The Dr Louise Newson Podcast - 50 - Testosterone and breaking the stigma

Episode Date: March 10, 2026

In this episode, Dr Louise Newson is joined by urologist, educator and hormone health advocate Dr Kelly Casperson to challenge some of the most persistent myths surrounding testosterone and women’s health. Drawing on both clinical experience and scientific evidence, they explore why testosterone is not just a “male hormone”, but an important hormone for women too, influencing brain health, energy, mood, sexual function and overall wellbeing.Louise and Kelly discuss how historical misunderstandings, stigma and perceived lack of research in women have shaped current attitudes to testosterone, and why confusion between natural testosterone and synthetic anabolic steroidscontinues to create unnecessary fear. They also reflect on the importance of education, advocacy and clinician training to ensure women can have access to this important hormone.Want more from the podcast? Sign up to my premium offer: https://www.drlouisenewson.co.uk/premium-podcasts LET'S CONNECT  Subscribe here 👉 https://www.youtube.com/@menopause_doctor Website 👉 https://www.drlouisenewson.co.uk/Instagram👉   / @drlouisenewsonpodcast  Download balance app 👉 / https://www.balance-menopause.com/balance-app/ LinkedIn 👉     / https://www.linkedin.com/in/drlouisenewson/ TikTok 👉   / https://www.tiktok.com/@drlouisenewson Spotify 👉 https://open.spotify.com/show/7dCctfyI9bODGDaFnjfKhg LEARN MORE Download my balance app 👉 https://www.balance-menopause.com/balance-app/Get tickets for my new theatre tour, Breaking the Cycle 👉 https://www.nlp-ltd.com/dr-louise-newson-breaking-the-cycle/

You're going to really enjoy this episode with Dr Kelly Casperson, who hopefully many of you will have heard of. She's a great advocate for testosterone in women. She was on the FDA panel recently. And we talk about testosterone, what it is, what it does in our bodies, how it works in a basic physiological way, and also how women feel when they are prescribed the natural testosterone too. So enjoy it.

Kelly Casperson, you are here. but you're not here, which is a real shame, because I loved, loved being with you in Australia. You are my new friend, best friend forever, because like me, you've got a really inquisitive mind. And I guess like me, you're quite happy to talk about things that you've learnt, things that you might have got wrong in the past, things that you were taught at medical school,

which now you know are not right. But also you've got a lot of clinical knowledge. And I find with a lot of things, especially in health of women where there seem to be very polarised views, is that a lot of people that do a lot of the shouting and are really anti-hormones, they never prescribed them. And there's two things I think, which I want to unpick because we want to talk a lot about testosterone in this podcast, is that if I don't know something, I go back to basic physiology and basic science. and then if I feel really down and I want to give it all up and I feel awful, I just do a day in my clinic and I do a good day, a week anyway,

it's very busy. And I just see the transformational effects of hormones. So you have this dual effect, really. You have science supporting what you think and then you have the art of medicine showing you what you think and learn is true. So I think we're both in a very privileged position that we can do both, can't we?

Yes. Yeah. Yeah, absolutely. But I think, you know, if we'd had this podcast conversation 20 years ago, well, I wouldn't even have it because I didn't know that women had testosterone. Like, that's madness, isn't it? Yeah, I didn't know it either. And I thought, the other thing, I thought osteoporosis was a fixed state.

Yeah. Right. Like, that was another thing. Like, your bones are just osteoporotic. You can't do anything about it. Like, that's another one that's coming up a lot. People just think it is how it is instead of bones react to the environment. So I was really freaked when I first learned that women had testosterone.

