Jillian Woodruff, MD (00:00)
Welcome back to the Modern Midlife Collective. We are kicking off today's episode with another midlife myth and bringing you the modern medicine that every woman deserves to hear.
Ade Akindipe, DNP (00:13)
I am super excited about this topic because I have my own personal story and I hate it when I hear testosterone is only for men. It drives me crazy and it really sticks around, right? Imagine going to the doctor and you're reading about it and you're being told, no, that's not for you. So I really want us to, know, bust this myth, give you the truth.
you know, talk about the side effects, what you should look out for, and really is this something that can improve your quality of life? So I'm really excited about this.
Jillian Woodruff, MD (00:44)
That's right. And this myth affects our quality of life. It affects the quality of life for many women. Testosterone is produced by the ovaries. So yes, it's produced by something that only women have, but that's not the full story. It's also produced by your adrenal glands and it plays a vital role in female health. Not just that, but in our peripheral tissues, like in our skin, we also produce testosterone. And in fact,
Women have about 10 times more testosterone than we do estrogen in our other female hormones. So testosterone is not just a male hormone, it is the hormone that we have in the most abundance. And you've heard it right, we need it for libido, for energy, for muscle mass, for our strength, for cognition, how we think, for our mood.
And even motivation, that was really interesting to learn more about and share with people. It affects how we are motivated to do things, motivated to exercise, motivated to live.
Ade Akindipe, DNP (01:59)
That's correct. And because it's labeled a male hormone, it's stigmatized. So many women don't even know that they make testosterone. We talk a lot about estrogen, right? Because it's, you know, estrogen and, you know, that's supposed to be helping with skin and hair and nails and all those other things. But also, you know, when you have that decline, like you said, it impacts so many vital functions in our bodies. And, you know,
when I turned 40, I started to notice all those symptoms and I didn't attribute it to hormone imbalance or decline in hormone levels at that time. But a lot of women experience these things and I think it's time for us to talk more about it and how that can impact your quality of life. fatigue, feeling tired all the time, brain fog, ⁓ decreased sexual desire. And I'm sure Dr. Jill, you probably see this a lot with women coming in.
after they've had children or maybe they haven't had children and maybe they just notice that there is a decline in their sexual desire, you that thought that you want to be intimate with your partner. And just because you're over 40 doesn't mean this is something that you have to deal with and if it's or not do anything about because this is just part of aging. So I think shedding some light on this about the importance of testosterone replacement if this is something you're interested in is key.
Jillian Woodruff, MD (03:21)
You're so right, Dr. Adai, and it may be typical for our sexual desire to decrease, but just because something is typical does not mean that it's normal, right? So yes, I hear that quite often. There are so many things that can lead to a decline in our sexual desire, and some of it we are hearing from women quite early on. It may be because of having children that kind of...
definitely decreases your sexual desire, right? So that's true. And that may not be related to testosterone, but you the decline in our testosterone levels is pretty sneaky. So we've talked a lot about perimenopause and we know how our hormones really fluctuate wildly. And when I'm talking about hormones, it's really that estrogen level.
Ade Akindipe, DNP (03:50)
I can imagine how that will do that. Especially right away. It's like, okay.
Jillian Woodruff, MD (04:13)
that goes up and down and it's super high and sometimes extremely low in perimenopause. Whereas with testosterone, the decline just starts to happen in your 30s and just gradually decreases from there. So it kind of happens to the majority of us in this way. And so we may start noticing symptoms even before we're in our 40s because of this testosterone decline, right?
Ade Akindipe, DNP (04:40)
Yeah.
Jillian Woodruff, MD (04:42)
And by the time you hit your 50s, then your level is significantly lower.
Ade Akindipe, DNP (04:48)
Yeah, imagine that, right? Imagine being in your 20s, you know, in your teens, your 20s, and you and you're noticing that decline as you start to get older. And it doesn't necessarily have to be for women over 40. I've seen women younger than that also experience some of these symptoms. But bringing it back to what does the evidence show? Of course, we as providers need to make sure that we're not just saying, well, yeah, testosterone is for you. What does the evidence show? What's the research behind it?
