[Music] you are listening to hitplay not pause a feisty menopause podcast for active performance-minded women I am your host Seline yger each week I bring you advice from athletes scientists researchers and other experts to help you feel and perform your best no matter what your hormones are doing this show is a production of live feisty media hello strong feisty women I hope you all are well so I have a great one for you this week as everyone hearing my voice has seen and heard the conversations around menopause hormone therapy MHT HRT HT whatever initials you
prefer have been evolving at Breakneck speed since we launched the show in the fall of 2020 and the landscape is now super confusing scroll through any menopause social media feed and you'll see messes is that hormone therapy will reduce your risk of dying prematurely by a third and it'll cut your risk of heart disease by half and and many similar statistics and there's a lot of promising research out there but then you turn around and you look at the guidelines from medical bodies like the menopause society and the American Heart Association and pretty much all
the governing bodies and they clearly state that they do not recommend hormone therapy for the prevention of chronic diseases like heart disease stroke cancer and dementia and it is 100% natural to throw up your hands and be like what the hell is going on I do it almost daily and objectively I can see what's going on for one often the statistics are presented in relative not absolute risk which we'll talk about in a bit but relative risk is almost always more dramatic sounding and also importantly the research landscape is just incredibly messy hormone therapy is
not one thing Harry and menopausal women are not a monolith they are not one thing women in early or surgical menopause often have different needs and outcomes than those going through the transition later severe menopausal symptoms especially vasil motor symptoms are correlated with increased risk of chronic diseases like heart disease so those women may have different outcomes than a woman who is not having severe or even moderate symptoms but the messages we hear often lump all these women together also there are myriad forms and formulations and doses of estrogen therapy and estrogen and progesterone or
progestogen therapy and we're just beginning to parse all that out in so far as the effects both short and long term so it's a lot and throw in testosterone which is increasingly being added into the mix and we'll also talk about in the show and it's a lot lot and to be 100% clear there is zero doubt that the risks of hormone therapy were overblown and that hormone therapy is a lifesaver for millions of women and far too many women have been denied care and are still being denied care I think every woman should be
able to have an educated conversation with her doctor about hormone therapy when she hits the transition if not before As We Have Heard on this show far too many times it's way too hard for too many women to have those conversations and get the care they need full stop it's ludicrous where the water is becoming muddier is if hormone therapy is a longevity or health span tool for women broadly whether or not we should all be taking it as a matter of course even if we're otherwise healthy or don't have symptoms and those are conversations
I'm having on the regular now because in many circles that's becoming the implication so I really just wanted to sit down and talk to someone who's had their boots on the ground for decades immersed in the research who could talk about where we've been and what we know about hormone therapy and what it can do for women in Perry and post menopause and pretty much all of it and I was really thrilled to have this conversation with Professor Susan Davis Professor Davis has many initials behind her name including PhD as well as AO which is
an officer of the order of Australia which he was recently awarded for being a Pioneer and leading expert in women's health as a clinical endocrinologist and researcher and educator she has literally Decades of experience as a clinical researcher with specific expertise in sex hormones and women across the lifespan her research spans basic science to clinical trials and she has been pivotal in our understanding of how sex hormones impact the brain cardiovascular system and other tissues like fat muscle joint cartilage and Bone she is the past president of the austral Asian menopause society and the international
menopause Society she has over 435 peer-reviewed Publications has received numerous National and international prestigious research Awards and just two years ago in 2022 she was awarded the medal of the royal austral Asian College of Physicians for her outstanding contribution and leadership in endocrinology and Women's Health I could go on and on and on here but you get the idea she has been steeped in the subject for a very very long time and she cut through a lot of the confusion which I really really appreciated and if I'm honest she also raised more questions because we
are always going to have more questions that's how science works it is iterative and never settled which I get it man it can be unsettling because we all want answers and we all want to take care of ourselves the very best ways we can and for many of us that's going to mean hormone therapy and of course if you're having symptoms it's the gold standard treatment for many of them but you shouldn't feel pressured to take hormone therapy if you don't feel like you need it and I know many women do because when it comes
to General Health there are lots of ways to take care of yourself and while some women do brilliantly with hormone therapy others don't some want it some don't in the end we all need to make up our minds on where we fall there and we have to make those decisions that we feel are best for ourselves knowing that there's plenty that we still don't know and I also feel like we should make those decisions with as much nuanced information as possible and we should understand that the statistics we hear from one study aren't necessarily found