But rather than thinking that's not true, I did what I always do. I went back to the basics. And I learned a lot of physiology about men and women because essentially our cells are pretty much the same and how testosterone works at a molecular level. And when I talk about testosterone, I talk about the hormone that we prescribe, which is the molecular copy of the testosterone we all produce, men and women, because it's the same, right, isn't it? The testosterone for men and women. But also what I have done, and I know you enjoy it as well,

is looking back at the history of hormones, because as soon as they discover the molecular structure of testosterone, they commercialised it and they made a synthetic version. So when people are worried about testosterone and the risks, they're actually talking about the risks of the synthetic testosterone, aren't they? Yes. That's right. I want to talk now about pure testosterone. The testosterone we make in our bodies and men make as well. Men make more than us, but we still make it. And it's a biologically active hormone, isn't it? Yeah. And it's made all over our body. It's made, obviously in our ovaries, but our adrenal glands, our brain makes it. Our muscles make it. It gets made everywhere, doesn't it? It's fun to talk about because so many people, they don't even know ovaries make it, let alone other body parts convert and make it.

to use locally. I always like to go back to the basics. Hormones make healthy cells stay healthy, right? They work in the nucleus. They help the mitochondria. As far as the brain goes, the glial cells, nobody knows what a glial cell is, but I have a neuroscience undergrad. Gleal cells are the support cells for the neurons. They help the myelin sheath of the neurons. Like testosterone's everywhere in the body.

But a lot of people start the conversation too high of like, what's it good for? What's it indicated for? It's like understand what it does first. Then we can talk about what makes sense of what it's what it's good for. Yeah. And I think this is really, really important when we think about why we prescribe testosterone, because we know that there's all the talk about libido, sexual pleasure. Yeah, fine. We know that testosterone prescribing can help with that. But if you've just mentioned the myelin sheath, now some people might not know what the myelin sheath is, but it's like the conducting part, it's the outside part of the nerve that helps our signals to go very, very quickly. So if I put my hand on a hot plate, I want my hand

to remove quickly. But I'll only do that if the signal goes to my brain very quickly and then the signal from my brain, which says, oh gosh, that's hot, goes back down my arm and tells my arm to lift my hand off. And the myelin has to be very, there's lots of other reasons, but the myelin has to be good. As we age, but also some autoimmune conditions, obviously we know multiple sclerosis, the myelin sheath gets damaged. So I put my hand on the hot plate. My myelin's not good. It's going to take longer for that signal. So therefore, I'm more likely to burn my hand. So when you read, and there's lots of papers, I know you've read them as well, that shows that testosterone will help keep myelin healthy, build the myelin sheath, repair the myelin sheath. So then you

suddenly start thinking, hang on a sec. What about multiple sclerosis then? Is that more common in men or women? Because men have more testosterone than women. Oh, no, it's more common in women. And then what about in men? Is it more common in men who have low testosterone? And oh, yes, we've got studies showing that men with low testosterone

are more likely to have multiple sclerosis. So then you're like, well, why don't all the neurologists know this? Why aren't we giving testosterone or measuring testosterone levels in people with multiple sclerosis? racist. Very good question. And neurologists, why aren't neurologists curious about testosterone levels? Yeah, you see, it's so interesting, isn't it? When you, and this is where what you do in medicine, you start with an idea and a concept, then you go back and work it out. And then if it fits the way you're thinking, we should be exploding that and thinking more and teaching it. And

I don't know why it's been ignored. I get cynical sometimes of like, because, you can't make money off a testosterone because it's generic because it's cheap because you can't patent a hormone. I mean, if you look at how things are, how money moves science, right? Like culture and economic shapes science, whether we want to believe that or not. And if there's no money in it, who's going to fund it unless it's a government that's funding it, right? Which I would say the health of a nation is very important and worth funding. But the other problem with testosterone is we've said only one gender has it. Right. We've made it binary.

So we've, people are like, we don't have the data in women. Literally, because nobody's studying women for anything. What's really interesting about that, which you're right, because people don't study women because we're too complicated because of our hormones. But there is very little data about the use of, I don't know, statins in women, for example. So the guidelines for women has been written on the evidence from men. And that seems fine. we can do that, or rub pressure treatments or, you know, any treatment.