So Dr. Jill, can you talk to us about what is it out there? And maybe we can take some of this information and go share it with our provider and say, hey, this is what I heard on Dr. Jill, Dr. Aday's podcast. What do you think about that?
Jillian Woodruff, MD (05:29)
That's right. Well, there are many studies regarding testosterone and we need to, you're right, share that with our providers that may not have this information or your provider may be experiencing a decline in testosterone themselves and so they may know this or they may be doing their own research. ⁓ I can share with you that the International Menopause Society in
Ade Akindipe, DNP (05:47)
All right.
Jillian Woodruff, MD (05:57)
2020, they put together a global position statement. So basically they took a lot of ⁓ big names in hormone and menopause research, brought them together. They perused all of the literature, the well-done studies that have been out there, and then they made their recommendation. And what came away from that is that they endorsed testosterone for the treatment of hypoactive sexual desire disorder. So low desire.
for sexolo libido basically. And so what this is showing us is that they're giving you one thing that testosterone can, right, could be used for, this is 2020, and it's if you have low desire, where there are so many benefits to testosterone. We have testosterone receptors, so we have organ systems all throughout our body, including our eyes.
Ade Akindipe, DNP (06:37)
Just one thing.
Jillian Woodruff, MD (06:53)
that need testosterone in order to function. Hormones are messengers that deliver signals throughout the body. So for missing certain messengers, then you're going to have side effects from that. although low libido in some can be very distressing, not everybody that has low desire has a problem. So that's important to note too. But if it is causing distress, then it's a problem and it ⁓
should be taken care of. And so one of those ways is with these testosterone. But we do not want to forget that there are ⁓ so many cognitive and emotional benefits to testosterone, and those have been studied too. There is this other ⁓ article, I don't know how you say the name, I think it's FUI, it's F-U-I, was the primary investigator, but they discussed how testosterone can enhance our mood and our memory and our mental clarity.
And there's also evidence that it can have neuroprotective benefits. We're studying that a lot with estrogen, right? And protecting us from cognitive decline or even dementia. So this was another study that they looked and they did see long-term benefits to the use of testosterone.
Ade Akindipe, DNP (07:55)
Yeah.
Right, I mean, that's great to know, especially if you're gonna take this to your doctor. I think there's also some research out there to talk about even cardiovascular benefits. I can't remember off the top of my head, but I remember reading something about just improving ⁓ vascular tone, ⁓ lipid profile, not to say that you don't eat right, you still have to do all the lifestyle things, but your metabolic health. ⁓
But I guess that kind of goes hand in hand. If you're feeling better, you want to exercise, you want to do all the things. If you're not so tired and you want to go exercise, right? So it makes perfect sense. So the takeaway here is that when prescribed appropriately, there are so many more benefits than just sexual desire, right? So that's great that you pointed that out, Dr. Jill. So another thing is safety, right?
So the 2021 paper testosterone in the heart outlines the premenopausal levels, right? So testosterone does not increase cardiovascular risk and may even support vascular health like we talked about. So the risk may increase when dosing goes beyond physiological range. So what does that all mean? It means you need to go to someone that is prescribing it appropriately, monitoring your labs, checking in on your symptoms.
Jillian Woodruff, MD (09:08)
Mm-hmm.
Ade Akindipe, DNP (09:28)
I'm sure we're going to dive more into it a little bit more about the risks and the things that you don't want to do where it becomes really dangerous for you. Right, Dr. Jill?
Jillian Woodruff, MD (09:37)
You're absolutely right. You need to go to someone that is well versed in hormones in general because all of our hormones kind of interact with each other and One hormone can influence another even thinking about testosterone when it's metabolized it can metabolize into Estrogen or a type of estrogen. There's more than one type group. So that is super important ⁓ one of the
It was a myth really that we could consider it a myth that testosterone leads to cardiovascular problems, which now there are so much literature that says quite the opposite like you stated that testosterone does not increase our risk of cardiovascular disease. In fact, it's more protective. ⁓ But yes, you need to go to someone that knows how to prescribe, how to monitor. One of the things that I see
from people that have come from other places a lot of times and they've moved to Alaska where we are and they're coming on a regimen. They have not had any levels tested for quite some time. It could be years and they've just been, yes, in taking this medication. It's not like, okay, they checked and that level that they took at the beginning was good.