in another and as I mentioned before we so often hear about risk and risk reductions in terms of relative risk instead of absolute risk and I know that sounds really really wonky but it's also really important so Peter AA did a really great post on this I'll drop it in the show notes but really quickly he puts it this way when you hear say like a new drug reduces cancer incidents by 50% that's relative risk but what doesn't that doesn't really tell you is what the risk was to begin with absolute risk puts it in
more perspective so in this case it could be that this new drug reduced cancer risk from two people per thousand to one person per thousand that's a 50% decrease but it lands differently when you hear it that way likewise you often hear statistics from observational studies which are useful for sure but they are considered less scientifically definitive than randomized control trials and all of that is nuance and that Nuance gets way lost in our social media universe so I hope this conversation helps bring that Nuance puts things in perspective I know it also creates more
questions but I really do hope you enjoy this conversation as much as I did all right I have talked a lot so I'll just get right to it here if you're looking for more education on all things menopause come on and join us for our fall session of navigate menopause where we have eight weeks of meeting together and going through nutrition hormones hormone therapy mindset symptoms training so much more you can sign up at Feisty menopause. comom super quick thanks to toosi optics for helping bring these kind of conversations your way they are great Sports
and Casual shades for whatever your outdoor activities and I appreciate their support and with that let's have a few words about our awesome sponsors and get on with the show okay Professor Davis I am over the moon that you are joining me today to maybe help calm the waters a little bit or at least shine some light on the waters on this conversation um I would really just like to set the stage for our show talking about where we are with hormone therapy at the moment and then segue into what your team is studying regarding
testosterone because I think that's really really interesting and important work and also the Wild West in the menopause space right now so let me just set the stage on my end of things so when I started the show in 2020 the online conversation was very very different about hormone therapy and we have we have seemed to have swung pretty wildly from like I don't know I'm a little afraid of that to I'm afraid to not use it you know and you did a great master class on Simon Hills the proof which I'd like to just
set the and explore a little bit and you said about the same thing you said women now are getting this message online that everyone should be on hormones and hormones fix everything and to be clear I've always been of the mind that every woman does not need to be on hormone therapy it's a great tool it's very helpful but here here is where I'm going to be very transparent and here is where I really do struggle because I have spent you know the past several years going to the menopause Society meetings in the literature reading
all the books and as you presented on Hills show even women with no symptoms can lose 6% of their bone cholesterol can change central abdominal fat can increase 20 to 40% cardiovascular disease risk Rises diabetes risk Rises and the studies do seem to indicate that women who take hormone therapy have less waist circumference increases and central abdominal fat gain it does help prevent fracture we know that it appears cardioprotective but in the very same breath the guidelines will say it is not indicated for primary or secondary prevention of cardiovascular other chronic disease and the natural
question Professor Davis is why like why not okay wow there's a lot in this I start to answer that so um let's tick a couple of boxes that are true okay our data corresponds to data from other countries in which people are predominantly of European ancestry because there are some differences in cultures in the experience of menopause for women of different um ethnic backgrounds and cultural backgrounds and that data shows that about a third of the women will have moderate to severe hot flushes night sweats smood swings Etc so the classic symptoms of a fallen
estrogen in a woman and the primary indication for hormone therapy is still for symptom relief so that's sort of ticks that box that is the clearest indication that if you've got symptoms that are really making your life very unpleasant or even making your life hell then um it's quite reasonable and appropriate if unless there's a particular indication like Contra indication like breast cancer Etc you would we would recommend hormone therapy then you raised a very valid point that well even without symptoms women will will tend to lose bone so on average women will lose 6
to 8% of their bone as they go through the menopause it is bone loss is much more likely if you're slim compared to being overweight or obese and the problem is we can't predict who are going to be the losers so it's an average loss it doesn't mean every woman's going to lose 6 to 8% that's an average some women lose very little bone across the menopause and some women lose even more and so my rule of thumb is a woman comes to talk to me about their menopause transition they've got the classic symptoms I
treat them if they then do not have the classic symptoms I will then say well hey you know you know a year or so into you know since you've had a period or since we think all this has started why don't we check your bone density and then I will see if the bone density is an indication for someone to go on therapy if their bone density is tending towards towards the Lower Side um we used the term osteopenic before it gets to osteoporosis so they're you know on the Lower Side than we would expect
