Testosterone: beyond libido

Testosterone is an important sex hormone for both men and women (although women have much lower levels) produced by your ovaries and adrenal glands and declines during the menopause.

When it comes to menopause, testosterone is a hormone that can be misunderstood, and many women struggle to access testosterone treatment on the NHS.

Here Dr Louise and her Newson Health colleague, GP and Menopause Specialist Dr Catherine Coward, talk about how it can be a valuable addition to HRT for women around the menopause and beyond.

NICE menopause guidance recommends testosterone can be beneficial for women experiencing low libido where HRT alone hasn’t helped. Yet Dr Louise and Dr Catherine talk how in their clinical experience, testosterone benefits can extend beyond sex drive-related symptoms, with patients reporting improvements including having more energy, and reduced brain fog and anxiety.

Click here for more about Dr Catherine

Transcript

Dr Louise Newson: Hello, I’m Dr Louise Newson. I’m a GP and menopause specialist and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving – and always inspirational – personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast, I’ve got a fellow doctor with me today who works very closely with me physically in the clinic, but also across the clinic and more than just the clinic, actually, because she works with Newson Health Group that helps many people in many different ways, not always just our patients. So Catherine Coward is a GP like me and, not like me, has worked in a small practice with her husband, amazing single-handed practice, for many years and now she works for us pretty much. I was going to say full time, but it’s more than full time because she’s always thinking, breathing and trying to really think about how we can work even more as an organisation to help even more people, not just in the UK and globally. So I’m very delighted that I’ve managed to force her to come onto the podcast today. So thanks for joining me today. [00:01:51][100.3]

Dr Catherine Coward: [00:01:52] Thanks, Louise. [00:01:52][0.3]

Dr Louise Newson: [00:01:53] So you’re like me, you’re very passionate about helping people and helping people in a way that we learned very early on actually as GPs in a way that they want, actually not what we want. It’s about them having a choice and a voice and all patients, regardless of their gender, regardless of their religious beliefs, regardless of their ethnicity or their race, actually deserve to be listened to. And I think that’s something as a general practitioner, I learned far more than I did in hospital. In hospital it was about treating the disease and the bed number almost. Whereas in general practice, it’s very individualised medicine, isn’t it? And very empowering and very enriching. And then we’re very fortunate in the clinic in that we have more time than many consultations. I have half an hour for new and follow up. Many of our, most of our other clinicians have longer they have more like 45 minutes for new patients, which is a real luxury, actually. So it really enables us to get to know our patients really well and explore what they need and really educate them as well in the consultation, which is something that we don’t always have the privilege in the NHS as a ten minute consultation as a GP. So you, I know, have changed your consulting style quite a lot, but you’ve also changed your knowledge quite a lot. And I have too, you know, we’ve both of us prescribed HRT for many years with transformational benefits, knowing that we’re reducing risk of diseases and improving quality of life. Really important. But there’s another hormone that if we’d had this conversation ten years ago, it wouldn’t have been a conversation because I didn’t know anything about testosterone. I did for men, but not for women. And for many years I have lectured for the British Society of Sexual Medicine hearing about the transformational effects of testosterone in men. And then the last eight years or so, I’ve been reading more about the transformational effects of testosterone in women, and we’re experiencing it firsthand in the clinic with the sheer number of patients that we treat. We’re experiencing it, some of us personally when we use testosterone, but actually we’re actually experiencing it more when we read about the biological effects of testosterone. So we’re going to sort of dedicate this podcast episode to a hormone that has been neglected for women for many years. Would you say, Catherine? [00:04:11][137.9]

Dr Catherine Coward: [00:04:12] Oh, absolutely. And I think my story is similar to you, and I think I’ve had three phases in my career, in terms of hormones. I think for many, many years, sadly the vast majority of my general practice career, I think I’ve misdiagnosed, certainly the perimenopause. And I know a lot of your podcasts cover that. So we’re not going to cover that today. So I think that was my first phase of my career. So my misdiagnosis clearly was if you get the wrong diagnosis, you’re going to get the wrong treatment. And I think I probably had poor outcomes looking back on it. And then I think the second phase followed that was when I identified how important hormones were, oestrogen and progesterone. And I started getting really good outcomes, if I’m honest, with oestrogen and progesterone and so exciting. And that has catapulted my career into wanting to know more. And then possibly like you sort of almost stumbled upon testosterone because I like you, I think I qualified just before you Louise, but yeah I was not taught about testosterone and I have four children of whom two of them have recently qualified for medical school and sadly, their learning is not that much greater than ours was either. And thankfully, as you suggested, I’m now in the third phase of my career and I’m delighted to be here today because now I use all three hormones and my poor outcomes at the start that became good outcomes for two hormones with three hormones, not for everybody, admittedly, but for a lot of my ladies, both in general practice and in the private sector, I’m now getting fantastic outcomes. And that’s not me saying that, I hear that time and time and time again and it just makes the job enjoyable and frankly fun. [00:05:52][99.7]