Ade Akindipe, DNP (10:51)
That's dangerous. No way.
Jillian Woodruff, MD (11:00)
That doesn't mean that it stays good, right? Because we have body changes that affect how we break down, right? Weight loss, liver function, the efficiency of our liver to break things down and get things out of our body. You kind of have to check up on these things. Even if you're at an appropriate dose at a certain time, doesn't mean that it continues that way. So you have to have someone that understands that, someone that can help with the efficiency of
Ade Akindipe, DNP (11:03)
Right.
weight loss, know, weight loss, you start to feel better. Yeah. Mm-hmm. Right.
Night.
Right.
Jillian Woodruff, MD (11:31)
metabolizing your hormones, that's important. So we have to keep that in mind. And then the other thing is that you had mentioned physiologic ranges, and this is the difficult part because there is a reference range that you would see if you get your blood drawn, for example. There's different ways to check hormones, but typically in traditional medicine, they're using blood draws. And with that, there is a range that on average a woman at your age would have this
Ade Akindipe, DNP (11:34)
Yeah.
Jillian Woodruff, MD (12:01)
level and it the level changes or the range changes depending on the lab that you go to so it's not always exactly the same but let's say it's four to forty this is on average what a woman your age would have this does not mean that this level is a normal level for you so you could be at 10 let's say and I would say that's pretty on the low side but for you you may not have any issue that may be just fine for you and you could be at
Ade Akindipe, DNP (12:16)
Right.
Jillian Woodruff, MD (12:26)
40 and have symptoms of low testosterone, need to be above that reference range, that average range. So you do have to go to someone that understands that and then also understands the the modes that you could get testosterone to.
Ade Akindipe, DNP (12:33)
Yeah.
Absolutely.
Absolutely, and I'm glad you brought up that point about physiological range because it looks different for everybody. mean, there's ranges and then there's symptom relief. And sometimes you may get symptom relief at something that might be above the physiological range, but we're checking to make sure that you're not having side effects of when it's too much for you. And we could probably talk a little bit more about that later, but.
making sure that you're not having strange side effects, making sure that you're getting imaging done, especially if you're a woman over 40, you know, making sure that you have your mammogram done so that you're not exposing yourself to, you know, if you have the risk for breast cancer, for example, that's maybe hormone response. If you want to make sure that you're getting you go into someone that's checking all of those things off before just writing you a 90 day supply of testosterone, six months supply with no, I mean, let's be real.
⁓ The access is there. There are lots of companies online that are just prescribing these things. It's not to say that there's anything wrong with ⁓ whether it's FDA approved, whether it's compounded. I believe in, I think compounded medications are great. It's a great way to kind of customize it to someone if they're not getting benefits with what, mean, testosterone, it's not even FDA. Is it FDA approved for women yet? I don't think it is, right? It's just for men.
Jillian Woodruff, MD (14:05)
No, it is not.
Ade Akindipe, DNP (14:08)
how do we get it? It has to be compounded. That's a whole nother thing. I'm not even gonna go there. It's like, and it is controlled.
Jillian Woodruff, MD (14:09)
That's a whole conversation. Yeah. And it is controlled. It is a controlled medication. So you cannot just, you know, go and get a prescription. There's certain things we have to do, just like an opioid, let's say. It is controlled like that. So you can't just have it year supply.
Ade Akindipe, DNP (14:22)
Right.
Right. It is a controlled prescription, you
can't just have, you know, not have any monitoring. So if it's something that you don't feel like you are getting the adequate care, I would recommend finding someone. And it doesn't have to be in person. These things can still be monitored. But I think, you know, if it's done properly means that you're being monitored, they're checking you out, you're going for the appropriate imaging, you're being scanned anyway.
So that's good quality care, right? So now let's go into myths. So this is where it gets a little bit more interesting here. So testosterone will make you grow facial hair or become more aggressive. All right, let's take this one.