have the conversation well maybe we should use some estrogen to protect your bones dropping even further if in fact the bone density is pretty good I might then say well how about repeating this in 2 years if it's not changing we're not going to worry if it's changing that would be an indication for considering hormones to protect you against this silent bone loss because bone loss is silent so I think that's sort of Fairly straightforward and we have developed What's called the practitioner toolkit for managing menopause it's free online it's endorsed by International societies and
most Australian medical societies and for the first time in that we've actually put guidance for women who are postmenopausal with osteopenia when estrogen should be added because there's clear guidance for osteoporosis but there's this wooly guidance for osteopenia at what point should you worry so we've put in some guidelines there and anyone can download that for free on the I'll put it in the show notes and I really appreciate that because here in the states at least the recommendation is age 65 and it makes me very upset like we need to be looking at Women's
bones before that yes so where we've put in that we've started at the beginning and said okay this group of people absolutely should have a bone density down so for example if you got you've had an overactive thyroid or you've got malabsorption or you've got various things you should have a bone density then there's a group of people people where if a bone density can be done it would be optimal so that would be people in women of normal to low body weight um women who are smokers so where there's a greater it's not a
absolute categorically urgently must do but boy if you could do it would probably be preferred and then you've got women who they've got no risk factors and it just might be their personal choice to spend the money and then it goes on to say okay what do you do with the result yeah and it's an algorithm beyond that so that that's the bone bit easily dealt with but I think the interesting part's the cardiovascular and as you've correctly said that cardiovascular risk factors change as women go through menopause again it's not every woman not every
woman gains abdominal fat not every woman's cholesterol changes but overall there is a trend that women will start to get more abdominal fat the cholesterol levels will go up in some a small subgroup of women blood pressure might change but that's a more my more less common thing and estrogen does help blood vessels stay healthy so when you go through manopause and estrogen drops blood blood vessel function becomes less optimal so therefore why don't we have the screaming evidence that estrogen protects against cardiovascular disease and the evidence is not strong I mean if you actually
look at the women's health initiative study using estrogen plus progestogen did not prevent cardiovascular disease but it did not increase it it was a a neutral effect and if you go out to the 13e and 18year followup it's completely neutral even for women up to the age of 70 in the estrogen only study there appeared as though even at 13 years there was a small significant reduction in cardiovascular disease and even deaths from cardiovascular disease but then if you look at the subanalysis in that study of women who' not used estrogen before the study there
was no protection so if there is a protection against cardia vascular disease the number you would need to treat to get some small benefits actually quite large you'd have to be putting a hell of a lot of women on HT to get a benefit the other thing is that how much is that benefit was due to the type of estrogen used and is that benefit seen with other estrogens so back in 1997 we published a paper in the New England Journal of Medicine showing that conjugated estr which is from pregnant May's urine is almost as
effective as statins in lowering cholesterol in postmenopausal with high cholesterol but when we repeated that study in women with using um estrogen patches we didn't see the same benefit so not all Delivery Systems of estrogen are going to give the same outcomes and in fact we really don't have data that estrogen through the skin as a patro actually prevents heart disease so to stand on a soap box and say everybody should be on estrogen to prevent heart disease is not based on a very sound data basis thank you for that clarification um that is one
of the things that as I indicated in some of the questions I sent you ahead of time I feel like the waters are so muddy when people talk about this because they are talking about a body of research that includes women who have uteruses women who don't have uteruses women who are using estrogen only combined therapy different forms of formulations of estrogen and doses of estrogen and I mean it's my Lord and that so while we are talking about that because you segwayed really well into um I would love to get your insights on on
Research that keeps getting cited over and over here you know you see HRT significantly reduces all cause mortality and cardio heart disease by 30% to 50% HRT reduces cardiovascular disease by 50% and that's all coming from that study menopausal hormone replacement therapy and reduction of all cause mortality and cardiovascular disease it's about time and timing but when you dig into it like I see that again like not all the randomatic control trials are there what do you think about these kind of Statistics being put out there I can share pick the statistics and present a