Dr Louise Newson: [00:05:54] You know, our jobs should be fun. I’ve got a couple of friends who literally are working for their retirement and they keep saying, oh, I’m just doing my job so I can pay off my mortgage. And I think what a shame, actually, because medicine is such a privilege. I have said that many times but it should be enjoyable. And it’s really sad because we both know people who are quite burnt out in their jobs in clinical medicine. And I think it’s a shame because when you talk to these people who are burnt out, they’re not burnt out with the clinical side. They love their patients like we all do, but they find the other clinical side really difficult and overwhelming and the bureaucracy and everything else. But I think one of the advantages of us having a clinic that isn’t in the NHS is that we can be in control of what we do, which is both exciting and bewildering at the same time. And I was trying to explain to someone just now actually that it’s quite scary being able to choose because someone a while ago who was mentoring me said, Louise, it’s your company. You can decide what to do. You don’t have to listen to all of these people. And I said, really? Gosh, that isn’t always the best thing because I have a thousand ideas and they’re not always the best ideas, or they can’t always be done for financial reasons, often because we don’t have the money and we’ve not had external funding to back what we do, including the app. But actually it’s quite fun. I feel sort of guiltily naughty actually being able to say, Come on, Catherine, what can we do? Shall we do some education about testosterone? Should we do an online event for people? Shall we go and do some outreach work? We’re going to talk to some people who are homeless and really help them. And yes, we can do all these things. And that’s something that you can’t always do in the NHS. Can you? [00:07:36][101.8]

Dr Catherine Coward: [00:07:38] No, and my own personal story, so I wouldn’t be here talking to you, Louise, without my hormones and all three hormones. And that’s been my personal story, my personal choice, and has transformed me now having been a full time GP, brought up four children with my husband and then dropped my hours due to poor concentration, losing the fun, becoming anxious, and despite recognising the menopause and the impact of hormones, sadly completely dismissed my own as just work harder, try harder. And now I’ve gone from that to full restoration, full fun and now working five days a week again. And it’s testament to hormones and they’re only my hormones that I’ve had for 50 plus years. And thankfully I’ve been fortunate to be on the planet for a bit longer and hopefully for even longer. But sometimes it’s very easy to feel slightly guilty. And when I’m sort of slapping them on here, there and everywhere, feeling fantastic thinking really. But I can be reminded by my husband that, yes, it is really. And please carry on. [00:08:40][62.5]

Dr Louise Newson: [00:08:40] Yes. And it’s really interesting, I was speaking to someone today, actually, who was a lovely lady who had come down from Scotland to see one of our doctors who works with us. She’s not one of my personal patients, but she’d reached out to me on social media to tell me that her GPs throw all of our clinic letters in the bin and they say, don’t listen to that Newson Health clinic. And she said, but I am because without them I wouldn’t be working, I wouldn’t be able to function. And they said, oh yes, but which is another story. But actually what I wanted to just talk to her and see what was going on with this. But actually what she was saying is that you’re clinic has enabled me to have a choice. It’s enabled me to get my life back and I come all the way from Scotland to come and see one of your doctors and I feel so empowered. And she said, when I first had my consultation, I was blown away with the things I was told. But what I did is I stayed up for two nights in a row reading all the information, all the evidence, trying to look for a counterargument for what you’re doing. And I couldn’t find one. And now I feel that I know it’s the right decision because I’m not walking with crutches anymore. I used to spend a lot of time in a wheelchair, and she said, I can sleep. I don’t have muscle and joint pain. And it’s been incredible. And so I think this is, it’s not a unique story. [00:10:00][79.2]

Dr Catherine Coward: [00:10:00] It’s repetitive, isn’t it? [00:10:01][1.0]

Dr Louise Newson: [00:10:01] It really is. [00:10:02][0.4]