Jillian Woodruff, MD (15:08)
Okay, I'd say that's somewhat of
a midlife myth. I will tell you that in midlife, women tend to start to grow more facial hair. And it does not mean that they have high levels of testosterone, quite the opposite. They typically do not. The issue is it's the balance, and I think we have said this before, but it bears saying again.
Ade Akindipe, DNP (15:31)
Yes, we have.
Jillian Woodruff, MD (15:33)
It's the balance of your hormones that's off. So the estrogen to testosterone ratio that is different than it was before. And you have more facial hair. So if we give you more testosterone, would you grow more facial hair or become more aggressive? I will say to the aggression part, no, I give a lot of testosterone and I probably have had maybe one, maybe two.
people that I can think of and I can like see faces when there's certain things that are that rare that occur. And I actually don't know that it was from the testosterone, but I never say never, right? Anything can happen from anything. ⁓ But that is not a typical response because like we said, testosterone is great for our mood. And so what testosterone does is it gives us this overall sense of wellbeing.
And for ladies, a lot of people comes in the office and will say that they're feeling very irritable, especially in perimenopause. They get angry more often. They are more aggressive already. ⁓ They, you know, maybe snap at people. They don't have as much patience with their family, with their kids, with their coworkers. You know, sometimes maybe that's deserved. Well deserved, right? But in general, they're not themselves. And so testosterone actually
has been the biggest thing that I think changes that and helps people to feel more like themselves and more calm and more patient. So quite the opposite of aggression, quite the opposite. Facial hair, you can change levels of what you're giving, right? So you may get to a point where a woman is saying that they're experiencing more facial hair. So maybe that is time to pull back a little bit.
Ade Akindipe, DNP (17:22)
Yeah, right.
Jillian Woodruff, MD (17:22)
Right? It could be that
that level, that dose that you've given is too high for that person. So there is a little trial and error. It's not a like, here's your dose, that's it. You you kind of have to work it.
Ade Akindipe, DNP (17:26)
Right.
Exactly. totally, I totally agree with
that. think everybody's different. I mean, you have somebody, maybe they got, I don't know, subcutaneous pellet therapy and maybe their dose was really high for them. And then of course you will have some of those symptoms of like maybe facial hair growth where you can notice it around the chin area. You know, you'll produce a little bit more oily skin. So, you know, you can break out with, you know, some acne, facial acne, those are some of the side effects of that.
but it doesn't mean that you're gonna grow a beard or you're gonna be muscular and manly, which is what people would normally ask. Which is totally not what is. It's really good to have that gradual, know, I tell women all the time, it takes time to get where you need to get to as long as you're not starting too high where you're getting all those symptoms. But, you know, I've heard of people say even darkening of the skin ⁓ with testosterone. ⁓
Jillian Woodruff, MD (18:04)
A hairy man with high desire.
Hahaha
Ade Akindipe, DNP (18:28)
Another one is voice. Your voice can change, you know, if you're super high and that can actually stay that way if you're not careful. So you got to make sure that you are, you don't want to be so excited. I want this testosterone. I want to get there today. It doesn't work that way. takes a lot of time. So absolutely physiological, but to the point where you're not causing more damage when you're on it.
Jillian Woodruff, MD (18:36)
Yes, this is true.
Yes. Yes.
Yes, absolutely. Some issues are reversible and others are, I should say side effects, some are reversible and some may not be. And so if you have deepening of the voice, is not a reversible side effect. So you do have to be careful. There are side effects like clitoral megalese. So your clitoris becoming enlarged and that's happened to some people that is completely reversible. Some people quite like that.
Ade Akindipe, DNP (19:17)
Yeah, absolutely.
Jillian Woodruff, MD (19:23)
they may and it's this is of like the clitoral bulb so just the visible portion they like it they feel like yeah yeah
Ade Akindipe, DNP (19:27)
Can you expand a little bit more on that? Now, this is something that
I ask, people get asked all the time. is that, does that produce any benefits for women, the fact that you have an enlarged clitoris?
Jillian Woodruff, MD (19:40)
They believe that it does. mean, the women that I've spoken with or that have experienced this or that I see on exams and ask them about, they quite like it. They feel like it does increase their pleasure and they don't want to let that go. But I see that as a sign of too much testosterone. So I would want to pull back from that. There are studies about this and actually the studies say that it doesn't.