story of whatever you want to see that's the problem and um yeah and when do you know medical conferences we often do debates and we often just debate a side different I mean if you cherry pick the literature you can find an argument for almost anything um and going just back to the question what's been shown if you really want to present prevent cardiovascular disease in women you treat hypertension which is mostly poorly and undertreated um you stop women smoking particularly in the young years but also old years and I know smoking's less today than
previously but there's still a lot of women who smoke um you have women exercising and you improve nutrition and and diet and um you know our our nutrition is if you look at the average American nutrition is probably worse than the average Australian nutrition so much processed food you know lifestyle trumps whether if if you we wouldn't be just arguing or discussing academically about does estrogen prevent heart disease if it was the bleeding obvious right was so clear like does anyone argued that smoking causes lung cancer or that smoking causes cardiovascular disease we don't it
it's so black and white but the effects of hormones on cardiovascular disease in terms of outcomes of mortality if was so black and white it would be dramatic but it it really Tinkers around the edges and we should really be focusing on the big tickets that will change cardiovascular risk and as I said blood pressure smoking not being overweight or obese not um eating you know poor quality food all of these things are what matter yeah and and this is a very active audience so that they're they're ticking that box at least in you know
we do talk about processed food and you know that's another show for another time a lot of us eat a lot of junk when we're out there running marathons and and doing long bike rides but hopefully eat your Whole Foods friends keep keep your time takes time to prepare but whatever but I'm I'm just saying if it was so clear cut conversation yeah and the effect size if there is a if there is a true statistical effect size it is small and you've got to but balance it against I think as you said it's a
mishmash of information different formulations different age group women different studies different environments healthy user effects you know it's complic and we don't have the black and white answers that people want to hear yeah it is really complicated and it's it's so interesting to me that you said that about because when I when I was looking into the the literature on um cholesterol specifically you know oral conjugated estrogens like you mentioned you know definitely seem to have because they have that first past liver effect so they did have the you know the the benefit there and
it's interesting because I've heard some podcasters out there saying well we should just throw the Whi data out because nobody uses that anymore but me nobody uses those formulations anymore but like that's it's important because of what you're talking about here well I mean there is some evidence that for example in the Women's Health Initiative study that showed that conjugated estrogens only were associated with a lower rate of breast cancer yeah that doesn't seem to be seen with other estrogen formulation so it is and there are some animal studies some Roden studies that suggests that
there's something about the conjugated EST estrogens which is a mixture of a whole lot of so estrogen cocktail like more than 50 they said right at the well a large number and I've heard sorts of numbers quoted but so the pregnant M's urine which is converted into conjugate estrogens which is um was used in the Women's Health Initiative is is a cocktail of hormones and it might be that that has something in it that protects against breast cancer which is not seen with estrogen only therapy when it's just pure estradi so I think it's really
dangerous that to keep generalizing and extrapolating from these situations it's complicated yeah it is complicated and and and before we leave that I'm I'm curious what do we understand about estro estrogen only versus estrogen plus micronized progesterone I guess my my real question is sometimes I wonder if the difference we're seeing is because of the population that those those formulations are used in you know you're talking about women who have early they're surgical versus like a natural menopause down the down the road yeah well I mean the estrogen only studying Women's Health Initiative um program
I if I remember correctly something like 45% of those women had had their ovaries remove not just a hysterctomy so you you comparing apples and peers yeah in terms of the populations so it might be something different that if you got a you know a a population of which a significant proportion have had that both ovaries removed and had a surgical menopause maybe hormone therapy is completely different in them and it's not nothing to do whether or not you're on a progestogen that's why we've got to be very careful about the generalizations um so A
lot's being said about you know you must have trans dermal therapy and you must have micronized progesterone because this is all more natural but maybe it's not better we don't know yes and I'm syp I'm sympathetic I have to say to I'm I'm very sympathetic to women because I feel like of course they want the answers now you know and the answers are not here now so when people speak very um like I have the answer and it is this it's very tempting right it's very tempting to listen to that but I always just encourage
people like science is iterative and we don't like there's a lot we don't know I mean it we won't talk about brain health that's a whole other podcast than I've done it but that's that's a very Sticky Wicket too right I mean I think Lisa muscone is doing amazing work but there's no way that you can definitively say every woman should be on estrogen so she doesn't get dementia well you see I don't think the evidence is said to even say that at all and I think the evidence to suggest that even going on EST