Dr Catherine Coward: [00:10:02] And so it’s not just the private sector, is it, Louise? There’s an awful lot of GPs out there issuing all three hormones. My husband, similar age to me, works in Gloucestershire and there’s an awful lot of excellent GPs, and as you alluded to earlier, yes, in the private sector we have the luxury of time, but there’s also lots of GPs out there who are providing it because the NICE guidance does allow us to do that within the NHS sector, doesn’t it? But look, GPs are limited because of the limitations in the guidance but also the lack of regulated products. So I think as we are both GPs, we can see it from both sides. But this is not just a private sector hormone, is it, that we’re talking about, although in reality it often is. [00:10:47][44.4]

Dr Louise Newson: [00:10:47] Yeah, absolutely. And this is a problem. A lot of GPs I know really want to prescribe and they’re told that they can’t and others aren’t able to get training. And what we do know about testosterone is it’s a biologically active hormone. We produce more testosterone than oestrogen when we’re younger. And it reduces as we get older and it comes from our ovaries. But other areas of my body as well. So it’s not really a menopause hormone. It’s more of a women’s hormone that declines really, isn’t it? [00:11:16][29.1]

Dr Catherine Coward: [00:11:16] So, I mean, it’s as important as oestrogen, isn’t it? So I think, you know, it’s not a new hormone. A lot of people, certainly in my day when I was a junior doctor in the 1990s, I worked for a gynaecologist. And at the end of the operation, when ladies had had ovaries removed, it was my job to give them an implant with oestrogen and testosterone. And I didn’t understand what I was doing at the time and and just did it. And he said, just don’t forget the testosterone, Catherine, they will notice it. And obviously, I would love, sadly, he has passed on, but I would have loved the opportunity to go back to him and say thank you. And he was ahead of his time. I mean, I think if you look back in the data, in the research, they were using testosterone back in the 1940s, weren’t they Louise? With good effect. [00:12:00][44.1]

Dr Louise Newson: [00:12:01] And actually I found a study where I can’t believe it, really, but in 1941, they did a study of testosterone in men and women. So they included women then. But then it seems to have been lost and forgotten about. And then the guidelines, as you say, do say we can prescribe testosterone, but they say we can prescribe testosterone for women who have reduced sexual desire despite being on HRT. [00:12:22][20.9]

Dr Catherine Coward: [00:12:26] I find that offensive Louise. [00:12:26][0.1]

Dr Louise Newson: [00:12:26] I find it very offensive. And also some menopause societies, as you know, say that we should only consider it if women are severely, psychologically distressed with their reduced libido. And I feel like it’s really difficult, isn’t it? Because what is libido? It is different things to different people. And Dan Reisel, our research lead in a recent conference was talking to us about Freud’s definition of libido. And it’s not just about sexual pleasure, it’s about wellbeing and life pleasure. It’s about opening the curtains and smelling the flowers and looking at the sunshine. [00:12:57][31.4]

Dr Catherine Coward: [00:12:58] And function as well, isn’t it? [00:12:59][1.5]

Dr Louise Newson: [00:13:00] Yeah. And that’s something that we see a lot. Obviously, for those people who libido or sex is important, of course we talk about it, but for some women it’s irrelevant. So we don’t talk about it. But actually it is the softer things, isn’t it? That’s quite hard to describe. But certainly we know testosterone is a neurotransmitter. It can light up our brains. But a lot of women just say that heaviness has gone and I’m enjoying my life again, life’s easier. [00:13:30][30.0]

Dr Catherine Coward: [00:13:30] I would say it for me personally, reconnected me. I remember the Christmas before I went on testosterone myself, and I’m fortunate to have a very lovely family and everyone was together and I knew it was a happy time. My brain knew it was happy, but my soul wasn’t there. And I felt that disconnect between life and the fun and, you know, and now I look back and I can see that now I’ve got that connection. I say to my ladies, it’s that disconnect and they absolutely they understand that and as a working professional woman, you know, I don’t think my libido should be something that is talked about, you know, and I don’t think whether I’m on medication, my hormones, should be determined by my libido, because that’s a very personal thing, isn’t it? [00:14:18][47.2]

Dr Louise Newson: [00:14:18] Absolutely. [00:14:18][0.0]

