Featuring Dr. Mok, author of “Testosterone: Strong Enough for a Man, But Made for a Woman” and Founder of Allure Medical.
Understanding Low Testosterone in Women
Most people are familiar with estrogen when it comes to women’s hormones, but testosterone plays just as big a role—and sometimes an even bigger one.
Did You Know?
Women have about 20 times more testosterone than estrogen between ages 20 and 50.
Your ovaries are the primary producers of testosterone, which is then converted into estrogen. So when testosterone is low, estrogen usually is too. That’s why focusing only on estrogen replacement actually misses the bigger picture—testosterone is the “master sex hormone” for women.
Symptoms of Low Testosterone (and Estrogen)
As women age, their ovaries gradually produce fewer hormones. This drop doesn’t happen overnight—it can take years, and hormone levels can swing wildly during this time. Common symptoms include:
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Hot flashes and night sweats (vasomotor symptoms)
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Brain fog and decreased sharpness
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Lower energy, libido, and mood
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Dry eyes, skin, and vagina
Call-Out:
These symptoms aren’t always dramatic. Sometimes it’s just feeling “off,” a little less sharp or energetic than usual.
Technically, menopause is defined as going a full year without a period or having your ovaries removed. But most women start experiencing symptoms years before that—this is called perimenopause. The average age for menopause in the U.S. is about 54, but it can happen years earlier or later.
Testing for Menopause: Useful or Overrated?
Labs can measure hormone levels, but they don’t tell the whole story. Hormones like estrogen and testosterone fluctuate constantly, so a single blood test might give a false sense of security—or doom.
Dr. Mok’s Perspective:
“We love our tests, but they’re just not that accurate for hormones. Menopause is really a clinical diagnosis, based on symptoms and age—not lab numbers.”
There are other tests, like saliva and urine samples, but these are hard to interpret and not very helpful. Bloodwork can confirm you’re approaching menopause, but if you’re a certain age and haven’t had a period in a year, you know you’re in menopause. The labs rarely change the treatment plan.
The History (and Drama) of Hormone Replacement Therapy
A century ago, menopause was dismissed as “hysteria” or a mental health issue. The first hormone therapies were made from ground-up sheep ovaries. Strange as that sounds, we still use animal-derived hormones for certain conditions today.
Eventually, the pharmaceutical industry developed Premarin, made from the urine of pregnant horses. This was a breakthrough for treating menopause symptoms, but it also came with risks: using Premarin alone could cause the uterine lining to overgrow, sometimes leading to cancer. Doctors added progesterone to balance this, and for a time, combination therapy became the standard.
By the 1990s, Premarin plus progesterone was the most-prescribed drug for women in the world. Large studies even showed that women on these hormones lived longer than those who took nothing.
Then came the Women’s Health Initiative Trial in the early 2000s—a turning point that many experts now consider a huge setback for women’s health. The study suggested a tiny increase in breast cancer risk (just 0.08%), but no increase in deaths. It also hinted at more heart disease, but later analysis showed the opposite: women on estrogen had fewer heart attacks and less breast cancer, especially if they started treatment within ten years of menopause.
What Actually Happened?
The study’s results were widely misunderstood, and hormone therapy prescriptions plummeted. Instead, women were given new medications—diabetes drugs, bone medications, antidepressants—to treat symptoms hormones once relieved.
The Shift to Bioidentical Hormones
As the risks of synthetic hormones became a concern, some doctors started using “bioidentical” or natural hormones. These are chemically identical to the hormones your body naturally makes. For example:
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Estradiol (the main female hormone)
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Progesterone (not synthetic progestins)
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Testosterone (already used in other countries for women)
Research from other countries showed that women using both testosterone and estrogen had 30-70% less breast cancer than those in the major U.S. studies.
FDA Facts:
There’s no FDA-approved commercial testosterone product for women in the U.S.—but testosterone is FDA-approved for women (for metastatic breast cancer) and has been for decades.
How Allure Medical Treats Women Today
Allure Medicals’s approach is to replace hormones as if the ovaries were still working like they did at age 30, using:
- Testosterone pellets (custom-compounded, inserted under the skin)
- A small amount of estrogen
- Oral progesterone (taken at night, since it can help with sleep)
Typical dosing is weight-based: about 1 mg per pound of testosterone, with much less estrogen (around 1/20th that dose). Progesterone is usually 100-200 mg at bedtime.
Important:
There are many ways to do hormone replacement, and what matters most is that you feel well. Allure Medical prefers bioidentical hormones and avoids synthetic progestins and estrogens. If you’re doing something that works for you, stick with it.
What About Other Methods?
Not all forms are equally effective. Topical testosterone rarely delivers reliable levels, and injectable testosterone isn’t ideal for women. Patches and other methods can work, but may not be as physiologic.
Key Takeaways
- Menopause and perimenopause are clinical diagnoses; lab tests don’t tell the whole story.
- Symptoms matter most—treatment should be based on how you feel, not just your numbers.
- Bioidentical hormone therapy (testosterone, estradiol, progesterone) is a modern, evidence-based approach.
- History matters: Much of the fear around hormone therapy comes from misinterpreted research.
- Talk with your doctor about what’s right for you—and don’t dismiss your symptoms.
If you’re struggling with menopausal symptoms, know that you have options. The science is evolving, and so are the treatments.