Sleep medicine. Yeah, so anything is always based on a 70-kilogram man. And so that's fine. We do that. No one argues. Whereas if we say, oh, we're looking at all the data of testosterone and men, and we want to equate that with women, you're like, no, no, no, we've got to do the studies in women, which we know for well we'll never do.

So that seems a bit weird, doesn't it? And it's a bias that, you know, is worth pointing out. Because once you point it out, It clicks. Like, you know, once we pointed out, it clicks in people's brains and they're like, wait. The other very interesting thing is Parkinson's disease, right? So testosterone and estrogen help the dopamine pathway. Parkinson's is a profound lowering of dopamine in a certain portion of the brain,

looking at testosterone in helping Parkinson's and possible prevention. Right. And we know in men, because we have the studies, low testosterone is correlated with depression and dementia. These are all brain things, going back to the role of testosterone in the brain, right? If brain cells work the same, I think the same is true for women. It's just very hard to do a long-term testosterone study for dementia prevention. But like biochemically and extrapolating the male data, it makes sense. And my other question is when dementia affects, you know, two times, two to three times the amount of women than men.

Women carry the burden. It's incurable. treatments are awful and expensive. Why aren't we doing everything we can to try to figure this out and to try to preserve brain health? Like that's my big view of like, we don't have any data to show it's dangerous and we have some good knowledge to show it's beneficial. Why can't we take that great leap? We're never going to do a randomized placebo-controlled trial looking at exercise versus placebo for dementia prevention. We're never going to do it, but we always say exercise is dementia prevention.

It's so true and it's so obvious as well. And I know Professor John Stud, who's now died, but he was a great advocate for hormones and did some really great research in the 1980s and 90s. And I remember him saying to me ages ago when I sat in his clinic once, he said, Louise, you don't always need a randomised control study. Sometimes it's so obvious that we just don't need to do it. When they discovered that smoking was associated with lung cancer, they didn't do a randomised control study. to prove the harm. When they discovered penicillin and they knew how it worked in the body, they didn't do a randomised control study. And that's the same with natural hormones. The problem is the only randomized controlled study we have with HRT is with the synthetic progestogens, which we know have risks, and mojoxyprogesterone acetate, which is a synthetic progestogen.

But with testosterone, there are smaller studies. There are a few randomized controlled studies. there's lots of observational studies. You know, even in 1940, they were doing some studies on women and men with testosterone. I think the other thing is because testosterone is so integral, it's myelin sheets, glial cells, mitochondria. It's not specific like for a shoulder problem, right? And the problem with that is when you give women and men testosterone,

they say, I feel more like myself. I have more motivation. The things they say, because that's an integral part of your being and your functioning, those things are almost too soft for medicine. Right? Like, I can measure your blood pressure. I can x-ray your spine. I can't say Louise feels more like Louise.

Yeah. Right? But these hormones are so integral. That's the things they help with. I feel more like myself. I'm more interested in the world. These are brain things that were very hard. to study and so I think it gets dismissed of like you can't use hormones for quality of life

and I'm like brain health is quality of life I totally agree does that make sense like it gets dismissed because it's so integral and it acts in everything this has happened with a lot of hormone research and this is why it went back and to just looking at flushes and sweats because if you had a hot flush in front of me and I was the researcher I could see your hot flush I could you know see you, but I can't see you smile in the same way. I can't see that internal thing. And even now, I see people talking about the testosterone research and say, well, it's just a placebo effect.

Now, firstly, you know, so many women benefit from testosterone. I don't think it's just a placebo. And also, there are lots of symptoms that improve with testosterone that people aren't expecting. So a lot of people say to me, gosh, my muscle and joint pain's improved. My sleep's improved. my migraines have improved. They weren't expecting that. I can think quicker.

Yeah. Which is very hard to measure. How do you measure somebody thinking quicker? No. I totally agree. And it's little things. Like, I just find that life's easier. I'm not overwhelmed as much.

