The Testosterone Myth Women Have Been Lied To About │ Dr. Susan Hardwick-Smith

Dr. Susan Hardwick-Smith (0:00)

Testosterone is actually made in far greater quantities than estrogen in female bodies. That's something that's often missed.

When I found that out, I was like, oh, what? Like, I didn't know that.

Dr. Gabrielle Lyon (0:13)

So it's been a real uphill battle for women to get access to testosterone?

Dr. Susan Hardwick-Smith (0:18)

Yes, absolutely. And I understand why big pharmaceutical companies don't want to go down that road. Turned out very badly in the past for them.

Dr. Gabrielle Lyon (0:28)

What is the role of testosterone in women?

Dr. Susan Hardwick-Smith (0:31)

Testosterone has been associated with men. Forever, we think it's a male hormone that makes you bulky, it makes you go hair on your chin. But I didn't think women made testosterone unless there was some sort of pathology.

Dr. Gabrielle Lyon (0:42)

Are there things that are particularly important for a patient to know?

Dr. Susan Hardwick-Smith (0:48)

Actually, testosterone improves all the functions of our sexual cycle. Blood flow to the clitoris, easier to have an orgasm, reduction in anxiety, depression, and then other things like memory, recall, brain fogs, athletic performance. It makes you perform better.

Dr. Gabrielle Lyon (1:04)

The FDA approved 31 products for men as of 2020?

Dr. Susan Hardwick-Smith (1:10)

Yes, there's probably even more now with kaisertrex and so on, but a bunch.

Dr. Gabrielle Lyon (1:13)

How many have been approved for women?

Dr. Susan Hardwick-Smith (1:16)

Absolutely none.

Dr. Gabrielle Lyon (1:17)

Define what the landscape is in terms of low, medium, and high doses of testosterone for women.

Dr. Susan Hardwick-Smith (1:24)

Here's something that I learned that was mind-blowing.

Dr. Gabrielle Lyon (1:36)

Dr. Susan Hardwick-Smith, welcome to the show.

Dr. Susan Hardwick-Smith (1:39)

So excited to be here.

Dr. Gabrielle Lyon (1:41)

I met you through our dear friend and colleague, Dr. Mahakara, who is a urologist here at Baylor, probably one of the leading voices in testosterone. I would also say his focus is largely on men.

Dr. Susan Hardwick-Smith (1:57)

That's right.

Dr. Gabrielle Lyon (1:59)

The focus on women is emerging across all specialties related to hormones.

You personally, one reason I'm very excited to talk about testosterone, is you spent 18 years building one of the largest OB-GYN practices. And then in 2020, you left that practice. You had 20 providers at the time and you launched right into menopause care.

Dr. Susan Hardwick-Smith (2:25)

Yes, we know why that happened is because I went through menopause. And being a very prominent OB-GYN, I knew absolutely nothing about it. And when it happened to me, I realized I had absolutely no information to help myself. I'm an athlete, I lost my sex drive, I lost my energy, I felt terrible. It became a real emergency to figure this out. In 2020, that wasn't that long ago, but the information was even vastly less than we have now.

So I left that practice thinking I just have a little quiet life, just doing a little menopause practice with me and my nurse practitioner. Well, that's not the way I roll. So now we have a big practice with three offices, a big virtual platform. We're growing. We've got 12 providers now looking for more. And it's really pushing the edges of trying to learn more about how to help women to feel better in midlife. And one of the aspects, not the only one, but a very important one that there's such a big gap in understanding about is using testosterone for women. So that's become a real focus of mine. I'm working with Dr. Kira and Baylor doing studies all about that, trying to figure out a better way to do it, because currently, we have very little guidance.

Dr. Gabrielle Lyon (3:35)

How much training did you have in testosterone for women?

Dr. Susan Hardwick-Smith (3:40)

Zero. The only thing I knew about testosterone was in the context of polycystic ovarian syndrome. So in women who were making too much endogenous testosterone, and that's a metabolic disease and all kinds of other things happen with that, heart disease, diabetes, so on. We only knew about it in that context. Absolutely nothing about the natural progression of testosterone loss that every healthy woman goes through as part of aging. So this is something that happens to every single woman.

So I think it's something that we should understand because it's half the population. Not to say men are also suffering from it as well, but we just haven't defined how to maximize this for women at all.

Dr. Gabrielle Lyon (4:25)

Unusual in the field of medicine to have such an untapped area in 2026

And the FDA, let's talk about the FDA. The FDA approved 31 products for men as of 2020