The Dr Louise Newson Podcast - 229 - Testosterone: beyond libido

Episode Date: November 7, 2023

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.

Hello, I'm Dr Louise Newsome. I'm a GP and menopause specialist and I'm also the founder of the Newsome Health Menopause and Wellbeing Centre here in Stratford-Pon-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, and always inspirational personal stories. This podcast is brought to you by the Newsome 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 Newsom 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 with 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 on to the podcast today. So thanks for joining me today, Catherine. Thanks, Louise. So you're like me, you're very passionate about helping people and helping people in a way that we learn 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 needs,

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 only 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 10-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. So, you know, both of us have 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 10 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've lectured for the British Society of Sexual Medicine and hearing about the transformational effects of testosterone in men. And then the last eight years or so, I've been reading more about the transformation 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. in for many years, would you say, Catherine? Oh, absolutely. And I think my story is similar to you,

and I think I've got had three phases in my career, I think 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 that followed that was when I identified how important hormones worse than estrogen and progesterone. And I started getting really good outcomes, if I'm honest, with estrogen 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, we qualified, I think I qualified, just before you Louise, but yeah, I was not thought about testosterone and I have four children of whom two of them have recently qualified from medical school and sadly their learning is not that much greater than as 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 with 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. You know, a job 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've said that many times on the podcast, but it should be enjoyable. And it's really sad because we both knew people

who are quite burnt out in their jobs in clinical medicine. And I think, oh, 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 non-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 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? Shall we do an online event for people? Shall we go and do some outreach work? Should we go and 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? No. And my own personal stories. I wouldn't be here talking to you, Louise, without my hormones and all three hormones. And that has 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 drop my hours due to poor concentration, not losing the full. fun, becoming anxious. And despite recognizing 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 there are 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. Yes. And it's really interesting, is it? I was speaking to someone today, actually, who was a lovely lady who had come down for 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 out all of our clinic letters in the bin and they say, don't listen to that News and 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 your clinic has enabled me to have a choice. It's been able to enable 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 counter argument of 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. It's repetitive, isn't it? It really is. And also 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 product. 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. Yeah, absolutely. And this is a problem with lots of GPs I know really want to prescribe it 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 estrogen when we're younger and it reduces as we get older and it comes from our ovaries but other

areas of our body as well. So it's not really a menopause hormone. It's more of a women's hormone that declined, isn't it? I mean, it's as important as estrogen, isn't it? And 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 gylicologist and at the end of the operation when ladies had had ovaries removed, it was my job to give them an implant with estrogen and testosterone. And I didn't understand what I was doing at the time 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 had loved to have had the opportunity

to go back to him and say, thank you. And he was ahead of his time. But 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. Yeah, 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. I find that offensive, Louise. And 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 means different things to different people. And Dan Reesal, our research leader 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 well-being and life pleasure. It's about opening the curtains and smelling the flowers and looking at the sunshine.

And function as well, isn't it? Yeah. And that's something that we see a lot. Obviously, for those people who, libido or sex is important, of course, we'll talk about it. But for some women, it's irrelevant, so we don't talk about it. But actually, it is the sort of, it's 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. I'm enjoying my life again. Life's easier. I would say, for me, personally, it 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. So I said 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 my medication,

my hormone should be determined by my libido because that's a very personal thing, isn't it? Absolutely. Because women after women after women, 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? Yeah. But what I have done is women come in time, I'm back, I'm happy, I'm back at work, my brain's working, I'm sleeping, I'm this, I'm there.

Oh, and how's your libido? Oh, yeah, that's a bit better too. 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. No, no. And, you know, Nabilia 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 and doing a podcast, we're not thinking the same about sex as we maybe when we're with our partners. and they'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 really slow.

And I was thinking actually earlier today, there were many times, and 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 quiet. And the amount of times at six 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've 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 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, oh, 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. And I wasn't doing much menopause work then. I said, look, I'll be really grateful if you can fit me and 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 and some cafe and it was 10 to 9 and I said, Jessica, at 9 o'clock, I just want you to do a bit of coloring and just be a bit quiet because I need to speak to this doctor that's really important. Okay, mommy, okay. And then at 5 past 9 this doctor phoned me and he said, Louise, I thought we had a consultation.

I went, oh, yeah, I forgot. I mean, that's just awful, isn't it? So like, how could you trust me to prescribe you if you were one of my patients then? It's really difficult. And I was at 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're 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 maybe as they're doing in their workplace. What they would really like to do is carry on working with the right treatment. And that's the privilege of a few, was it? Because most women can't afford, you said it 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?

Absolutely not. And I know, you know, obviously, for those of you listening, I'm sure, know that, you know, 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 manifolds care. And 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 stuff. 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 a lot of people who just come back and say, I can't get it. Most can't, they can't. And we do use the same, that we use a symptom questionnaire, we use the same criteria is nice actually. So women do usually have reduced libido as well as other symptoms. So it's fine. We're not doing anything out of kilt or anything at all. No, we're definitely not. But it's still these poor women are unable to,

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. I think GP's struck, it's hard for GPs 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 the wider. That's just impossible when half the population of women. And so, and again, as GP, 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? So it's very, very hard because GPs do feel underskilled because as GPs, we do have

to know about everything, which is tricky. But in menopause care, it's the only specialty. They have no access. We have no access. Well, we do, but it might be 18 months. And you and I know we have spoken to many women together and independently who have try to take their life or not. And, you know, 18 months, we cannot wait for that sort of device.