Dr Catherine Coward: [00:14:19] Because woman after woman, when they come back into my consulting room on a regular basis, to be honest Louise, I don’t think I’ve ever restored anyone’s libido to what it was when they were 30. Sorry. But what I have done is women come and say I’m back, I’m happy, I’m back at work, my brain’s working, I’m sleeping, I’m this and that. And how’s your libido? And that’s improved, thanks for that. But, you know you’re right, it’s often isn’t… it’s an important part for many women, but it’s not what keeps life going. [00:14:49][30.1]

Dr Louise Newson: [00:14:51] And you know libido and sex is important for a lot of people, of course, but it’s not as complicated or as simple, depending on how you look at it as it just being a hormone. And, you know, when we’re sitting here doing a podcast, we’re not thinking the same about sex as we may be with our partners as we’re in a different social environment, but actually we’re still using our brains. And I found that it was like thinking through treacle without testosterone. I could do it, but it was very slow. And I was thinking actually earlier today, there were many times, this sounds really embarrassing, I would just forget to take my children to like a swimming practice thing, or one of them was in a choir on a Sunday night and I had a blackboard in the kitchen and it told me Sunday 5 o’clock choir and the amount of times at 6 o’clock I went, oh, Sophie, I’ve forgotten to take you to choir. She was only eight, so it’s hard for her to remember. And I just had a baby a year before. So I was thinking, oh, it’s because I just got a baby and I haven’t slept very well, but I didn’t forget things quite as much when I had two children under the age of two. Maybe it’s because I’m old now. I’m 41 and I was younger when I had my other two children, so I was blaming myself. But it sounds stupid to forget something that two hours before you would have remembered. But even actually the morning that I was seeing my consultant because I couldn’t get HRT from my GP, I then went to see a doctor who’s now very well known in the menopause space, and I just had a phone consultation because he couldn’t see me because he was busy and I got very stressed with a poor receptionist and she said okay, because I said, do you know who I am? This is really important. And she said, well, no, I don’t know who you are. I said, well, and I wasn’t doing much menopause work then. I said, look, I would be really grateful if you can fit me in. I’m really struggling with my work and everything else. And so I remember very distinctly because I was with my daughter having a cup of tea in some café and it was 10 to 9. And I said, Jessica, at 9 o’clock, I just want you to do a bit of colouring and just be a bit quiet because I need to speak to this doctor. It’s really important. Okay, mummy, okay. And then at five past nine, this doctor phoned me and he said, Louise, I thought we had a consultation. I went, ah yeah, I forgot. I mean that’s just awful isn’t it? [00:17:03][131.2]

Dr Louise Newson: [00:17:05] So how could you trust me to prescribe for you if you were one of my patients then, it’s really difficult. And I was at a meeting this morning and they were saying we’ve done some really good work on flexible working. And now it’s so much easier for women to apply for flexible working when they are menopausal. And I was trying really hard not to put my head in my hands because I did put my hand up at the meeting and say, that’s really great you’ve done it for those people that want it. But most women don’t want flexible working. They don’t want to reduce their hours and reduce their pay and reduce their status in their job. What they would really like to do is carry on working with the right treatment. [00:17:48][43.3]

Dr Catherine Coward: [00:17:49] And just that’s the privilege of a few isn’t it, because most women can’t afford, you said earlier, and that is a privilege for a few people, which is fantastic for them. But so many people have not got that option, have they? [00:18:00][11.3]

Dr Louise Newson: [00:18:01] Absolutely not. And I know you know, obviously, those of you listening, I’m sure know that I run and you work in a private clinic and it’s private because we couldn’t set it up in the NHS because no one was interested seven years ago in me working in the NHS doing menopause care. We see a lot of people who really can’t afford to come, but they really want to try their hormones and whatever. And then we do try and encourage GPs to carry on the prescribing and we obviously have, I know you’ve worked very hard to do this testosterone quick start consultation, so for women who are on HRT, it’s cheaper, it’s quicker, it’s easier, they could just have testosterone. But there are lots of people who just come back and say, I can’t get it. [00:18:43][41.8]

Dr Catherine Coward: [00:18:43] Most can’t, can they? [00:18:44][1.4]

Dr Louise Newson: [00:18:45] And we do use the same, we use a symptom questionnaire, we use the same criteria as NICE, actually so women do usually have reduced libido. [00:18:51][6.4]

Dr Catherine Coward: [00:18:51] They do. [00:18:52][0.3]

Dr Louise Newson: [00:18:52] As well as other symptoms. So it’s fine. We’re not doing anything out of kilter at all. [00:18:56][4.1]