I've heard it said that going on estrogen early you know even in the late 40s will make difference the data is not there um we have done studies in women with early menopause well within the early period of menopause and found no benefit of giving estrogen on complex um cognitive tasks I I think it's and I think no one should be taking estrogen purely to prevent cognitive decline because the data is not there so and our brain cells in in Petri dishes yeah well that that is that is a fact and and I do that's
why I mean I'm it's her work lead the Dr mcone I'm talking specifically is so intriguing to me because she is doing you know these scan but it she she says all the time too that this indicates more work this indicates we need more study in this area you know she she is clear about that yeah we can there oh boy yeah we can um but I do want to you know you said something on on Simon Hill show that also kind of landed with me and made me go okay but then now what you
know you said it's not necessarily natural that we're living to be 90s you know and our hormones were never designed to carry us through our 80s and 90s and beyond that is like you said that very clearly but many of us are living that long I have you know my my great-grandmother lived to be over a hundred um so then I go well then I can't I live am I doomed you know like that's I it sort of leaves you feeling that way right like well if my hormones weren't designed to this but I'm outliving
what my hormones were designed shouldn't I just put those hormones back I mean it does seem like one plus two equals three she wasn't taking horm to 100 that bit no she wasn't and I mean if you look at the populations where there's longevity they're not taking hormones it's a whole lot of other stuff that's going on and I don't think you know R thinking hormones are going to be the Quick Fix is obvious you know um there's genetics and there's environmental factors and definitely some women benefit by hormones but but it's not about longevity
all the other things in in our environment and our lifestyle and our as I our nutrition our General Health our our psychological well-being I mean if I'm correct in remembering you know in the communities where people do live to quite aged years there's a lot of positive Community strength and a positive socialization big deal there are so many things I mean we did a study years ago of cognitive function and one of the biggest predictors of of poorer cognitive function even in younger women was living alone so community and connectivity and socialization are part of
good health and I think we tend to forget that and just think hormones hormones hormones yeah yeah I had on a neuroscientist um who said the exact same thing she's like we've taken estrogen and we've made it the biggest weight on the scale and she's like it's not the biggest weight on the scale when you're talking about no so many things yeah so many factors contribute to cognitive health I I would like to rewind in the conversation just a bit and talk about you know the menopause transition period especially as women get to that place
where everything is kind of chaos for them you know they're in that sort of like hormonal chaos period And when I listened to your master class on Simon Hill I was like oh this makes sense I you know we have a group of about 31,000 women it's a complimentary Facebook group for this for this podcast and I hear all the time women in that period who are you know getting hormone therapy and sort of struggling with it you know like sometimes they feel worse sometimes it's not you know they're they're they're manipulating the doses and
turning the dials and you know you had mentioned that when the hormones are swinging It's tricky to treat because sometimes you can make their symptoms worse because they might have a lot of estrogen going on right now so can you talk a bit about that for a little Clarity okay so um the normal menstrual cycle is a very predictable roller coaster of hormones you know we know that estrogen eases up until or increases gradually until ovulation drops a little bit a second little Peak during the last part of the cycle and then drops an the
Ade whereas progesterone is low and increases after ovulation like a little Hilltop coming up and then comes down so we have these natural undulations of hormones during the menstrual cycle that in a woman having a predictable 28 30 32 day cycle repeats the same pattern over and over again get to menopause and the undulations become chaos and if you were to track daily hormone levels they're up and down like a yo-yo so if you're you then layer on hormones on top of that all you're doing is exaggerating the PE PS and maybe softening out the
troughs but so sometimes when you get the pics when that you get the full breasts and the bloating and irritability you're adding more hormones to make that worse you might soften the troughs but what's happened is that you've put in some more hormones and then if ovulation does occur then suddenly bleeding might be worse so you can basically amplify the symptoms and make some of the symptoms worse by just layering it's just like putting thick a thick layer of icing on a cake or or you know you're just amplifying and at at different times so
I have always found that a very challenging period of time to to help a woman and in fact my Approach in general is to try and Flatline the hormones so it isn't time where we have different things available in Australia to what's available in other countries so a classic thing I would do if there were no contraindications I would put a woman on an oral contraceptive pill that contains estradi just like HRT so for example we have two oral contraceptive pills in Australia that instead of containing synthetic ethanol estrad contain estrad so women get just