Because as you say, actually, when you understand hormones and HRT and menopause, it's actually, frankly, quite straightforward, isn't it for most women? Yes, 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 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, you know, once you get the right dosin 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 say. 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-health care 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, some drugs for arthritis, you know, some of the, like metatrexate where you have to have blood tests and everything, you still think, gosh, it's a big responsibility for me as a clinician to prescribe something. But I actually I've never once worried about prescribing hormones. Like I've never worried prescribing thyroxin.

Yeah, and it's the only area of, well, I think probably the only area of my clinical practice in general practice whereby I can actually get people back to 100%, I can cure them, 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 that I probably misdiagnosed over the years, it was such an exciting time. Women came back and said, thank you very. very much, I'm sorted. And, you know, these are often there in general practice, you know, they'd seen cardiologists, dermatologists, had seen rheumatologists, we'd had a few synchnotes,

we'd maybe prescribed a bit of antidepressants that hadn't worked or given the side effects. And then once my penny started, once my, I started to work, hang on a minute, this is hormones, it was, it's been a great time of my life, really, in the last 10 years since I started to work it out because I can reverse it. 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?

Absolutely. And I do think the time will come where 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 obviously we fund balance app, we fund our education program.

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 pushed back

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 News and Health placebo effect. And all we're doing, I mean, because obviously this podcast is insightful testosterone, isn't it? When we do replace it, we're not giving people oral tablets. We're just giving testosterone through the scheme, which is completely safe. And we do an 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.

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 two and a half percent will still be normal, but have above the range and two and a half percent below. That's how they work out 95 percent, isn't it, 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. Like 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, their function. But systemic side effects are only going to occur if we were giving mega doses, 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 see, in our patients where we start HRT with testosterone, these women, we're not seeing side effects at all. And I think in clinical practice, I think we've got obviously three hormones, but predominantly for outcomes, we're talking estrogen and testosterone. And I think there are some women that get most of their

symptom resolution from estrogen. Yes. And are very happy. But I think there's a big majority of people, particularly ladies with the more psychological issues, low mood, anxiety. Yes, Eastern absolutely helps partially. But I think we're all very, very different, aren't we, in our absolute, that balance of either the two Eastern and testosterone or Eastern testosterone and progesterone. And that balance, it's getting it right, isn't it? And persevereign and, you know, and that's why, again, it's hard in general practice because we don't have as much time. But it is worth perspiring. And 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. Yeah, absolutely. Because I was speaking at an event yesterday and a lady had started it and she said, I'm not really feeling much better. Or sometimes I do and other times they don't. But she'd only started it two months before.

And you really have to wait because it can take quite a long time. Absolutely. And it doesn't take long actually to reverse if you could stop it. No, it doesn't. No, but it could take quite a long time. I just understand that, Louise. It directly took me six months. But if I miss it, you know, I've tried it just for my own,

from a professional point of view. And within five days, I find I start to slip and I spoke to other colleagues here who have done the same. Yeah. So obviously we need to understand that better, but it works, doesn't it? But you do need to give it time. You've got to. get that right balance and what is right for my eight is going to be very different for what is

right for you isn't it louise and absolutely change as well as we sort of 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 oh great so i hope having three daughters at a son i really We hope that by that time my daughters come through, and I know you've got three daughters, I really hope that our generation has, you know, I've got to grips with this. I hope so that. It's so much easy.

And again, you know, we happily as GP, as doctors give the contraceptive pill, don't we, which is high dose, man-made estrogen to younger women. And, you know, I've given lots of that out. And yet there's this kickback on me giving transdermal body identical. And again, it's that mismatch, isn't it? Absolutely. Lots of mismatches. in, you know, in female health

there's an awful lot of mismatches, sadly. 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 libido, and we're working collaboratively with other groups as well. So watch this space, and we'll come back and talk about it in the future.

But I'm very grateful for your time today, Catherine, to talk about testosterone. And just before we end, though, like three tips. So there'll 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?

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 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 I know some GPs have to then ask for further advice from a secretary Claire clinic. So if that is your only option, then so be it. But I think there are three Fs.

Don't worry, I'm not going to be rude, Louise. The first I would 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. And then 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 estrogenized, 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 that not so fab three and that's what women at work comment most on in terms of their 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 estrogen. 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 we said earlier, fun as well. but I'm not sure I'm allowed that, but it does come. And the third is fact. 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 estrogen.

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 testosterone. Estrogen improved things for me, but I was very fortunate. I didn't have that many estrogen symptoms, so estrogen 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, Louise? Very good. Love all the Fs. Brilliant. Thanks very much. It's a little longer. I had to do that just to sort of weave it in. No, it's very good. It'll make people think and that's what all this is about.

So thank you ever so much. I've really enjoyed it. Lots, Louise. Thank you. Bye-bye. You can find out more about Newsome Health Group by visiting www.newsonhealth.com. And you can download the free balance app on the App Store or Google Play.