Dr Catherine Coward: [00:18:56] No, no, no. We’re definitely not. [00:18:58][1.4]

Dr Louise Newson: [00:18:58] But it’s still these poor women are unable to get an evidence based treatment that’s mentioned in NICE guidance. And for me, that feels a real shame because I can’t think of any other area of medicine where a specialist, someone who’s got a lot of knowledge, has started a treatment and then they just can’t have it prescribed for them, especially when it’s making a big difference to their quality of life. It’s very difficult, morally and ethically I think as well. [00:19:27][28.7]

Dr Catherine Coward: [00:19:29] It’s hard for GP’s as well, isn’t it? Because as a GP if on Friday morning I see someone with a heart problem and I don’t know the answer, I can easily access either advice or I can refer that patient. But GPs are also handcuffed in many ways because the access to secondary care to a specialist menopause service. I mean, I worked in Birmingham for most of my life and I think we had one consultant for the whole of Birmingham and wider, that’s just impossible when half the population are women and so and again as GPs, if I had that person with a heart problem and I refer and I get my question answered, that’s part of my learning isn’t it? And so it’s very, very hard because as GPs we do have to know about everything, which is tricky. But in menopause care, and it’s the only specialty they have no access. We have no access, well we do, but it might be 16,18 months. And you and I know we have spoken to many women together and independently who have either tried to take their life or not. And, you know, 18 months, we cannot wait for that sort of advice because as you say, actually, when you understand hormones and HRT and menopause, it’s actually quite straightforward, isn’t it? For most women. [00:20:44][74.6]

Dr Louise Newson: [00:20:44] It’s for most women. It is straightforward. I mean, we know that about a third of women who come to our clinic are already on HRT. So it shows they’re not on the right dose and type. And for a minority of women, they do need a slightly different dose, higher dose, they need a different regime. We sometimes give a combination of transdermal preparations because their absorption might not be great, but the majority of women we see are actually still quite straightforward. We don’t, once you get the right dose and type, you’re giving them lots of advice about nutrition, exercise, sleep, the whole holistic package, if you like. And many women just come once a year and they’re absolutely fine. And I was very sad, really, to listen this morning on the meeting because they were talking about how we all need to support women so they can self-manage without needing medical intervention. And they were saying that a lot of this education can be done by non-healthcare professionals. So from nutritionists or psychologists. And I found that very frustrating because we can learn, of course as women to self-manage and self-care, but we can’t get our hormones back by doing the best exercise or nutrition or sleep or whatever. So again, I think there’s a lot of medical gaslighting going on and there’s a lot of negativity towards hormones, which are just hormones, aren’t they? There’s a lot of things in medicine I have felt quite uneasy prescribing over the years, a lot of psychiatric drugs when they’ve been started by a psychiatrist, you think, Oh goodness. And then even drugs and some drugs for arthritis, you know, some of the like methotrexate where you have to have blood tests and everything, You still think, gosh, it’s a big responsibility for me as a clinician to describe something. But actually, I’ve never once worried about prescribing hormones, like I’ve never worried prescribing thyroxine. [00:22:34][109.5]

Dr Catherine Coward: [00:22:35] Yes, it’s the only area, I think probably the only area of my clinical practice in general practice whereby I can actually get people back to 100%. Admittedly they have to carry on the hormones. And as a doctor, once I started to get it, once I started to recognise it, and particularly the patients I probably misdiagnosed over the years, it was such an exciting time. Women came back, said, thank you very much, I’m sorted. And, you know, these are often there in general practice. You know, they’d seen cardiologists, dermatologists, rheumatologists. We’ve had a few sick notes, we’d maybe prescribed a bit of antidepressants that hadn’t worked or given the side effects. And then once my penny started, once I started to work out hang on a minute this is hormones. It’s been a great time of my life, really in the last ten years since I started to work it out because I can reverse it. I…We’re not actually doing anything. We’re just topping up or restoring aren’t we to what ladies have had all their life. And for most of us, we’ve got on with it, haven’t we? [00:23:38][62.9]

