In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Mohit Khera, a board certified urologist and professor at Baylor College of Medicine, where he directs the Laboratory for Andrology Research at the McNair Medical Institute. Dr. Khera specializes in sexual dysfunction and has spent nearly two decades researching testosterone therapy, focusing much of his career on closing the gap in research, training, and treatment access for women.
Dr. Khera lays out the biology behind the episode title: testosterone is not a male hormone. Women actually produce more testosterone than estrogen, with receptors for it throughout the brain, heart, bone, and muscle, yet not a single FDA approved testosterone product exists for women in the United States. He walks through the history of three failed attempts to bring one to market, the funding gap between men's and women's sexual health research, and why testosterone deficiency in women is so often dismissed, misdiagnosed as depression, or treated with antidepressants that make the underlying problem worse.
The conversation covers the practical details women and clinicians both need around hormone therapy: how to test testosterone levels correctly, why timing and fasting matter, what SHBG is and how oral contraceptives can permanently elevate it, and the real differences between creams, injections, and pellets for dosing. Dr. Khera is direct about the risks of super physiologic dosing and unmonitored compounding, while making the case that properly dosed testosterone can meaningfully improve libido, mood, cognition, muscle mass, and bone density during perimenopause and menopause.
They also discuss the couple's dimension of hormonal health, the so-called hormonally dangerous decade between 50 and 60 when both partners' hormones can decline at once, and why Dr. Khera insists on evaluating partners together. Dr. Khera closes with practical advice for women: ask your doctor to test your testosterone levels, know what the normal ranges are, and don't accept dismissal if your concerns aren't taken seriously.
Guest links:
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Dr. Mohit Khera, M.D., M.B.A., M.P.H. (Baylor College of Medicine)
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Dr. Mohit Khera
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Dr. Mohit Khera (Facebook)
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Dr. Mohit Khera (LinkedIn)
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Dr. Mohit Khera (X)
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Dr. Mohit Khera (Instagram)
Recommended Books:
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“The New Perimenopause,” by Dr. Mary Claire Haver
- “The New Menopause," by Dr. Mary Claire Haver
Articles:
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Insufficient Medical School Sexual Health Curriculum Leads to Inadequately Prepared Trainees (Journal of Sexual Medicine)
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Help-seeking behaviour for sexual problems: the Global Study of Sexual Attitudes and Behaviors (The International Journal of Clinical Practice)
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Sexual problems and distress in United States women: prevalence and correlates (Obstetrics & Gynecology)
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Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health (Journal of Women's Health)
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Metabolic benefits afforded by estradiol and testosterone in both sexes: clinical considerations (Journal of Clinical Investigation)
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Association of genetically determined chronotype with circulating testosterone: a Mendelian randomization study (Frontiers in Endocrinology)
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International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women (The Journal of Women's Health)
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The Role of Androgens in Health and Disease in Females: A Narratıve Review (Anatolian Journal of Obstetrics and Gynecology Research)
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Testosterone in Female Depression: A Meta-Analysis and Mendelian Randomization Study (Biomolecules)
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Safety and Efficacy of Testosterone Therapy on Musculoskeletal Health and Clinical Outcomes in Men: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials (AACE Endocrine Practice)
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Global Consensus Position Statement on the Use of Testosterone Therapy for Women (The Journal of Clinical Endocrinology & Metabolism)
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Effects of moderately increased testosterone concentration on physical performance in young women: a double blind, randomised, placebo controlled study (British Journal of Sports Medicine)
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Effects of long-term testosterone administration in HIV-infected women: a randomized, placebo-controlled trial (AIDS)
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Low-Dose Testosterone Augmentation for Antidepressant-Resistant Major Depressive Disorder in Women: An 8-Week Randomized Placebo-Controlled Study (The American Journal of Psychiatry)
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Endogenous testosterone concentrations and muscle mass, strength and performance in women, a systematic review of observational studies (Clinical Endocrinology)
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Cardiovascular Safety of Testosterone-Replacement Therapy (New England Journal of Therapy)
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Effect of Testosterone on Progression From Prediabetes to Diabetes in Men With Hypogonadism: A Substudy of the TRAVERSE Randomized Clinical Trial (JAMA Internal Medicine)
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Concentrations of endogenous sex steroid hormones and SHBG in healthy postmenopausal women (The Journal of Steroid Biochemistry and Molecular Biology)
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Bioavailable testosterone and androgen receptor activation, but not total testosterone, are associated with muscle mass and strength in females (The Journal of Physiology)
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Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study (Archives of Women's Mental Health)
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Efficacy and safety of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial (Menopause)
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Diurnal Variation of Serum Total Testosterone in Women: A Single-Center Study From Basrah (Cureus)
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Lack of diurnal variation in plasma levels of androstenedione, testosterone, estrone and estradiol in postmenopausal women (Journal of Steroid Biochemistry)
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Classic and 11-oxygenated androgens in serum and saliva across adulthood: a cross-sectional study analyzing the impact of age, body mass index, and diurnal and menstrual cycle variation (The European Journal of Endocrinology)
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Fasting Versus Non-Fasting Total Testosterone Levels in Women During the Childbearing Period (Cureus)
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Low Free Testosterone Is Associated with Hypogonadal Signs and Symptoms in Men with Normal Total Testosterone Get access Arrow (The Journal of Clinical Endocrinology & Metabolism)
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Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction (The Journal of Sexual Medicine)
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The Biologic Effects Of Androgen (Testosterone Propionate) In Women (JAMA)