I don't hit a wall at 3 p.m. is what a lot of people say, right? How do you study that? How do you study not hitting a wall at 3 p.m.? And my point is, these hormones are so, integral to how the body functions, that it's almost hard to study it because the human is just feels better. And let's go into that placebo. Number one, statins have a placebo effect. Nobody knows that. Number two, SSRIs, the big studies say they probably don't work much more than placebo. And 25% of

American women are on an SSRI. So that dismissing testosterone because it's a placebo effect, makes no logical sense when we've got 25% of American women on something that doesn't work much better than placebo and we don't blink an eye we also don't have much long-term studies on SSRIs and stat you give people a statin

or a placebo statin and their cholesterol actually goes down why are we looking into that right like so the placebo argument to me falls apart so quickly you're absolutely right and I think it just feels like people are scared of testosterone.

And I don't know whether they're scared because women are stronger and better and happier or the other thing is this confusion about the synthetic testosterone. Because we know that the chemical testosterone that are made in a very different structure do have risks associated with them of heart disease and clots.

But when they made them, and like going back to your... point about money, as soon as they found the structure of testosterone in the late 1930s, they wanted to make chemical estrogen, chemical, estrogen, chemical testosterone, and as you probably know, they were trying to make a chemical progesterone, and they were testing it on the womb, because of course, with women, it's always about the womb and bleeding. And they did, they saw it didn't have the same effect as progesterone on the womb, but it had other effects on muscles, and the womb. But it had other effects on muscles, and various things.

And then they thought, gosh, this is very similar to testosterone. So they forgot about progesterone and went straight to the testosterone substances that they made and pushed them to market very quickly. And now there's hundreds of different testosterone. And some of them are anabolic steroids, of course. And a lot of them have side effects. And once certain communities got hold of them, it had a really bad rat for, for whole of testosterone.

And that's a real problem, isn't it? I joke now because it's so silly at this point. But I'm like, the American political community did not like East Germany winning gold medals in the 1980s at the Olympics. And so an act of Congress, truly an act of Congress passed the Anti-Doping Act of 1991. And that's why testosterone is on because of doping swimmers in the Olympics. And there's a lot of doping and sport. Nobody wants that. I get that they're trying to control it.

But what happened is they took a hormone your body naturally makes and they put it on our DEA list along with ketamine, Tylenol with codeine, and now you need a DEA license. And that's where the reputation of this is dangerous because why else would it be on this list? It's on the list because of sport doping. And Laura knows, I always joke, I can't make you an Olympic gold medal pole jumper on female dose testosterone.

There's going to be other anabolics in there, right? And there was in the Olympics, lots of anabolic. But this one natural hormone got thrown on the list. I do believe we are working to get it off the list to de-stigmatize the fact that this is not a threat to life at normal physiologic doses. And that's all we're talking about, keeping the doses from going low in life, not doping, not trying to make you win a gold medal. So I'm super excited to announce to you.

that my next book is now available for pre-order. It's coming out on May the 21st. It's called The Power of Hormones, Break Free from Fear and Misinformation About Hormones, and Harness them for a healthier, happier life. It's very historical, it's very factual, it talks about how hormones work in our body and the mess that we're in actually when we don't have them. There's a lot of information. It's taken a lot of work and I really hope you enjoy it when it comes. So you can find out more about it on my website, on my social media and pre-order it. We've been doing quite a lot of campaigning over here to try and get it changed and I have a few patients who and some of them have been on my podcast who are now having to make the really difficult decision to either

give up their sport or take testosterone because they're very. very testosterone deficient and they're having lots of symptoms. But even if you take it at a really high level, just looking at the randomised control studies, we know that testosterone can improve libido. The women who, I've been speaking to with very low testosterone, have a myriad of symptoms, but they also have reduced libido. And so in my mind, it seems absolutely outrageous that an organisation is saying that women who are professional, sports players with low testosterone are not allowed to have an orgasm and not allowed to have sexual pleasure.