Ade Akindipe, DNP (20:01)
Mmm.
Jillian Woodruff, MD (20:09)
make a difference in your desire. But I think the only one that knows your body is you, right? You know? But yeah, they've seen that it doesn't cause more, the size of your clitoris, it does not correlate with the amount of pleasure or stimulation you get. So that is important. There are people who have a very petite clitoris and they are very well stimulated.
Ade Akindipe, DNP (20:11)
Okay. Okay, ladies, you hear that?
If you're okay with it, I guess. All right.
Jillian Woodruff, MD (20:32)
And there's others that have larger ones and they may be lacking in stimulation. And we're only talking about the visible portion. Your clitoris is actually much longer than that. It's like a, is that called a horseshoe? A wishbone, a wishbone. A wishbone, yes. ⁓ For those who are maybe watching this, it's like a wishbone shape. And so the only visible part is the little knob, the bulb of the clitoris.
Ade Akindipe, DNP (20:32)
Yeah.
Sure.
Yeah, a wishbone.
Jillian Woodruff, MD (20:59)
And then you have skin that kind of lays above it and that's like, like would be similar to foreskin and it should move and expose that little bulb. Now there are some problems which we'll have to get into a whole different program where your clitoris kind of covers it too much and that can interfere with your, your stimulation. ⁓ but yeah, typically that bulb getting larger or smaller really shouldn't affect your sexual stimulation. Yeah.
Ade Akindipe, DNP (21:12)
Right.
So interesting, so interesting.
mean, some of the benefits that I really love about it is just the focus, just the ability to clear the fog and be able to sit and concentrate. I think that was a big one for me. ⁓ Definitely energy. ⁓ Let's see, even sleep, importance of sleep, that definitely helps. And I've seen some other clients that have said, just sleep much better when I'm on testosterone. ⁓
Jillian Woodruff, MD (21:28)
I think so.
Yes.
Ade Akindipe, DNP (21:56)
skin. You know, if it's balanced, I think it really does help that glow, that feeling of, feel great. So, ⁓ yes, lots and lots and lots of benefits. ⁓ Everybody did experiences differently. Maybe you didn't have a libido issue before. like, well, I don't need testosterone, but there are so many other benefits besides just that. okay. So here's another one. Yeah, go ahead. Yeah.
Jillian Woodruff, MD (22:02)
Absolutely.
I think, Dr. Adai, if I can
interrupt to expand on the skin portion because you know how I love the skin. And you had mentioned earlier about acne and now we're saying it's great for the skin. So I just want to explain quickly that testosterone does increase the oils in our skin, but oils are not necessarily bad. They can be in some situations, but oils are what will help your skin have that glow, like you said. ⁓ Otherwise, your skin will be dry.
Ade Akindipe, DNP (22:24)
I know you do.
Right.
Mm-hmm.
Jillian Woodruff, MD (22:48)
and dull
looking and more prone to wrinkles, right? So testosterone helps to combat that. The problem with the acne is if you have more oils and those oils get trapped and then they can become infected with a bacteria and then it can form whiteheads, blackheads, pimples, right? So what we should do really is work on our skin turnover. And I think we talked about the skin a bit.
Ade Akindipe, DNP (23:08)
Yeah.
Jillian Woodruff, MD (23:16)
but we need the cells to turn over. We need to do things like exfoliation so we can shed the cells on top. And if we're exfoliating, those oils can just, they're not gonna get clogged beneath dead skin cells. So it can be great, but there's so many other things kind of that we have to do to make sure we get the great benefits of testosterone.
Ade Akindipe, DNP (23:17)
Mm-hmm.
Yeah, right.
Yeah.
I mean, definitely you're right. I mean, I definitely had to improve my skin regimen on testosterone, like you mentioned, the oily skin, but it's almost like, I mean, this is my own experience, like aging backwards. Cause I, the dry skin, that was a real thing. It was like, man, I wouldn't like, do the moisturizers weren't working the same way. It's like, yeah, it's, it's great, but it's just not that moist, firm, plump skin is something that I noticed.
Jillian Woodruff, MD (23:45)
Thank
Yes.