Dr Louise Newson: [00:23:38] Absolutely. And I do think the time will come when people will go back and say, why were they making such a fuss? Why was there so much resistance? And I feel like there’s a lot that we’re doing not just in the clinic, but with obviously we fund balance app and we fund our education programme. We’ve done a huge amount that actually is empowering women and healthcare professionals. So although I have mentioned some negativity, we’ve had a huge amount of positivity and I get a lot of emails and correspondence from other doctors, not just in the UK but globally as well, saying thank you because I’ve listened from you and your team and it’s changed my practice and now I’m seeing the results. And last night I had a meeting with some Norwegian colleagues who are just incredibly inspiring. They’re gynaecologists, but they’re saying they’re getting pushback from endocrinologists because they’re prescribing testosterone, but they’re seeing the same results as we are in their patients. So it’s not just a Newson Health placebo effect. [00:24:36][57.4]

Dr Catherine Coward: [00:24:36] So all we’re doing, this podcast is entitled testosterone, isn’t it, when we do replace it, we’re not giving people oral tablets, we’re just giving them testosterone through the skin, which is completely safe. And we do endeavour to check blood levels once ladies have started to make sure we’re keeping them in a normal female range. And I’ve never had one go wrong on me as yet. [00:24:59][23.3]

Dr Louise Newson: [00:25:00] No, and I think that’s really important. Thank you for highlighting Catherine, because actually we’ve just been looking at our results for another research project I was doing. And actually, all the results are within normal female range, but 50% are half or below the upper limit of normal, whatever normal is for women. And that’s very interesting because when you look at a normal result, we know the way that the normal range has been made is that there’s 2.5% will still be normal, but have above the range of 2.5% below. That’s how they work out 95% distribution. So but actually we run our patients, if you look at the levels, quite low, but actually they’ve come from being very low usually. And we don’t always do a baseline result because we know they’ll be low. Women in their 40s, 50s will have low testosterone levels. And so actually just topping up a little bit, as you say, can help with their brain that their function, the systemic side effects are only going to occur if we were giving megadoses, which we don’t do. And the people that have had side effects are really people, I’ve seen people with some hair growth who have come from other clinics or they’ve bought it online and haven’t known the dose so they have been giving higher doses. But when you reduce those doses, the side effects have gone. So any side effects, like with other hormones as well, actually are reversible, which again, is very reassuring. But like you say, in our patients, where we start HRT with testosterone, these women, we’re not seeing side effects at all. [00:26:34][94.4]

Dr Catherine Coward: [00:26:35] And I think in clinical practice, I think we’ve got obviously three hormones, but predominantly for outcomes, we’re talking oestrogen and testosterone. And I think there are some women that get most of their symptom resolution from oestrogen. And they’re very happy. But I think there’s a big majority of people, particularly ladies, with the more psychological issues, low mood, anxiety. Yes, oestrogen absolutely helps, partially. But I think we’re all very, very different, aren’t we, in our absolute, that balance of either the two oestrogen, testosterone or oestrogen, testosterone and progesterone and that balance, it’s getting it right, isn’t it. And that’s why, again, it’s hard in general practice because we don’t have as much time. But it is worth persevering. What I would say, my only downer on testosterone is it can take up to six months, can’t it? And I think even then I would say it’s incremental over the next year. I still think you get added once you get to that. [00:27:34][59.0]

Dr Louise Newson: [00:27:34] Yeah, absolutely. Because I was speaking at an event yesterday and a lady said, I’m not really feeling much better or sometimes I do and other times I don’t. But she had only started it two months before and you really have to wait because it can take quite a long time. [00:27:48][14.8]

Dr Catherine Coward: [00:27:49] Absolutely. [00:27:49][0.0]

Dr Louise Newson: [00:27:49] And it doesn’t take long actually to reverse, if you stop it, but it could take quite a long time. [00:27:55][5.6]

Dr Catherine Coward: [00:27:56] I agree, I would love to understand that, Louise, exactly. It took me six months, but if I miss it, you know, I’ve tried it just from my own professional point of view. And within five days you start, I find I start to slip and I’ve spoken to other colleagues here who have done the same. Yeah. So obviously we need to understand that better, but it works doesn’t it. [00:28:15][19.7]

Dr Louise Newson: [00:28:15] Yes. [00:28:15][0.0]

Dr Catherine Coward: [00:28:15] You do need to give it time. You’ve got to get that right balance. And what is right for me is going to be very difficult for what is right for you, isn’t it, Louise? And absolutely strange as well, as we go through that period. We don’t know that do we either, because it’s all just so new. And yes, we need more research. We need more research. And but until we start using it, we’re not going to get that research. So I’m proud to be part of that research, you know? [00:28:42][26.4]

