What’s the Deal with Testosterone Therapy? And How Does It Impact Libido, Energy and Overall Health? with Dr. Maria Sophocles
Show Snapshot:
Testosterone therapy is suddenly all over the news (again) as actress Kate Winslet shares how it turbocharged her sex life. In today’s show, host Katie Fogarty does a deep dive into testosterone and testosterone therapy with board-certified OB/GYN and leading menopause and sexual health expert Dr. Maria Sophocles. We cover the misunderstood role of testosterone in women’s health, explore the risks and benefits of testosterone therapy, get into the different delivery systems (think creams and gels), and learn why most medical providers do not recommend testosterone pellets (even if they are all over Tik Tok). Plus, how specific lifestyle choices can boost testosterone levels—no hormone therapy required!
About Dr. Maria Sophocles: Dr. Maria Sophocles is an OB-GYN and author of “The Bedroom Gap,” drawing on 30 years and tens of thousands of patients treated. She's a leading voice on midlife sexual health, offering practical, judgment-free solutions — from mindfulness to sex tech — for reigniting desire and preventing painful sex.
Show Links:
Follow Dr. Sophocles:
Other episodes featuring Dr. Sophocles on A Certain Age:
From Triple-Booked to Turned On: How to Reignite Midlife Intimacy with Dr. Maria Sophocles
What’s Your Pleasure? Bridging the Midlife Bedroom Gap with Dr. Maria Sophocles
Quotable:
"Female sexual health has been such a low priority, it hasn't been developed. Women were excluded from formal medical studies for many years — we didn't have data on the effects of things like testosterone in women."
Transcript:
[0:00] Dr. Maria Sophocles We know there's a link between testosterone and libido, but we also know that testosterone works in our brain, in our muscles, and in our bones. It has a lot of basic health benefits, and that's why when it decreases after menopause, women find it more difficult to build lean muscle mass, and often their libido tanks.
[0:28] Katie Fogarty Welcome to A Certain Age, a show for women who are unafraid to age out loud. Beauties, we have a fabulous show today — do not go anywhere. We are talking all things testosterone. Yes, testosterone, and how it impacts midlife bodies: desire, arousal, and overall health. And we're doing it with one of your favorite doctors — Dr. Maria Sophocles is back on the show to bring us up to speed on a misunderstood hormone that plays a key role in women's health. Think sexual wellness, energy, overall health, and longevity.
Dr. Sophocles was on the show earlier this summer to talk about closing the midlife bedroom gap, and you loved that episode and downloaded it like crazy. Dr. Sophocles is a top gynecologist and sexual medicine specialist. She's been at the vanguard of women's health and sexual wellness for over 30 years, and she's turning her TED Talk on closing the midlife bedroom gap into an upcoming book. But lucky us — she's back once again today to give us the 411 on this important hormone, just in time for Sexual Health Awareness Month. We'll cover testosterone's benefits, side effects, all the delivery systems, and how to know if you're a candidate.
Welcome, Dr. Sophocles!
[1:50] Dr. Maria Sophocles Hi, Katie! So great to be back here.
[1:52] Katie Fogarty I'm so happy that you're back on the show to help us talk through and think through this important hormone. I had such great feedback on your first episode — I got so many DMs, and we had wonderful downloads. Your information is so needed. I want to start off by having you do a little stage-setting, because I think many women — or even men — think of testosterone as a male hormone. While the word is getting out, and a lot of people are getting up to speed and recognizing that women make testosterone and that it's an important part of our health, confusion still exists. So let's start off: tell us about women's bodies, testosterone, and its impact on our health.
[2:37] Dr. Maria Sophocles Your statement is totally right. Testosterone is known, more than any other chemical in the human body, as a male hormone. It's an androgen — andro means "man" in Greek, and gen means "generating." So an androgen is something that makes us more like men, and it's no shocker that men and women associate testosterone with becoming male-like. If the Y chromosome is the essence of maleness, then testosterone is the essence of masculinity — at least in the popular mind.
Testosterone is present in both male and female blood, but in females it's present in minute quantities. So both sexes make it, but men make 10 to 20 times as much as women. Despite the fact that it's present in both men and women, it's definitely achieved a reputation as something by and for men — but that's actually not true. It's made in our ovaries, just like estrogen and progesterone, and we don't realize it, but it's silently giving us health benefits. It affects our personality, the way we strive for things, the way we build muscle — a lot of things we associate with men. I think it's kind of fascinating, actually, and I'm glad it's coming out of the closet, if you will.
