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E134
May 05, 2026
Estrogen, Progesterone, and Testosterone: The Science of Hormones, Sexual Function, and Menopause
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In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Tami Rowen, an obstetrician, gynecologist, and leading gynecologic surgeon at the University of California San Francisco, and an internationally recognized expert in sexual health and sexual medicine. Together they get precise about some of the most misunderstood terrain in women's health: estrogen, progesterone, progestins, and testosterone for women, what they actually do in the body, how the confusion around them began, and what becomes possible for women when care is evidence-based and not fear-based.

Dr. Rowen opens with something most women have never been told: that contraceptive estrogen and menopausal estrogen are fundamentally different molecules with different goals, different mechanisms, and different effects on the body. She walks through why ethinyl estradiol, the synthetic estrogen in most birth control pills, binds to the estrogen receptor 300 times more strongly than natural estradiol, why that matters for everything from blood clotting to testosterone levels to bone density, and why modern contraception is still valuable and worth defending even as we get more precise about how it works.

Progesterone and progestins come next, with Dr. Rowen unpacking what they are, how they differ, why they are not interchangeable, and why the progestin component of birth control is actually the primary driver of ovulation suppression, not the estrogen. She explains progesterone intolerance, who is most at risk, how it connects to PMDD, postpartum depression, and perimenopausal symptoms, and what the alternatives are for women who cannot tolerate micronized progesterone. She also addresses how progesterone sensitivity shows up differently across perimenopause and menopause, and why hormone therapy is rarely one size fits all.

On testosterone, Dr. Rowen covers what the evidence actually supports, where the data is strong and where it is not, why dosing matters and what the risks are when testosterone levels are pushed far beyond a woman's natural range, why pellets carry absorption risks, why packets should never be used for women, and what options exist when no FDA approved product for women is available. She also addresses low libido and sexual desire, the FDA approved libido medications Addyi and Vyleesi, how they work in the brain, and who they are most likely to help.

Dr. Rowen also explains why orgasm changes in midlife, how sexual pain, vaginal health, and GSM and genitourinary syndrome of menopause affect sexual function, why recurrent bacterial vaginosis may have a hormonal root, and why the Dutch test, often marketed as a comprehensive hormone assessment, does not measure what many people believe it does.

Guest links:

Recommended Books:

Articles:

Other Resources:

Chapters

00:00:00 – The Truth About Testosterone & Menopause (Big Myths)
00:04:00 – Hormone 101: Estrogen, Progesterone & Testosterone Explained
00:10:00 – Birth Control vs Hormone Therapy (Why They’re NOT the Same)
00:16:00 – Synthetic Estrogen: Why It Works (and Its Side Effects)
00:23:00 – Progesterone vs Progestins: What Doctors Don’t Explain
00:30:00 – How Hormones Affect Your Brain, Gut, Mood & Libido
00:38:00 – Why Birth Control Feels Different for Every Woman
00:46:00 – Hormone Risks: Breast Cancer, Clots & What’s Actually True
00:55:00 – Testosterone for Women: What It REALLY Improves
01:05:00 – Brain Fog, Mood & the Placebo Effect Explained
01:15:00 – How to Take Testosterone Safely (Dosing, Gels, Creams)
01:25:00 – Pellets, High Doses & the Future of Hormone Therapy

About the guest

Dr. Tami Rowen

Dr. Rowen is an obstetrician and gynecologist whose care and research focuses on sexual health, menopause, transgender health, and complex gynecologic care for people with cancer as well as an associate professor of obstetrics gynecology and reproductive sciences at University of California, San Francisco. A lead gynecologic surgeon at UCSF, Rowen has expertise in laparoscopy,  vaginal and vulvar surgery, especially hysterectomy. She is medical director of perioperative services for the UCSF obstetrics and gynecology department, and the UCSF lead for the University of California-wide menopause consortium. 

Dr. Rowen earned her medical degree and a master's degree in health and medical sciences through a joint program of the University of California, Berkeley and UCSF. She completed a residency in obstetrics, gynecology and reproductive sciences at UCSF and joined the faculty at UCSF upon completion of residency in 2013. She is also ABOG subspecialty certified in complex family planning.

Dr. Rowen has served as a board member for the International Society for the Study of Women's Sexual Health as their education Chair, Scientific Committee Chair, Director at Large and now Secretary. She was an associate editor for the journals Sexual Medicine and  the Journal of Sexual Medicine where she currently serves on the Editorial Board. She has held several committee positions for the International Society of Sexual Medicine. She is a sought-after speaker on sexual medicine and has published dozens of papers and book chapters on the topics of sexual health, menopause, surgery, family planning and safe motherhood in developing countries.