like a constant hormone level they get bleeding cycle control they get contraception and they get a constant even estrogen dose and we do that really commonly and then for women who um can't take oral estrogen for example women who get migraines with aura or who've had a thrombosis Etc we will give them instead a progestin only pill that contains a hormone called dras py but unlike the mini pill this particular pill switches off ovulation and then we give them a patch or some gel to top them up with some estrogen so the point is that
we switch off the ovarian chaos right Flatline the hormones in a very even way and wait for women to go ovaries to go through the transition and then after 12 18 24 months um have a break and see what's going on but but adding adding more fuel to the fire but just by throwing horm ANS at a very chaotic time often does harm and and so women are clear um why doesn't traditional hormone therapy have that same effect because after a woman's gone through um the menopause oh we have a visor just coming in the
room they've gone no problem while while um once women have gone through the menopause and have become postmenopausal the ovaries produce very subliminal amounts of anything so the hormones we're giving are basically the major hormones of woman's body he's going to say and then if they're for people who are trying to use traditional hormone therapy in that per menopausal period where you're talking about which is which is very frequently used you know like the a birth a more oral contraceptive route um why does in traditional hormone therapy work in that same way is the dose
too low oh why doesn't traditional but traditional hormone therapy does is not contraceptive it it does not switch off ovarian function right that's what I want to clear you're giving hormones often in a cycle to induce a bleed and then the ovaries start working and then you get another blade and then you feel terrible because you've got all these hormones on board you've got the stuff taking and the stuff you're making and it's just like you know a mish mash of hormones with no regularity or a control yep that thank you for that clarification and
then the final clarification U because you speak so beautifully on all this is boy hormone testing hormone balancing that it's everybody you know there's a lot of promises out there there's a lot of uh things being sold like but can you please just talk about what women should know about having their hormone levels test and quote unquote balancing their hormones well firstly there's no such thing as balancing the hormones I cannot tell a person what their hormones should be I mean it's it's a complete nonsense because and the best example might be is that some
women can very effectively and successfully ovulate and conceive with an estrad level of we use different units 500 pamol per liter which is probably about oh it's divided by three 150 Pices per liter that uh pams per Mill yeah other women can in order to successfully ovulate instead of make having 500 pamal pure in their blood they have 1500 pical poia you know I can give an estrad patch to somebody and their blood estra can be 200 and I give the same patch to someone else in their blood estrogen's 500 the one with a level
of 200 has their symptoms cured the one of the level of 500 still got hot flushes and night sweats I mean I I don't know nobody knows what the right dose of hormon is for you why is that because we're measuring something in the blood that tells us nothing about what's happening in the cell the hormone has to one get into the cell and secondly once it's in the cell how it will act in the cell will depend on somebody's own personal genetic biology whatever so a blood estrogen in me could be great but in
you you could either feel overtreated or undertreated that's the first thing the second thing is that many of the methods used to test hormones are relatively insensitive and then the other thing is even if you look at patches or gels I've seen original data that you know submitted for their um FDA or TGA what or european medicines approval even within a single woman your absorption changes from day to day that makes sense so one day you could have the same dose every day for a week and every day taken the blood drawn at the same
time will be different yeah no that that makes a lot of sense and and research clearly shows that levels do not correlate with symptoms I mean that has been shown again and again and again um and what your receptors are doing and all of that so I really really appreciate you uh putting that into words no one should be paying money to have their hormones balanced the only time I do do it is that occasionally women simply do not absorb EAS well through their skin there's no test that's going to predict who that's going to
be but if a woman says to me you know they're on a decent dose of estrogen patch gel whatever and they're still feeling horrible I will test their estrogen level not to treat to a level but occasionally it'll come back they've got like a a 100 microgram patch on and they've got almost an undetectable estr level and they're just not absorbing it so it doesn't matter how many patches I throw at them they're not absorbing it that's test excellent thank you so much for all of that clarification um I would like to segue now into
the work you're currently doing on another hormone that is a rising star in this space I feel like because everybody's talking about it um you're doing really important work on testosterone that I would love to hear more about you know um you hear of so many women are getting pellets so many women are are know exploring this into themselves my understanding is you're looking at the role testosterone may play in muscle and bone loss and maybe even protecting the heart I would love to to tell us more about that so I mean it's I think
