Was contemplating stopping T gel due to DHT side effects. After reading your article, it appears there are a couple tweaks that may make it more tolerable. Thank you for your research and for sharing with all of us.
Thanks for the info. I had wanted to try T for a while, but never had a doc willing to rx. I finally was able to try some estratest although it wasn't my first choice. I've only been on it a couple of months. Nothing negative so far. A couple of face breakouts, but manageable.
This is the rare testosterone post that actually improves clinical thinking instead of inflaming it!
Two things you nailed that would prevent a lot of unnecessary suffering in real-world care:
1. “Normal” labs don’t equal “no problem.” The symptom cluster matters, and total T alone can be a false reassurance when binding/availability (and the broader endocrine context) shifts what tissues actually “see”.
2. Testosterone isn’t synonymous with libido. The way you describe the clinically observed downstreams (energy, cognition/brain fog, training response, sense of “self”) is exactly what many patients report, even though guidelines have historically been narrow because that’s where the RCT density is strongest. 
I also appreciate the implicit safety posture: this is not “take T because Instagram said so”, it’s individualize, choose delivery thoughtfully, monitor for androgenic side effects, and don’t ignore the physiology (like SHBG dynamics) that explains why two patients with similar totals can feel completely different. 
If more clinicians read this, fewer women would get dismissed with “your number is fine”, and more would get the kind of careful, symptoms-first, risk-aware care that actually matches how endocrine systems work. Thanks again!
Fun fact: bring a copy of your testosterone Rx with you if you travel to a foreign country, or at least check rules before traveling. Went to Australia, and the announcement on-board the aircraft said to declare ANY medications. I did and my testosterone was almost confiscated since it is a "controlled substance". I only had one of the little tubes with me, not the rx or label. They did let me keep it but it could depend on who questions you at entry.
This is very informative. However, I think the picture with measuring T is more complicated. Dr. Sue Davis, a testosterone expert and researcher out of Australia, actually says that measuring total T is the current standard. You want to capture both the circulating and protein bound T. There is currently no evidence that Free T is the most biologically active fraction. Apparently binding is v. complicated. It is not linear and is affected by other hormones and the formula used for calculating Free T is outdated. She does recommend measuring SHBG. Fun fact - did you know SHBG can be elevated for years after stopping the birth control pill? I did not!
Interesting that I can apply it to my clitoris to help with sexual function. How often and when should this be applied. I use the Testim gel. Is that OK to apply down below?
This was great, wish I had read this 6 months ago, high DHT from the cream, switching to shot subcutaneous to see if I can get those levels down. Thank you
SQ testosterone has been such a game changer for me. The focus, drive, muscle building have improved so much! I wish more women knew about all the positive benefits so thank you for all that you do!!
I’d love to know how many times per week you do this and where you got your injections? My OB/GYN only seems comfortable prescribing gels or grams and in one year. I’ve barely moved from a level of 2 to 20!
I do it twice a week (assuming I remember the 2nd time!) I definitely notice a difference when I get the 2nd one in. I had the same resistance with my pcp. She put me on troches and it was awful.
I go to bio restoration in Utah. What state are you in?
Another great well explained and detailed article. Thank you! Particularly interesting that being metabolically healthy means you could have higher SHBG and in turn low free T. And definitely super frustrating that all the menopause guidelines speak only to measuring or looking at total T.
And don´t you also use oral estradiol? How do you mitigate the binding more of your T? Every time I try to use oral E, due to the binding of my T, I feel flat, depressed, unmotivated. Basically losing all my T benefits. And adding more T doesn´t fix it.
Thank you for this amazing information. I find the the updated or exposed truth of womens health to be exciting & enlightening. Equally I find the slow acceptance by the medicinal industry, fda, and I surfaces to be frustrating and at times rather debilitating (as what now?)..
Ah the brain fog and memory… I relate to remembering!! I am in CA. If goodrx has it as affordable as this article states, I may just copy and paste this into an email to my OB and ask! She always wants to go compounding pharmacy but the prices are so high for everything!
Very helpful information. I wish all of your hormonal related substacks were free to read, but I understand you’ve put in the work and should be compensated. There are so many helpful substacks that I can’t subscribe as a paying customer to all of them though. Thanks for providing this info!
Thank you! This is absolutely fascinating - there's a lot I didn't know about testosterone. Sounds like something more GPs should be reading too!
This was an excellent post! Thank you very much!
Thanks for reading!
Was contemplating stopping T gel due to DHT side effects. After reading your article, it appears there are a couple tweaks that may make it more tolerable. Thank you for your research and for sharing with all of us.
