The Truth About Testosterone in Women

Episode Overview

• Dr. Gabrielle Lyon addresses the scientific and linguistic confusion surrounding the word "steroids," explaining why lumping medically monitored hormone restoration together with illicit performance drugs harms patients—particularly as society shifts into an era where sarcopenia (low muscle mass and strength) is overtaking obesity as the primary body composition issue.
• The episode traces the chemistry and history of Anabolic Androgenic Steroids (AAS), from the isolation of testosterone in the 1930s for wasting diseases to the creation of Dianabol in 1958, elite sports stacking in the 1960s and 1970s, and the crossover into public aesthetic use in the 1980s.
• Dr. Lyon breaks down the physiology of female testosterone, contrasting evidence-based clinical restoration for postmenopausal women against the pharmacological mechanisms and contamination risks of gray-market synthetic androgens like Oxandrolone.
• The discussion concludes by debunking media claims of a surge in general-population female steroid use, clarifying the relationship between GLP-1 weight loss and muscle loss, and providing a clinical checklist for evaluating hormone therapies safely.

Key Concepts

• Precision in Medical Language and the True Definition of a Steroid: Just as clinical terms like "3+ Pitting Edema" have exact definitions (a skin indentation 5 to 6 millimeters deep taking 15 to 60 seconds to bounce back), hormone terminology requires precision. Chemically, a steroid is not a drug, but a molecular shape made of four rings of carbon (three six-sided, one five-sided). Cholesterol, cortisol, estrogen, progesterone, bile acids, vitamin D, prednisone, hydrocortisone cream, and asthma inhalers are all steroids.
• Anabolic vs. Androgenic Spectrum: Anabolic Androgenic Steroids (AAS) include testosterone and synthetic molecules modified from it. "Anabolic" means tissue-building and "androgenic" means masculinizing. Both act through the exact same cellular doorway—the androgen receptor—though compounds sit on a spectrum (e.g., testosterone is more androgenic, while Nandrolone is more anabolic).
• Historical Dosing vs. Medical Restoration: Originally isolated in the 1930s to help wasting patients retain nitrogen and build tissue, testosterone was soon co-opted for strength in the 1940s and early 1950s. Following Soviet dominance at the 1952 Olympics, Dr. John Ziegler helped develop Dianabol (Methandrostenolone) in 1958, leading to athletes in the 1960s and 1970s stacking doses up to 100 times higher than a medical replacement dose.
• Female Testosterone Physiology and Clinical Evidence: Every adult body produces testosterone, with women operating at a lower set point that shifts after menopause (though Dr. Lyon notes more data is needed to evaluate these shifting ranges). Replacing low female testosterone is clinically analogous to using levothyroxine for hypothyroidism, yet there is no FDA-approved testosterone product for women in the US. Both the 2021 ISSWSH guidelines and a 2019 Global Consensus Position Statement (endorsed by 10 international medical societies) support testosterone in postmenopausal women for Hypoactive Sexual Desire Disorder (HSDD). While the 2019 consensus states evidence is currently insufficient for other uses (such as cognitive enhancement), a 1995 2-year randomized trial by Susan Davis ($n = 34$ postmenopausal women) showed that adding testosterone to estradiol implants increased bone density faster at every site and was the only group to gain fat-free mass.
• Cellular Mechanisms and the "Low-Estrogen" Trap: Fat-soluble steroid molecules pass through cell membranes, bind to internal androgen receptors, and alter DNA gene transcription, which increases muscle protein synthesis while breakdown appears to go down. (Bhasin's foundational 1996 NEJM trial in men demonstrated that supraphysiological testosterone combined with supervised lifting yielded considerably more lean tissue than lifting alone). Because testosterone naturally converts downstream into estradiol and DHT to support bone and blood vessel signaling, synthetic steroids engineered to skip estrogen conversion to avoid side effects inadvertently deprive the skeleton of estrogen's protective benefits. Furthermore, oral compounds (outside of medications like Kyzatrex) carry structural modifications to survive first-pass liver metabolism.
• Gray Market Contamination and Irreversible Side Effects: While Oxandrolone (an oral DHT-derived steroid that strongly suppresses natural testosterone) has FDA-approved indications for severe burns and catabolic states, Australian drug-checking research reveals that gray-market Oxandrolone sold to women is frequently mislabeled, underdosed, or substituted with more masculinizing agents. Because androgen receptors exist in the brain, bone, skin oil glands, hair follicles, vocal cords, and clitoral tissue, high androgen exposure in women can cause acne, menstrual cycle cessation (which sometimes does not return even after stopping), clitoral enlargement, and permanent voice deepening—with clinical cases documenting permanent vocal cord changes after just 6 weeks of use and tracking voice changes for 20 years. Individual susceptibility varies, and no test can predict who will experience irreversible effects.
• Debunking the Female Steroid "Surge": Media claims that female steroid use rose from 1.6% to 4% over the last decade misinterpret the literature. The 1.6% figure comes from a 2014 meta-analysis of 187 studies on lifetime prevalence. The 4% figure comes from a 2024 systematic review in Addiction pooling 18 studies with wide confidence intervals (2% to 9%) and 95% heterogeneity. Subgroup analysis of the 2024 data shows prevalence is 16.8% among bodybuilders, 4.4% among athletes and gym-goers, and 1.4% in the general population—meaning general population use has not risen (1.6% vs. 1.4%), and longitudinal data in women is currently lacking to claim otherwise.