I think, ironically, with Donald Trump, we actually learned his testosterone levels, and that was sort of the beginning of people going, "Oh, okay — is testosterone male, female?" Even in this interesting political climate, we're seeing different conversations around maleness and femininity. I think the fact that this is an election year, and the fact that testosterone is coming into its own this year, is maybe not a coincidence. More than ever, women need to know that they have it, what it is, whether they need it, why they need it, and whether they should keep taking it after menopause, and why. So I hope we'll hit some of that today.
[4:52] Katie Fogarty Absolutely, we're going to cover it all. And it's interesting you mention the political climate — we also just came out of the Olympics, and I've got a question about that later, because testosterone was part of the conversation at the Olympic Games. But I want to pick up on something you shared a minute ago: that women make testosterone in minute quantities compared to men. Even though we make it in minute quantities, it has a big impact on our overall health. Why do we need testosterone? What are the benefits it delivers to us as women?
[5:20] Dr. Maria Sophocles Some of the effects of testosterone work in addition to, or in conjunction with, other things that impact libido. Honestly, Katie, you and I could do hours just on libido — what the components of a healthy libido are, and what we can do to maintain, grow, improve, or change it. The role of testosterone in libido itself isn't super direct, because there are other things that impact libido. But that doesn't mean testosterone doesn't play a role in libido and sex drive.
We know this from — honestly — some pretty grim data: men who've been castrated show plummeting libido, and in states and countries where castration has been used as a punishment for rapists, libido has decreased. So we know there's a link between testosterone and libido. But we also know that testosterone works in our brain, our muscle, and our bone. It has a lot of basic health benefits, and that's why when it decreases after menopause, women find it more difficult to build lean muscle mass, and often their libido tanks. But again, libido can decrease for several reasons, so I hate to make it too cut-and-dried in the libido world. Testosterone's impact on the development and maintenance of lean muscle mass, though, holds true in both sexes.
[6:53] Katie Fogarty It's so interesting — in prepping for this episode, I reconfirmed something I already knew: testosterone is not FDA-approved for women in this country, although it is for men. One of the only approved uses for testosterone in women is to treat hypoactive sexual desire disorder, which I guess is just a fancy way of saying low libido. So testosterone and women's libido are firmly linked, but there are other benefits too.
So let's start here: why doesn't the FDA approve testosterone for women the way it does for men? To me, the lack of an FDA-approved testosterone for women is one of the most obvious and glaring examples of the sexism and ageism that's been present in medicine and the biosciences in the United States for the last half-century — from drug development right through to what we're able to access by prescription or over the counter. Why do you think that is?
[8:00] Dr. Maria Sophocles Female sexual health has been such a low priority that it hasn't been developed — that's number one. Number two, women were excluded from formal medical studies for many years; we didn't have data on the effects of things like testosterone in women. And number three, it's more expensive to develop any medication when women are included in the studies. Drug companies are for-profit, so it's always going to be more cost-effective for them to develop something for men, even if it's ultimately indicated for women.
This seems crazy, right? But just look at Cindy Eckert, who developed flibanserin, the first FDA-approved medication for female sexual desire. When it was first being developed, it was studied only in men — a drug for female sexual function, studied in men. We have such backwards and outdated ways of studying medications for women. And this is all part of why, now in 2024, when we're trying to be progressive about women's health and close the gendered health gap, we still have no FDA-approved testosterone formulation for women.
I do think it's going to happen — certainly within this decade — because there's real pressure, including Jill and Joe Biden's push for increased NIH and government funding for female-specific disease research, including menopause. I think that will drive more research and development money.
In the meantime, the cost to develop a testosterone product for men is — and I'll probably get these numbers wrong, my husband's in biotech and he'll correct me — but I remember reading it's around $200 million. The cost to do the same for women would be upwards of a billion dollars, because of the rigorous standards around things like making sure women aren't pregnant. That's what I was told by people at the FDA — it's just a completely different magnitude of cost, and a total double standard.
The other thing you should know: there was a testosterone patch, called the Intrinsa patch, that made it all the way to the top levels of FDA approval. After about $900 million invested, it missed approval by one vote — one person at the FDA in charge of cardiac safety said, essentially, "I can't be 100% sure there couldn't be some slight effect," and it tanked the whole thing. The ironic part is that we now know testosterone can actually support a healthy cardiovascular system, and we've even seen studies showing it can negatively impact the growth of breast cancer cells — a roundabout way of saying it could even have a positive impact on breast cancer risk. I don't want anyone to run out and try to use it to prevent breast cancer, but there can be adverse effects to testosterone, and there can also be positive ones. The bottom line is, we still don't have anything approved yet.