it's irrefutable that there is good evidence that testosterone improves sexual interest in women with low sexual interest it doesn't work on everybody and it's not a miracle I mean I have been giving women testosterone since the mid 80s initially as pellets because that's all we had available then and I constantly hear women say yes you know my libidos improved but not as much as I expected it's not like when I was 30 right you know so expectation shouldn't be too high so the effect is modest to moderate that's the first thing um in terms of
of mood and well-being in randomized Placebo control trials we do not see a benefit so the women often come back and say oh my mood's so much better well and my energy is so much better but in you know partly that's going to be a placebo effect um but we're really interested in muscle and bone because in we know that some wom will still lose bone even when they get adequate amount of estrogen and our very old study done in the 0s suggested a significant benefit for bone with testosterone pellets but other Studies have not
reproduced that so we're currently doing a study of women under the age of 55 who are on hormone replacement therapy and we're adding testosterone or Placebo it's double blind randomized placebo control trial and we're looking at the effects primarily on bone um using a whole lot of different things we do what's called tracular bone um qct scans of the radius which gives us microarchitecture and also bone density and Bob composition so um and that's a 12- month study so that's quite important it's very important the other question we've looked we're interested in is sarcopenia muscle
loss so from the age of mid-50s women start to lose muscle and it's very hard to maintain that muscle wether testosterone will protect against that we don't know and one of the problems with starting muscle is that the tests for assessing muscle function are very crude so the classic would be you know a how far you can walk six meters how fast you can walk met stand and walk you know okay can stand up and I can walk yeah or the What's called the sit stand test with your arms folded across your chest how many
times you can sit stand sit stand in a in a period of time well that's really relevant if you're frail or debilitated but if you're otherwise a healthy person it depends what side of the bed you got out that morning really or or if you did a gym session the night before you know right so they're very crude measures so we're using quite a sophistic ated measure where it's a pressure match where it really measures Force weight and very sensitive measures of muscle function and strength and um so we're using sort of computerized tests of
muscle function and test to strength to get very um subtle changes within the normal range for healthy people and how far are you into the study at this point oh we've recruited we haven't been pushing that too much because we've got all these other studies going on where we've recruited about a third of the people who are going to be in it okay okay so watch this space I am going to definitely watch the space because I'm very I'm keenly keenly interested in that um i crystal ball do you foresee a day where testosterone becomes
more of a standard part of the considerations of hormone therapy for women and menopause um I don't know that it's just women in menopause I think we need to understand it okay so our our data shows that testosterone levels decline by about 25% between the ages of 18 and 40 okay and our older data using fairly imprecise measures of testosterone suggests that that decline continues until about the age of 60 completely una affected by the menopause transition just a slow Decline and then after bottoming out around the age of 60 it then increases I remember
reading that and do we have any idea why no and then what we've got is for women aged 18 to 39 and women aged 70 to 994 thousands of women we have published data for testosterone measured with great Precision so we can precisely measure the low levels seen in women so we see this slope down in women from 18 to say 40 and then from 70 onwards the levels are identical to the women aged 18 to 40 but increase between the age of 70 and 80 and then the the rise declines a bit so we
don't understand why women from the age of 70 have the same blood testosterone levels as young women and why they increase and they not only increases a group but when we've had women who have had blood levels taken three years apart in individual women testosterone increases so what we've got at the moment is this black hole between 40 and 70 where we haven't measured testosterone with great Precision but we now have blood samples of 1,400 women in that age and we're at the moment as I speak we're measuring testosterone with Precision in that age group
so in the next three months we will be reporting what happens between the ages of 40 and 70 with testosterone and women because right now we don't know that's so interesting I wonder if there's a compensatory like mechanism going on like we don't know but it it was not what we did not really expect to find such high levels in older women but you think about it why does granny get whiskers well totally I mean when you say that I'm like okay you know like why do women why do women in their 70s and 80s
start to say hey I've you know got these dark hairs I don't like it they start to get thinning of their hair yeah their testosterone is is is is sort of normalized to premenopausal levels but we don't know where it dips out where it you know really bottoms out and that's what we're looking at right now and the reason it's never been done before is is you know you need a populationbased study where you've got women who are otherwise healthy and you actually Comm measure their hormones that's really really interesting I it's really interesting and