Quotes

• At 1:41 - "If we keep telling the same old story, if we keep saying that testosterone and anabolic agents are going to get lumped into one dirty word right at the same moment that GLP-1 medications are everywhere, we are going to build an environment full of frail, sick people." - Dr. Lyon explaining the urgent public health stakes of clearing up hormone misconceptions as society faces rising sarcopenia.
• At 3:40 - "A steroid is not a drug. Yeah, it's a shape. Four rings of carbon stuck together. Three of them six-sided, one of them five-sided, that's the steroid part. What the molecule does depends on the little pieces hanging off that frame." - Dr. Lyon demystifying the chemistry of steroids to show why everyday compounds like vitamin D and cholesterol share this classification.
• At 19:00 - "The problem is not that GLP-1 medications destroy muscle. The problem is that fast weight loss with too little protein, with no resistance training, will cost you lean mass at any age by any method." - Dr. Lyon clarifying why patients lose muscle during rapid weight loss and why reaching for gray-market androgens is the wrong fix for a nutrition and training deficit.
• At 21:16 - "A woman who avoids female-range testosterone because she thinks it's steroids gives up a monitored treatment for nothing. And a woman who takes a synthetic androgen because she thinks it's, quote, 'just hormones' accepts a risk she never even had the chance to evaluate." - Dr. Lyon summarizing the dual dangers of medical stigma on one hand and casual gray-market hormone use on the other.

Takeaways

• Protect Lean Mass on GLP-1s Through Diet and Lifting, Not Gray-Market Androgens: If using GLP-1 medications, prevent muscle and strength loss by slowing the rate of weight loss, increasing dietary protein intake, and engaging in progressive heavy resistance training rather than turning to unmonitored anabolic compounds.
• Apply the 4-Question Safety Checklist Before Taking Any Hormone: Demand clear answers to four questions before starting therapy: (1) What is the exact molecule name (never accept vague descriptions like "something mild")? (2) Are we restoring a physiological level or exceeding one, and against which reference range? (3) Who is monitoring treatment and how often? (4) Can the chain of custody be verified through a regulated pharmacy rather than an unverified gym or online source?
• Require Comprehensive Clinical Monitoring on Androgen Therapy: Any woman taking an androgen should have a clinician actively tracking a complete blood count (CBC), a metabolic panel, a lipid panel including ApoB, blood pressure, and hormone levels.