Thanks for the info. I had wanted to try T for a while, but never had a doc willing to rx. I finally was able to try some estratest although it wasn't my first choice. I've only been on it a couple of months. Nothing negative so far. A couple of face breakouts, but manageable.
Good luck
This is the rare testosterone post that actually improves clinical thinking instead of inflaming it!
Two things you nailed that would prevent a lot of unnecessary suffering in real-world care:
1. “Normal” labs don’t equal “no problem.” The symptom cluster matters, and total T alone can be a false reassurance when binding/availability (and the broader endocrine context) shifts what tissues actually “see”.
2. Testosterone isn’t synonymous with libido. The way you describe the clinically observed downstreams (energy, cognition/brain fog, training response, sense of “self”) is exactly what many patients report, even though guidelines have historically been narrow because that’s where the RCT density is strongest. 
I also appreciate the implicit safety posture: this is not “take T because Instagram said so”, it’s individualize, choose delivery thoughtfully, monitor for androgenic side effects, and don’t ignore the physiology (like SHBG dynamics) that explains why two patients with similar totals can feel completely different. 
If more clinicians read this, fewer women would get dismissed with “your number is fine”, and more would get the kind of careful, symptoms-first, risk-aware care that actually matches how endocrine systems work. Thanks again!
Fun fact: bring a copy of your testosterone Rx with you if you travel to a foreign country, or at least check rules before traveling. Went to Australia, and the announcement on-board the aircraft said to declare ANY medications. I did and my testosterone was almost confiscated since it is a "controlled substance". I only had one of the little tubes with me, not the rx or label. They did let me keep it but it could depend on who questions you at entry.
Oh no! That's a great tip!
Interesting! I went to Costa Rica and there was no problem bringing 4 tubes with me
This is very informative. However, I think the picture with measuring T is more complicated. Dr. Sue Davis, a testosterone expert and researcher out of Australia, actually says that measuring total T is the current standard. You want to capture both the circulating and protein bound T. There is currently no evidence that Free T is the most biologically active fraction. Apparently binding is v. complicated. It is not linear and is affected by other hormones and the formula used for calculating Free T is outdated. She does recommend measuring SHBG. Fun fact - did you know SHBG can be elevated for years after stopping the birth control pill? I did not!
Interesting that I can apply it to my clitoris to help with sexual function. How often and when should this be applied. I use the Testim gel. Is that OK to apply down below?
Yes I’d like more information related to the clitoris and improved sexual function.
I hope she answers. It's been 4 days since I commented!
This was great, wish I had read this 6 months ago, high DHT from the cream, switching to shot subcutaneous to see if I can get those levels down. Thank you
SQ testosterone has been such a game changer for me. The focus, drive, muscle building have improved so much! I wish more women knew about all the positive benefits so thank you for all that you do!!
I’d love to know how many times per week you do this and where you got your injections? My OB/GYN only seems comfortable prescribing gels or grams and in one year. I’ve barely moved from a level of 2 to 20!
I do it twice a week (assuming I remember the 2nd time!) I definitely notice a difference when I get the 2nd one in. I had the same resistance with my pcp. She put me on troches and it was awful.
I go to bio restoration in Utah. What state are you in?
I am in CA!
Another great well explained and detailed article. Thank you! Particularly interesting that being metabolically healthy means you could have higher SHBG and in turn low free T. And definitely super frustrating that all the menopause guidelines speak only to measuring or looking at total T.
I also have a high SHBG. I get it.
And don´t you also use oral estradiol? How do you mitigate the binding more of your T? Every time I try to use oral E, due to the binding of my T, I feel flat, depressed, unmotivated. Basically losing all my T benefits. And adding more T doesn´t fix it.
Thank you for summing up what I thought was appropriate treatment! I am working with a new population of patients and this is perfect!
Thank you for this amazing information. I find the the updated or exposed truth of womens health to be exciting & enlightening. Equally I find the slow acceptance by the medicinal industry, fda, and I surfaces to be frustrating and at times rather debilitating (as what now?)..
Ah the brain fog and memory… I relate to remembering!! I am in CA. If goodrx has it as affordable as this article states, I may just copy and paste this into an email to my OB and ask! She always wants to go compounding pharmacy but the prices are so high for everything!
Surgical menopause already low testosterone, wouldnt oral rstradiol lower it even more ? How do you get around that ? Patches make me feel awful .
Very helpful information. I wish all of your hormonal related substacks were free to read, but I understand you’ve put in the work and should be compensated. There are so many helpful substacks that I can’t subscribe as a paying customer to all of them though. Thanks for providing this info!