Dr Louise Newson: [00:28:42] Oh, great. [00:28:42][0.3]

Dr Catherine Coward: [00:28:43] So I hope having three daughters and a son, I really hope that by that time my daughters… I know you’ve got three daughters. I really hope that our generation of, you know, have got to grips with this. [00:28:54][10.6]

Dr Louise Newson: [00:28:54] So that it is so much easier. [00:28:55][1.1]

Dr Catherine Coward: [00:28:56] You know, we happily, as GPs, as doctors, give the contraceptive pill don’t we, which is high dose man-made oestrogen to younger women. And, you know, I’ve given lots of that out and yet this is kickback on me giving transdermal body identical. And again it’s that mismatch, isn’t it? [00:29:15][18.6]

Dr Louise Newson: [00:29:15] Absolutely. [00:29:15][0.0]

Dr Catherine Coward: [00:29:16] Lots of mismatches in you know in female health. There’s an awful lot of mismatches, sadly. [00:29:20][4.4]

Dr Louise Newson: [00:29:22] So there’s a lot we need to do. And we’re certainly doing a lot of internal research looking at the effects of testosterone beyond improving the libido and working collaboratively with other groups as well. So watch this space and we’ll come back and talk about it in the future. But very grateful for your time today, Catherine, to talk about testosterone. And just before we end though, three tips. So there will be people listening who’ll be thinking it all sounds great, but you know what? I can’t get it. So what are the three tips for those people who you know, what words should they use or how should they approach their healthcare practitioner to start that conversation about testosterone? [00:29:58][36.8]

Dr Catherine Coward: [00:29:59] Okay, Louise, you know, I’m not known for brevity, but I am known for enthusiasm. So thanks for the opening. I think the first thing is to be kind to your healthcare practitioner, because as I said at the beginning and you said, there are a lot of people, there are significant numbers who would like to who can’t, and then some GPs have to then ask for further advice from a secondary care clinic. So if that is your only option, then so be it. But I think there are three Fs. Don’t worry Louise, I’m not going to be rude, the first F to say, well, it’s a female hormone, I’m a female, I just want to carry on being female. I’m not asking for anything clever. I mean, I would say it’s the not so fab three. When I’m giving talks to anyone who will listen, I talk about the not so fab three, and when I say fab, it’s fatigue, anxiety and brain fog. And I find that that’s very much in part of our function. And I often find that when I’ve got my ladies fully oestrogenised there is still that fatigue, anxiety, brain fog, which I find clinically that I know it’s not licensed for this, but testosterone can resolve. So the not so fab three and that’s what women at work comment most on in terms of that impact on their day to day life. So I’m a female. I want to carry on. We’ve got the not so fab three that often testosterone will reverse over and above oestrogen. If that keeps me at work, it keeps me feeding my children, it keeps me paying taxes. So be it. That’s really good. So I’m female. I’d like to stay at work and I’d like to function. But also, as you said earlier, fun as well. But I’m not sure I’m allowed that. But it does come in, and the third is facts. The facts are it’s not for all women. And I’m not going to sit here with you and say all women should have testosterone and I know nor would you. But as we said, it is endorsed by our national guidance in the menopause guidelines. It’s endorsed for sexual dysfunction in addition to oestrogen. But, you know, I am not going to sit here on a podcast and discuss something like that, but I will discuss my fun and my function, which actually ultimately it was to…oestrogen improved things for me. But I was very fortunate I didn’t have that many oestrogen symptoms. So oestrogen helped a little bit, but nothing significant. But adding testosterone in restored my fun and my function. It enabled me to be female. It’s enabled me to be back in the workplace full time. And fact, it’s not all about my libido is it? [00:32:35][155.5]

Dr Louise Newson: [00:32:35] Very good love all the Fs. Brilliant. Thank you so, so much. [00:32:39][3.3]

Dr Catherine Coward: [00:32:39] So I had to do that, just to sort of weave it in. [00:32:41][2.3]

Dr Louise Newson: [00:32:42] Very good, make people think and that’s what all this is about. So thank you ever so much. I really enjoyed it. Thank you. [00:32:48][6.4]

Dr Catherine Coward: [00:32:49] Bye bye. [00:32:49][0.2]

Dr Louise Newson: [00:32:54] You can find out more about Newson Health group by visiting www.newsonhealth.co.uk. And you can download the free balance app on the App Store or Google Play. [00:32:54][0.0]

ENDS