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Testosterone therapy in women with gynecological and sexual disorders: a triumph of clinical endocrinology from 1938 to 2008 (Journal of Sexual Medicine)
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A Personal Prospective on Testosterone Therapy in Women—What We Know in 2022 (Journal of Personalized Medicine)
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Subcutaneous Implantation of Female and Male Hormone in Tablet Form in Women (The BMJ)
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Testosterone deficiency: a historical perspective (Asian Journal of Andrology)
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Mammary Carcinoma Response To Implantation Of Male Hormone And Progesterone (The Lancet)
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Accelerating Testosterone Prescribing for U.S. Women: Implications for Cardiovascular Safety (JACC Journals)
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The range and variation in serum estradiol concentration in perimenopausal and postmenopausal women treated with transdermal estradiol in a real-world setting: a cross-sectional study (Menopause)
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Efficacy of changing testosterone gel preparations (Androgel or Testim) among suboptimally responsive hypogonadal men (International Journal of Impotence Research)
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The Impact of Testosterone Therapy on Cardiovascular Risk Among Postmenopausal Women
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Cardiovascular Disease in Anabolic Androgenic Steroid Users (Circulation)
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Anabolic Androgenic Steroids Induce Reversible Left Ventricular Hypertrophy and Cardiac Dysfunction. Echocardiography Results of the HAARLEM Study (Frontiers in Reproductive Health)
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Voice Change Following Testosterone Supplementation in Women: A Multi-Institutional Case Series (Journal of Voice)
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Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data (The Lancet Diabetes & Endocrinology)
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Serum sex steroid hormones and frailty in older American men of the Third National Health and Nutrition Examination Survey (NHANES III) (The Aging Male)
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Sex Differences in the Association between Serum Levels of Testosterone and Frailty in an Elderly Population: The Toledo Study for Healthy Aging (PLOS One)
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Effects of testosterone replacement in androgen-deficient women with hypopituitarism: a randomized, double-blind, placebo-controlled study (The Journal of Clinical Endocrinology & Metabolism)
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Combining Exercise Training and Testosterone Therapy in Older Women After Hip Fracture
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The STEP-HI Randomized Clinical Trial (JAMA Network)
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Association between Serum Total Testosterone Level and Bone Mineral Density in Middle-Aged Postmenopausal Women (International Journal of Endocrinology)
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Sex-steroid hormones and risk of postmenopausal estrogen receptor-positive breast cancer: a case–cohort analysis (Cancer Causes & Control)
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Sex steroid hormones and risk of breast cancer: a two-sample Mendelian randomization study (Breast Cancer Research)
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Endogenous hormones and risk of invasive breast cancer in pre- and post-menopausal women: findings from the UK Biobank (The British Journal of Cancer)
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Breast Cancer Incidence Reduction in Women Treated with Subcutaneous Testosterone: Testosterone Therapy and Breast Cancer Incidence Study (European Journal of Breast Health)
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First-time orgasm in a young man with lifelong anorgasmia after flibanserin use: a case report (The Journal of Sexual Medicine)
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Emerging Use of BPC-157 in Orthopaedic Sports Medicine: A Systematic Review (HSS Journal)
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Triple-Hormone-Receptor Agonist Retatrutide for Obesity - A Phase 2 Trial (New England Journal of Medicine)
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Sexual experience of female partners of men with erectile dysfunction: the female experience of men's attitudes to life events and sexuality (FEMALES) study (Journal of Sexual Medicine)
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The Association Between Female Sexual Dysfunction and Sexual Dysfunction in the Male Partner: A Systematic Review and Meta-Analysis (Journal of Sexual Medicine)
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Women's sexual function improves when partners are administered vardenafil for erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled trial (Journal of Sexual Medicine)
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Effects Of Oral Testosterone Undecanoate On Semen Parameters In Hypogonadal Men: An Interim Analysis Of A Prospective Pilot Study (Journal of Sexual Medicine)
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The health of normally aging men: The Massachusetts Male Aging Study (1987-2004) (NIH)
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Sex steroids, bone mass, and bone loss. A prospective study of pre-, peri-, and postmenopausal women (The Journal of Clinical Investigation)
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Endogenous sex hormones and bone mineral density among community-based postmenopausal women (Postgraduate Medical Journal | Oxford Academic)
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Endogenous sex steroids and bone mineral density in older women and men: the Rancho Bernardo Study (The Journal of Bone and Mineral Research)
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Testosterone enhances estradiol's effects on postmenopausal bone density and sexuality (Maturitas)
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Comparison of oral estrogens and estrogens plus androgen on bone mineral density, menopausal symptoms, and lipid-lipoprotein profiles in surgical menopause (Obstetrics & Gynecology)
- A two-year, double-blind comparison of estrogen-androgen and conjugated estrogens in surgically menopausal women. Effects on bone mineral density, symptoms and lipid profiles (The Journal of Reproductive Medicine)
Other Resources:
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Testosterone Information (Sport Integrity Australia)
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FDA issues class-wide labeling changes for testosterone products
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Laboratory for Andrology Research at the Baylor College of Medicine
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United States Securities And Exchange Commission Biosante Pharmaceuticals, Inc.
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About NHANES
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Hypoactive Sexual Desire Disorder in Males (HSDD)
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Women's experiences of perimenopause and menopause
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International Society for the Study of Women’s Sexual Health
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The Menopause Society
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Sexual Medicine Society of North America
- Study initiated to explore effect of oral TRT on spermatogenesis