[11:51] Katie Fogarty We don't have anything yet, but other countries do — Australia has a female-specific formulation that they offer. So other leaders in Western medicine and science are making this available to their female population.
We're heading into a quick break, but when we come back, I want you to help clarify something for listeners, because they might be thinking, "Wait — there's no FDA-approved testosterone medicine, but I hop on Instagram, social media, and TikTok, and it seems like everyone's using testosterone. Why, and how is that happening?" We'll pick that question up when we return.
[Break]
We're back. Before the break, we explored a couple of reasons the FDA hasn't yet — and we hope it's a "yet" — approved a female-specific testosterone formulation. But many people are using testosterone. I myself use a compounded testosterone cream prescribed by my gynecologist, and I know many other women are using gels, oral testosterone, and pellets. Testosterone is very buzzy, which is why we're having this conversation — people all over social media are using it, and there's been a lot of talk about problems with self-dosing, and whether women are being correctly informed about its efficacy, or whether it's being used to treat the right symptoms. Currently, it's really only approved and studied for low libido. So what's going on? Walk us through what's happening.
[13:33] Dr. Maria Sophocles I think what's happening is we're having a kind of menopause renaissance, if you will. Menopause is coming out of the closet. I think this happened over the last few years because the Baby Boomers became menopausal, and the Boomers and Gen Xers are a wealthy, educated, and well-informed generation and a half of women. There are something like 78 million of us in the U.S. and 500 million worldwide, and we're living longer. We want to stay vibrant, healthy, and sexually active longer, and that's propelled an explosion of interest in menopause information and education.
As that Pandora's box opened, women started asking, "How do I stay fit? How do I increase my muscle mass?" Testosterone got dragged in with it — which is wonderful, because those of us who've studied female sexual function for the last 30 years have known all along that testosterone can increase muscle mass, improve bone density, and improve mood. It's always felt like it needed to be part of hormone replacement therapy. It's just going to be a while longer before the biopharma community actually gets something to market.
In the meantime, progressive-minded clinicians — and progressive, informed patients like yourself — can go to certain clinicians to get testosterone. What I want listeners to know is how to find that kind of clinician, what to ask for, what side effects to consider, and how to do it right. I don't want people just going on TikTok.
[15:27] Katie Fogarty Perfect — how to do it right is exactly what this conversation is all about. Longtime listeners have heard me say repeatedly that the best way to deal with menopause and all the changes that come with your midlife body is to find a doctor who gets it. So let's start there, and then we'll explore everything else you just brought up — how to do it, what the side effects are, who isn't a candidate. So: how do we find a doctor who gets it?
[15:55] Dr. Maria Sophocles I'm going to give you two websites you can go to, but beware — some of the clinicians listed may be very progressive about menopause generally, but not comfortable prescribing testosterone specifically. Listeners may have to go through the site and ask proactively, "Are you comfortable prescribing testosterone?" If they get a no, they should go to the next person on the list.
First, you can go to menopause.org — the North American Menopause Society's website — and find a menopause clinician. Why is that a good place to start? Because more and more menopause clinicians are becoming aware of the need to understand testosterone. But remember, some still aren't there yet.
The second website — the second national society that's embraced testosterone use for probably 20 years, and where I learned about it — is ISSWSH: I-S-S-W-S-H, the International Society for the Study of Women's Sexual Health. ISSWSH has been on the vanguard of sexual health for at least 20 years, and an ISSWSH provider is much more likely to be comfortable with testosterone.
Next, let's talk about what your provider should be telling you about: the formulations. There aren't that many. Your clinician might suggest the male version of testosterone, called Testim, T-E-S-T-I-M, 1%. This is FDA-approved for use in men, and one tube lasts 10 to 15 days — you can reseal it. Your clinician will show you how to use one-tenth of the male dose. That's one option.
[18:01] Katie Fogarty That's important to note —
[18:03] Dr. Maria Sophocles Yeah.
[18:04] Katie Fogarty — it's FDA-approved for men, and working with a trained clinician, they can help you modify the dose to make it appropriate for your female body.
