietly. You are allowed to change format without changing your values, and you are absolutely allowed to want more energy, more clarity, more agency in your own body and your own life. If this episode gave you language, confidence, or even just the feeling that you're not imagining it, then it's a job well done. Thank you for trusting me with your ears, your questions, and your midlife curiosity. Take what serves you, leave what doesn't, and remember you don't have to overhaul your life to honour what's shifting. Sometimes it's enough to notice and keep moving. See you next time we get on the moans. Bye bye.