The Truth About Testosterone in Women

Dr. Gabrielle Lyon (0:00)

We have a steroid language problem. We are going to build an environment full of frail, sick people.

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. We are moving into a new era of body composition, one in which obesity is not the primary issue any more. And if we do not get ahead of the conversation that people are very divided on testosterone, then we are going to be in an even more dangerous spot than we were when the obesity epidemic hit.

I recently got interviewed for a woman's magazine about steroid use in women. And they were good questions, they were reasonable questions, and they were asked in good faith. But somewhere around the fourth one, it struck me that my job in that room wasn't to just answer the question in front of me, but it was to translate the science, to clear up confusion that was underlying every single question. Before I could say anything useful, I had to get us all on the same page. Can you imagine a woman telling her sister that she's going on testosterone, and her sister says, oh my gosh, you're going to take steroids. Now that reaction, as you know, is unfair. And that is the reaction that we're going to fix today.

Because here's what worries me. 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. So in medicine, a shared vocabulary is a necessity. It is mission critical. Think about the phrase, quote, this patient looks sick. Now, sick to a surgeon and sick to a family medicine doctor like myself are two completely different, quote, six. So we can't rely on that. We have to build standard language instead. Now, if I say a patient has three plus pitting edema, there's a defined standard for exactly what that means. There's no guessing. We have that kind of standard language for medications as well.

But somehow, steroids, and even when I say that, I'm sure you're cringing, got exempt from that standard. And what do I mean by this? When I say steroids, people don't picture a molecule, which is exactly what it is. They picture a baseball field, jacked guys, manly-looking women, a bad spray tan, and probably a skinny tank top. That picture is doing a lot of damage in both directions. And today, we're going to fix the word and the science. What you're going to leave with today, three things. First, what a steroid is, because right now that one word is covering your asthma inhaler, the cream you put on poison ivy, the cholesterol in your blood, and a vial, somebody's cousin, sold at the back of the gym. These things, they are barely related. Second, the difference between restoring a hormone level and pushing a supraphysiologic one. This is the whole game, and it comes down to a range. Third, what these drugs do inside a cell, and probably my favorite part, I'm going to fold in a little bit of history along the way. Are you ready to get your mind blown? 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.

So what counts as a steroid? Cholesterol, I feel like I'm on the prices, right? Cortisol, the hormone your adrenal glands make. Estrogen, yes, estrogen is considered a steroid. Progesterone, your bile acids, vitamin D is built on a steroid backbone and prednisone. Hydrocortisone cream and the inhaler that maybe if you have asthma you have used. All of these are steroids.

And no one has ever lowered their voice and said, Oh my gosh, you're using hydrocortisone cream.

Now, nobody in the history of ever, which means the word as a whole carries more than just information. It carries also a reputation and a stigma. And unfortunately, that reputation is from one branch of a very large family.

And this branch is called anabolic-androgenic steroids. The family is testosterone, plus all the synthetic molecules someone built by modifying testosterone. Now, you notice how I'm just stating this simply. There is no judgment. Anabolic means tissue building, not muscle specifically, tissue.

Androgenic means masculinizing. And those two effects, they ride together to varying degrees because they're both triggered through the same doorway, and that is the androgen receptor. I've talked a lot about this, and I will continue talking about the androgen receptor. Let's talk about androgenic-anabolic steroids, and what they do for anabolic agents. There is a spectrum. For example, testosterone is more androgenic, meaning it has masculinizing qualities, whereas something like nandrolone is more anabolic, meaning it builds tissues. Both the androgenic and anabolic activities both work through the same androgen receptor. It just depends on what the molecule is.