[18:13] Dr. Maria Sophocles That's right — women use one-tenth of the male dose. Again, many clinicians just aren't going to be comfortable with this, so keep going until you find one who is, or reach out to me through my website and I can try to connect you with my network of clinicians nationally and internationally, and see if we can find someone in your area. If not, we'll find someone through telehealth.
The second option is a generic testosterone gel. Generic companies like Teva (T-E-V-A) or Perrigo (P-E-R-R-I-G-O) make generic testosterone gel, and many clinicians are comfortable using this male formulation — 1% or 2%. You apply half a cc. It comes in 5cc syringes, and a male would use all 5cc's; we use a tenth of that, or 0.5cc. You put a little of the gel on your calf, underarm, or leg — it doesn't really matter where, since you're just trying to get a little into your bloodstream — and you do that every day.
The Australian formulation you mentioned earlier is called AndroFeme, A-N-D-R-O-F-E-M-E. It's a 1% gel available in Australia, and some clinicians, myself included, have set up accounts with the Australian company so we can get it for our patients.
Those are three options. The fourth — and probably the most commonly used now, even though you won't find it formally endorsed by NAMS or ACOG — is a 1% or 2% testosterone cream from a high-quality compounding pharmacy. Good practices, like mine, vet our compounding pharmacies to make sure they're certified, and it's okay to ask your doctor about that: "Is the compounding pharmacy you use your neighborhood one, your cousin's pharmacy, or one that's been certified? How did you pick it?" It comes in a little twist-top container — you twist it, and a little blob comes out. That blob is your daily dose. You apply one click, or one blob, to the back of the knee or the upper thigh every day. This is what I use, and —
[20:42] Katie Fogarty That's what I use too. That's what I was going to say — it's —
[20:44] Dr. Maria Sophocles — super common, because it's super easy. And the reason it's super safe is that these are very low doses. Now, what do we do to ensure safety — actually, before we move into that —
[20:58] Katie Fogarty — Dr. Sophocles, let's talk about pellets, because I know that's another delivery system, and it's also created some controversy.
[21:11] Dr. Maria Sophocles Yes, let's explain why. Pellets were very in vogue — they're small pellets inserted into the buttocks, and they can contain testosterone, estrogen, progesterone, DHEA, or combinations of those. Different clinicians mix different formulations. They're very effective, meaning you feel great on them. Unfortunately, testosterone levels in most pellets run very high, you can't remove them once they're in, and we have no long-term safety data on pellet use.
The American College of Obstetricians and Gynecologists has effectively — I can't say "banned," because that sounds illegal — but they've strongly discouraged the use of pellets among board-certified clinicians in America, which represents roughly the top 10% of all OB/GYNs. So we don't use pellets in my practice. I'm trained to use them, and I've learned how, but I believe in safety first, and I don't want to put anything in my patients' bodies that I can't take out.
I have patients who come to me and say, "I use pellets, and I'm really happy — I feel like a million bucks." I love that they feel good, but I have to make sure they know I can't tell them it's a safe practice. That's why I think the three or four options I just gave you, Katie, are safer choices — even if they're less powerful.
[22:53] Katie Fogarty Yep, those are the best practices. Thank you for clarifying what's going on with pellets, because it's super buzzy — I see a lot of people on social media and in the news talking about and using pellets.
Before we get into who isn't a candidate and some of the side effects that can occur, walk us through this: once you find the right doctor and start using testosterone, how long does it take to become effective? And once you're using it, is this forever, or do we ever stop? Do we need blood tests to monitor it? What happens next?
[23:42] Dr. Maria Sophocles Testosterone, like estrogen and progesterone, could be a lifelong thing — it really depends on your philosophy. If you're taking estrogen and progesterone for HRT to alleviate hot flashes, you might say, "I'll take it for that, and after a year or two, once the symptoms are gone, I'll stop." If you're taking it for long-term protection against osteoporosis, to keep your arteries clean, to support healthy brain aging — all the functions we know estrogen supports — then you're probably thinking of it as a long-term process. That's become widely accepted: women don't just take hormones for acute symptom relief, they take them for health span, because they want to optimize their health into their 70s, 80s, and 90s. I'd put testosterone into that same philosophy.
You could use testosterone today to improve your libido, and it could be a short-term effect — you use it for a few months. A lot of patients come to me just for help with libido, and sometimes they use testosterone for three to six months alongside other things — reading erotic literature, watching movies with erotic content, self-touch, masturbation, massage with their partner, and a hundred other things. Once those things are in place and sex feels more welcome in their life, they'll often stop the testosterone — they just used it to amp things up. Other women use it on an ongoing basis. They'll tell me, "I ran out, I was on vacation, I came back a month later, and I realized my libido was different" — so they want it long-term, to maintain the level of desire they used to have. So, long-winded way of saying: it could go either way.