Ade Akindipe, DNP (24:06)
with testosterone therapies. Anyway, just throwing that out there. Okay, so here's another one. So you shouldn't need testosterone if you're on estrogen. So that's like saying you don't need protein if you're getting fiber or, you know, I've exercised one day so I don't need to exercise tomorrow. Like this almost doesn't make sense. You know, it's still part of a hormone that you lose as you get older. So it only makes sense that if you need estrogen, then you probably also need testosterone, right? Like we just talked about.
Jillian Woodruff, MD (24:08)
Absolutely, ⁓
Yeah, absolutely. absolutely, we need to normalize testosterone as an integral part of female care because that's what it is. It's a large, it's a hormone like we said that you have in the most abundance. It has many great benefits to a lot of our organ systems and just like estrogen does, there's side effects to everything.
Ade Akindipe, DNP (24:36)
Thank
Jillian Woodruff, MD (25:01)
So even things that are valuable, good, beneficial, they can have side effects that we don't like. But just because there's ⁓ maybe a side effect we don't like doesn't mean it's off the market and not good for us. So it's a part of our care. We talk about estrogen, we talk about progesterone, we just have to talk about testosterone too. It's just as important. But the difficult part is in the US, there's no FDA approved version of testosterone for women. There are many for men.
Ade Akindipe, DNP (25:12)
Right.
Jillian Woodruff, MD (25:30)
but not for women. And I think this is really a disservice to us. I don't, I really do not understand. can't think of any reason why I just...
Ade Akindipe, DNP (25:40)
Apparently we don't need it. We're just supposed to just deal
with it. Thank goodness for science.
Jillian Woodruff, MD (25:45)
I just, I
don't know how we come to it. That it really, it's upsetting. But the thing is, mean, just because it's not FDA approved doesn't mean that it's not beneficial. I mean, there are many things that aren't FDA approved, right? I mean, there's vitamin supplements. Also, many medications we use for one purpose, but they're FDA approved for a different purpose. So that doesn't mean that it's bad or not able to be used, but it does give a loophole to your insurance companies.
Ade Akindipe, DNP (26:02)
Mm-hmm.
Jillian Woodruff, MD (26:15)
that if you do have medical insurance, do not or they may not pay or reimburse for this. So that's an issue that I come up with with my patients quite a bit really is that the testosterone can be expensive and their insurance isn't covering it because it's not FDA approved.
Ade Akindipe, DNP (26:33)
Yeah,
it's an ongoing thing. And I know that there's been a lot of talk out there too about FDA approved and what's not FDA approved. I I know that there are some doctors who are speaking out and they went to the FDA and I'm, you know, but I think it was about vaginal estrogen. I'm sure Dr. Jill, you're hearing about that. It's all over. I'm glad that this is finally being take those things off these labels. There's nothing wrong with vaginal estrogen anyway, but that's just off topic. But
Jillian Woodruff, MD (26:49)
Yes. ⁓
Mm-hmm.
Ade Akindipe, DNP (26:59)
The truth is there are so many benefits that women need to know that if you are suffering from one thing or the other, whether it's urinary tract infections, whether it's depression, there's a lot of benefits to getting these hormone replacement if it's right for you. this ⁓ is something that we may have talked about before. What about modalities? ⁓ So we know that there's creams, there's pellets,
Jillian Woodruff, MD (27:11)
Yes.
Ade Akindipe, DNP (27:29)
all of these different things out there. And I know that there are some people that are completely against pellets ⁓ because they think it's not a good route, you know, it doesn't give you. So let's talk a little bit about that. What is your experiences with creams versus pellets? What do you recommend?
Jillian Woodruff, MD (27:46)
that's a very good question. I'm like, I don't want to be trapped in something because I'm not against pellets. my goodness. You're going to boot me out of all the societies. I will tell you with any method you choose, the issue is not the method, the issue if there's one, it may be the person that is providing that. The dosing is important. Working with each person as an individual is important.
Ade Akindipe, DNP (27:53)
just can't believe it. But anyway, I'll let you go first. I'll let you go. Drives me crazy.
Thank you.