Because that's basically, isn't it? What it boils down to if they're only looking, so forget the feeling better in yourself, forget the joint pain, forget the migraines, forget all the other symptoms, just let's look at libido and orgasm. So how can a committee say that women are not able to have an orgasm? Because we can't give you the treatment that will improve. And they can take, they can take gastroids. is my understanding. Yeah, of course they can. Yeah, there's a bias in what hormone you're allowed to

replace. Yeah. And so this is wrong. And I feel sorry for the committee because I think they've been miseducated by the wrong people having this confusion between the anabolic steroids, which, of course, we don't even prescribe and we wouldn't recommend for people to take whether they're athletes or not, with a natural testosterone where we're just replacing a hormone deficiency. To my understanding, no natural testosterone is just showed increased risk in breast. And In fact, Rebecca Glazer's work shows decreased risk of breast cancer. So whenever people say, it's just like estrogen, right? Are you talking about oral synthetics or are you talking about, you know, natural, transdermal

because they're very different mechanisms. So when you talk about testosterone and the mitochondria, you talk about inflammation, it's very similar actually to a debate that's been going on for many years about testosterone and prostate cancer. Because people used to say, well, one of the treatments is blocking. hormones for some people who've had prostate cancer. So therefore, testosterone is bad. But now they know that actually if you have low testosterone, your prognosis is worse and giving testosterone back will improve the prognosis from prostate cancer. And so, yeah, that's right. Cancer, you know, obviously there are different types and different organs. But Rebecca Glaze's work is amazing,

but it makes people think about testosterone for people who've had breast cancer. There are no studies that show that natural testosterone increases incidents or breast cancer or worsened survival if people have it afterwards, if they've had a diagnosis. Yeah, that's exactly right. And I think, I mean, it, it, we know that grassroots can make things move mountains. You know, grassroots helped get the black box warning off of estrogen products in America very recently. And so I really think the importance of conversations like this, to let people start thinking,

about what we're currently doing, does it make sense? Does it make sense to be afraid of this? Does it make sense to not research this? Does it make sense to not try it if the risks are so low and your fear of dementia is so great? Right? Like body autonomy and self-advocacy of like education is the way for people to start thinking their way through this because just accepting the status quo, we've learned time and time again, especially in medicine.

we're wrong a lot. We're wrong a lot. That's how we advance. And to be humble and curious, to progress this profession forward is what is needed. Because if we just think we know everything that we know based upon what's available right now, history has proven us wrong 200 times.

Absolutely. And I think we can be humble and we can change and we can learn and we can advance. And, you know, we desperately need studies, but most studies are still funded by pharmaceuticals, school companies. No one is interested in a chief as chips testosterone. But what we can do and what we're all doing actually is educating women to allow them to have a choice. And that's so important. And I just wanted to touch on FDA, Kelly, because, you know, I felt bit like your mother. I was so

proud of you and Rachel. Like, I was so tingly watching you stand there and represent millions of women. because you're as cool as cucumber. Like, you must have been really nervous and you knew what you were doing was so important. And they just weren't to publicly, yeah, congratulate you because it's, you know, and also two women. You know, I think it says a lot when women are representing women. It was a great, great honor.

So exciting. I had tear. I was sitting. I was like, I was the last one to speak. And I was like, I was had to like, get the tears, get the tears. get the tears back because you got to speak next. Like it was very moving for me to be on that stage. Yeah.

And it started a conversation, which is what's been needed for decades, actually. And I think we should be allowed to apologize and move on. And that doesn't happen enough actually in medicine, not just with hormones, but in general. People get greedy, things change. They're doing what they think is right initially. But then science might overtake or knowledge might overtake current practices, and that's fine, you know. So I think it's credible. Amazing to be witnessing something in our lifetime where it's going to make such a difference.

We're now in the post-Blackbox era. This is the next one. Watch out for the patch shortages and the progesterone shortages because the women are coming, wanting to try things to help them feel better. And female dose testosterone, we don't have that in America. you're lucky you have Andrafam. It's coming. It's on its way. I know it. I don't have a timeline exactly, but it's coming.