it also I mean then you think well we don't want to be adding more testosterone to that picture necessarily down the road right um well we don't understand it so in women age 70 to 94 having a testosterone in the bottom 25% was associated with a twofold greater risk of having a cardiovascular event a heart attack or a stroke after adjusting for age body mass index R diabetes blood pressure Etc so you know we're wondering if there's some protective effect of testosterone increasing with age but we don't know we don't understand it we're trying to
that doesn't mean women should take testosterone check we're trying to work this out right I mean we're we're treating ourselves like test tubes right now and people are not test tubes I I'm I always make that point like everybody's physiology it doesn't work that way you don't just dump things in and expect the same thing um you used to use pellets because that was what you had uh what are your thoughts on pellets now well we used pellets because it's what we had and because they were made by a particular pharmaceutical company under controlled and
and calibrated and um certified circumstances that were approved by the um government regulators and around about 2010 the production was stopped because it was felt that the quality control was no longer as good as it should be and the commercial interest wasn't as much so they to reinvest so they just stopped the production of the pellets and since that time most of the pellets available are are compounded um there's a US company that does make pellet that a testosterone pet approv for men um the safda regulated um but many of the testosterone pellets are used
to compounded so that means they've never been um studied to look at what blood you know what blood levels do women actually get from these pets what's their rate of dissolving um what level do you need what dose should you use how often should you use them Etc so the safety margin's not there um we have the good fortune in Australia that we have a testosterone transdermal cream that's approved by our drug regulated B body for use and women for women boy you are lucky we don't have that yeah it's now been approved in South
Africa I think it will be approved in Europe in not too long a time um but the problem is in the US the FDA have not approved anything they've had opportunities to approve things but they've made the bar so ridiculously high and I'm highly critical of the FDA for this because they just sit back and watch everybody get unregulated un unknown pharmacokinetically non-established testosterone and they just wash their hands of it and just say no that problem yep and that we will not fix this morning hard to where you are in this evening but um
thank you so much for sharing your Decades of wisdom and research and understanding with us I really really appreciate it is there anything we haven't talked about that you wanted to make clear anything you wanted to leave this audience with with regard to this topic well I guess the final thought I'd say is it is it is a work in progress um there is more unanswered question questions and answered questions um I do believe if you're using not everybody needs hormones if you do um have symptoms use the lowest effective dose but use it as
long as you need it there's no time that you have to stop not everybody has to have transdermal estrogen for some women it's not the best option it doesn't alleviate their symptoms and they have to take tablets and everybody's talking about micronized progesterone as it's the Holy Grail some women don't tolerate it because of side effects it makes them too sleepy or too puffy or too bloated we don't have evidence that it will be adequate to protect the lining of the uterus for women using high do estrogen the data is not there it's only been
studied with 1 milligram of estrad there's no data for a 2 mgram tablet there's no data for 100 patch you know so if you're using higher dose estrogen you have to make sure that you're getting the lining protected and I do hear it said that micronize progesterone so safe it doesn't cause breast cancer we don't know and I think it's dangerous to say that not to frighten women but just don't assume that there's data where there isn't and we just don't have the data that that micronized progesterone is so so so much safer than any
other progesteron although that's being pushed out a lot and I don't have Shar any of these companies so I'm not conflicted to say this and I just as a disclosure I do con I do consult with lots of drug companies but no one in particular yeah and you help with the guidelines to be clear I mean you you you help with the hormone guidelines yeah well I appreciate you I appreciate the work you're doing and um hope to see you at the menopause meeting in September I won't be there in September you should come to
the World Congress on the menopause in melbour oh I should that's on October yeah you should definitely come to that all right have a reason to go to Australia well thank you very much Professor Davis I really appreciate your time he my pleasure well well that's our show coming back next week when I sit down and talk to mountain bike skills coach Karen Brooks we had a great conversation about how skills coaching in any sport really can help midlife and menopausal women through the anxiety and fear many of us face during this time of life
as well as just have more fun and enjoy our active Pursuits broadly it's great conversation so come on back for that and until then as always stay feisty [Music] you've been listening to hit play not pause a feisty menopause podcast for active performance-minded women I'm your host Seline joerger the show is edited and produced by the strong talented and amazing women at live feisty media follow us on social media at Feisty menopause and please help us spread the word screenshot and share this episode on your social media channels with the tag at Feisty menopause share
the show with your friends and please subscribe like review and rate the show wherever you get your podcasts word of mouth and good reviews make it easier for other listeners to find thanks for listening and as always stay feisty [Music]