Jillian Woodruff, MD (28:15)
important. If you're pushing just one way to get something, then that could be a problem. If you don't have experience with all of these other methods, that could be your problem right there. And so I think with the pellets, it's really, I think that people are just biased against it because there's so many people that may be doing pellets who don't have experience with hormones, haven't really studied it. They've just studied
Ade Akindipe, DNP (28:37)
who really shouldn't. Right. Exactly.
Jillian Woodruff, MD (28:41)
from a business that is there to make money as businesses are. And so there's appellate business and appellate businesses really, they do make a lot of money, just like medications you get at your pharmacy. The people who created that make a lot of money. Yes, yes. And then testosterone does have the benefit of making you feel better quite quickly when it's at the level that you need, right?
Ade Akindipe, DNP (28:57)
There's not the only way there's so many all the other FDA ones are making money too.
Jillian Woodruff, MD (29:10)
Or if you go above that level even, yeah, you may feel better quite quickly. I think the issue with pellets is that you can dose it super high. So you can dose it based off of, which this is the part I like, is that it's dosed based off of your weight, based off of your level, based off of your kidney function. And then there is a calculation that's done and you can spit out like, this is a good starting dose for you, which
could be, or it may not be, really need to follow it up. I tend to be more conservative with my levels because I say this is a journey, let's work our way up. And then also with the pellets, you have a bit of a surge. it kind of, you know, overshoots the mark and then comes back. It may go up and then come down and then your next dose kind of.
Ade Akindipe, DNP (29:51)
Right.
Jillian Woodruff, MD (30:06)
keeps it even, have to figure out what that pattern is, if it's every three months that you're getting this. And it's a little, I should explain, it's like a little ⁓ grain of rice. So there's a little incision made in your lower back, upper bum area. And this little grain of rice is placed in the fat there. And then based off of your own cardiac output and how active you are, when the blood flow goes by, it picks it up. But.
It's not reversible, you cannot remove it once it's put in. So if you do have side effects you don't like, it cannot be removed. So, you know, it's quite a commitment. So that's one of the reasons why you just start lower and work your way up. ⁓ And understand you may not be your most optimal self straight away, but you're getting there little by little. So there's just a way to dose it.
Ade Akindipe, DNP (30:38)
Right.
Jillian Woodruff, MD (30:57)
as opposed to these high levels where you have sky high, you're not monitoring. think that's where the problem is. I myself use testosterone palates. I love it. For me, I feel great. Like, can I say it's for every single person? Absolutely not. Absolutely not. Another, yeah, yeah. You know, another form is creams, right?
Ade Akindipe, DNP (31:04)
Right.
Yeah.
I'm so glad that you mentioned that. Yeah,
exactly. think if you've been out there and you've been watching it on social media and one person is kind of leaning one way, I don't think it's fair to just say it's just one way. I mean, there are tons of women who are getting effective results with pellets.
like you said, it needs to be done the correct way. sometimes, especially with pellets, you probably need to be more conservative and make sure that you're not dosing super high. And I think it's having that conversation with the patient and saying, let's be patient. We're going to check your labs. We're going to check your symptoms. Maybe six weeks to eight weeks. How are you feeling? Do we need to give you more? And then going from there versus just starting super high and then it just ruins everything, the experience for the person and they don't want to do it again.
Jillian Woodruff, MD (31:57)
That's right.
Ade Akindipe, DNP (32:06)
I personally, I've done the pellets, or they want more. Exactly. Your body is like, okay, this is exactly what I need, right? But you know, I've tried the pellets. I've tried the pellets and I loved being on the pellets. Personally, it just, it didn't matter what dose I was on, I would break out really badly. ⁓ for creams,
Jillian Woodruff, MD (32:07)
Yep. Or they want more and more and more. That also happens. That happens too. They're like their bodies kind of need it and then they want more and
on their way to being a hairy man.
⁓ yep.
Ade Akindipe, DNP (32:35)
creams have been working great for me. So I do the topical every day and I feel great on it. So it really depends on the person. ⁓ I can't say, yeah, you can only do creams. will, you know, so just so if you're out there, you know, give it a try. Don't just say I've tried it once. Give it some time for you to get where you need to get to, whether it's creams or pellets.