It's got to, hasn't it? But, you know, yes, we have Androfem that's become licensed in the UK, but we don't have any product. So it's just dangling a carrot. We can't prescribe it in the NHS. But it is licensed. Like, how did that help women? It didn't really, did it?

Wait, you mean it's licensed, but it doesn't exist? Yeah, so at the moment in the UK, we can only prescribe it privately, which we've done for many years, but the MHRA have licensed it, but we don't have any stock so we can't actually prescribe it in the NHS. Wild. I know.

We have you guys as the beacon of hope, so. Well, I wouldn't. I wouldn't because, you know, the FDA response, you know, it blew up. Everything I saw on my social media was all about the FDA announcement. There was nothing in our media over here.

Nothing. Like, absolutely nothing. Oh, I think it was. was firstly because it was good news for women. So if you were all standing on that stage to say we've got new data that HRT is more dangerous than we think, it would probably be in the front page of our papers. I think media is very selective. We know that.

But I think what for me is really disappointing is that the menopause societies in general have not come out with a really good statement. Some of them have been completely quiet and some of them have put out some very confusing messages. You know, we should be just reminding ourselves. that all guidelines globally, doesn't matter who's written them, say that first-line treatment for menopause is HART. And they all mention testosterone and say reduce sexual desire. Some say this stupid hyperactive sexual desire disorder, HSDD, which is just barbaric.

It's just made up. It's all made up. It is. But I think, you know... Not to dismiss female sexual dysfunction at all. No, but to require a woman to have nothing else in her life going on to affect her desire before she can try testosterone. We don't say that with Viagra and we don't say that with male testosterone. No, but also, it's not just that.

They also say women have to be severely psychologically distressed for at least six months. Distress, yeah. Nobody wants to admit to that. Like, you know, we went into medicine to help people. So thinking about testosterone can improve quality of life isn't a bad thing really, is it? Sometimes I wonder why I love testosterone advocacy so much because there's so many barriers to it.

I'm like, I'm picking the most like forlorn hormone to try to advocate for because it has so many barriers against women getting its use. But once you fully understand it, you're like, we can overcome all of this because this is all just myth, oppression, fear. Yeah. Like, it's an incredibly safe medication.

I come back to that. I'm like, doctors prescribe unsafe medications all the time because they perceive their benefits to outweigh their risks. That's what, at the end of the day, benefit risk, benefit risk. And with our natural hormones, the risk is so low and the benefit is so great that a woman really should have the opportunity to have. to advocate and have that if she wants. Absolutely. It's a brilliant way to end the podcast thinking about that.

So the three take-home tips I'm going to ask you. What three ways do you think we can enable more women to access testosterone if they want it? Learn about their bodies. Learn how it works. Learn how to talk to doctors and learn how to find a doctor that already does it. Right. We need to have, enable women to go to a warm audience, right? And then, and then train more doctors and clinicians. And we're doing that. Doctors and clinicians, at least in America, are getting trained on hormones at a unprecedented rate right now. And I'm not just talking obese. Like, I had a GI doctor text me yesterday being like, nobody else is doing this. I see the need. I need to learn. Right. So more and more doctors are getting trained. So I think that. That's it.

Like education, advocacy, and then physician and clinician knowledge and education, the know-how. And we need an FDA-approved product because not that it's going to be absolutely superior, but it's going to blow open the conversation. It's going to give it a permission slip with which we don't have right now. Yeah. So let's hope we can all work together and keep this conversation getting busier and louder and help more women. the end of the day. So thank you so much for all your work, Kelly. Thank you. Pleasure to talk. And all your support and look forward to seeing you in the US sometime soon. Sounds good.

Cheers. Thank you. Bye. I've got something really exciting to share with you. Every Thursday, I'm going to be releasing an extra episode for those of you that sign up. It's an opportunity that I can have more guests, share more information, dig deeper into the research that I can share with you. And when you subscribe, this money is going to be used to help with research, much needed research that's away from pharmaceutical companies. So information is down in their show notes. So have a look and subscribe and enjoy.