Jillian Woodruff, MD (32:37)
you
Yes, creams are great. I have many patients that are on creams as well. And it's all expectation setting as well, because with creams, I think it just takes a little longer to get where you need to be. And so you have to be in for it and for the journey. It's extremely safe method though, ⁓ less likely to have side effects because you don't have that surge. And I think maybe that was happening for you that every time you're kind of surging.
Ade Akindipe, DNP (33:07)
Yeah.
Mm-hmm.
Yeah.
Jillian Woodruff, MD (33:27)
and it's going too high and it's causing those breakouts, right? ⁓ Where with creams, when you're working your way up, you, yeah, yeah, yeah. ⁓
Ade Akindipe, DNP (33:27)
right?
My body just loves it. It's like, okay, every day
I just have a routine. I just have it right there and everyday applications worked just right. just getting that dosage where it was great, where it wasn't too much and it was just great for what I needed.
Jillian Woodruff, MD (33:41)
Mm-hmm. Every day.
And absorption through the skin is typically very good. ⁓ Another method are injections and more men do injections than women do. I have very few people on injections and I don't think it really, I don't like it for women. And it's usually like once a week, twice a week. There's a lot of kind of fluctuations. Where testosterone doesn't have those fluctuations, it's very different than estrogen, right?
Ade Akindipe, DNP (33:52)
Mm-hmm. Yeah.
What are your thoughts about it for women?
I don't like injections for...
A lot of up and downs. Yeah.
Jillian Woodruff, MD (34:20)
So I don't like it as much. The people that I have on it have come from other places where they've been on ⁓ a testosterone, they've been doing well. So I never say never, right? Different things work for different people and they're pleased with it. So I'm fine with continuing that. But yeah, I typically, I don't initiate that treatment. ⁓ And then there's oral as well. ⁓ I don't initiate that or continue oral.
Ade Akindipe, DNP (34:31)
Right.
Jillian Woodruff, MD (34:48)
I think that even just like estrogen, although I have, do prescribe some oral estrogen, but with testosterone, there's just more downsides to that than there are upsides as far as safety. then absorption is also not as good with that either.
Ade Akindipe, DNP (35:04)
Yeah, agree.
I totally agree with that. my goodness, we have been talking so much about this. It's a really important topic. But you know what? We want to make sure you have all the information, you know, because there's so much out there, especially recently. It's like, you know, one modality is attacked and the other one's more favored. You know, you need to go to someone that is open minded and is listening to you because you are different from the next woman.
Jillian Woodruff, MD (35:09)
Okay, yeah. Yeah.
Ade Akindipe, DNP (35:30)
So just because the pellets didn't work for your friend doesn't mean it won't work for you. So just be open-minded, have that conversation with your provider, and hopefully you get the results that you deserve.
Jillian Woodruff, MD (35:42)
Absolutely. Testosterone should just be part of the conversation when you're being evaluated, when you're evaluating perimenopausal and menopausal symptoms. Ask questions.
Ade Akindipe, DNP (35:53)
Yes, when you're considering homeowner, yes, lots of questions.
Hey, write it down. Open up your voice note or Google Doc, write it down. Ask all the questions you need to. So ⁓ whether you're trying to understand your options, this episode really is your permission to be ⁓ informed so you can have better answers.
Jillian Woodruff, MD (36:16)
If our conversation surprised you today, good. That's what we're here for. It is a midlife myth that testosterone is just for men. It's not. It's a powerful part of female health.
Ade Akindipe, DNP (36:20)
You
Absolutely. So just so you know, this podcast is educational only, not medical advice. I'll always speak to your provider who understands the nuances of your midlife health. So very important.
Jillian Woodruff, MD (36:42)
Yep. And we'll be back with more science, more stories, more straight talk. think we are done for today. So until next time, please follow us on Instagram. Send us an email if you have questions or there's something you want us to cover. Send an email to connect at modern midlife collective.com. We'd love to feature your questions or comments in a future episode.
Ade Akindipe, DNP (37:06)
This is the Modern Midlife Collective. Thank you for joining us.
Jillian Woodruff, MD (37:10)
Bye.