[25:54] Katie Fogarty So interesting. I felt like a big engine turnover when I started using it. I'd started HRT six months before — well, my provider had me wait six weeks, not six months, pardon me — then begin testosterone, and I noticed the libido turnover, an engine turnover, and more energy overall. I don't know if that was testosterone specifically or the fact that I'd already been on HRT for several weeks, but I noticed a marked improvement. I remember thinking, "I didn't even know this was missing" — when it came back, I thought, "Oh right, this feels familiar again." I had a great experience with it.
However, I know not everyone does, and testosterone made some big, bad headlines over the summer around the Olympics — it's banned as a performance-enhancing drug. We're not going to weigh in on that specific case with the boxer and what went down, but I'd like to ask: what are some of the health watch-outs?
[27:01] Dr. Maria Sophocles You have to realize that testosterone given to enhance an elite athlete's performance is given at a really high level — think of steroid use in professional baseball, where players develop those huge muscles. That dose is totally different from you applying a little hydrocortisone to a poison ivy rash — all you need is a tiny amount of hydrocortisone for a rash. Same thing with testosterone: we're talking about tiny amounts of supplementation, just to gently nudge libido, muscle mass, and energy.
But even at tiny doses, people should be aware there can be androgenic effects — slight increases in acne or body hair. There shouldn't be any significant increase in weight or BMI. There could be a slight elevation in LDL, the "bad" cholesterol, or a reduction in the "good" cholesterol, but that's really only with oral testosterone, not the topical version. Importantly, we don't see changes in mammograms — that's really important — and we don't see any increased breast cancer risk in the short term. We don't have long-term studies looking at breast cancer risk at the doses we're talking about, but these creams really don't carry serious adverse effects, like blood clots or elevated liver function tests. That's why I'm comfortable with patients using the same low-dose approach you're using. If it makes you feel better — more energy, more libido, better results from your weight training — there's very little downside. We check blood levels six to eight weeks after starting.
[28:58] Katie Fogarty And how often do you keep that up? Is it an annual thing? Do you need regular blood testing while using testosterone?
[29:05] Dr. Maria Sophocles I'll tell you the official position from the North American Menopause Society: they say we should measure testosterone before starting, to establish a baseline, along with cholesterol and liver function tests, and repeat those labs after six months of use, and then every six months after that — so, twice a year. A lot of my peers tend to repeat it once, a few months in, and then not again, because the levels tend to stay the same year after year — that's anecdotal, but by the textbook, you're supposed to check twice a year.
There's nothing wrong with knowing your cholesterol every year or twice a year, but the beautiful thing about these tiny doses is that they really do produce fairly stable levels. So: check total testosterone before starting, check again six to eight weeks after you begin treatment, and if you change your dose, recheck six weeks after increasing it, or two to three weeks after decreasing it, to make sure the level has come back down. This is all pretty simple — your clinician will walk you through it. You just have to remember that even at these tiny topical doses, it's wise to make sure your testosterone level stays in a range your clinician is comfortable with.
[30:43] Katie Fogarty Absolutely — straightforward, and checking in with your doctor to help manage it is key. Just reiterating: you can head to NAMS at menopause.org, or to Let's Talk Menopause, whose board I sit on, to find clinicians. I'll also offer one more idea beyond the ones Dr. Sophocles shared earlier — ISSWSH and sexual wellness practitioners — which is that urologists can often help with this too. I've had the pleasure of interviewing both Dr. Kelly Casperson and Dr. Rachel Rubin on the show, and Dr. Rachel Rubin, in addition to being a urologist, is board-certified in sexual medicine and a member of ISSWSH. That gives listeners a third option: if you can't find a menopause specialist, try a—
[31:45] Dr. Maria Sophocles — urologist. Find a—
[31:46] Katie Fogarty — urologist who can help you with this, because they're prescribing testosterone day in and day out to men, and they have a lot of practice in this area.
This is a good time to segue into non-hormonal ways to boost testosterone, because I know we can add it back with creams and gels, but this is a naturally occurring hormone, and there are lifestyle choices that can also help. I definitely want to cover this, because not every listener is comfortable taking hormones, and there are options for everybody. So let's talk about those.
[32:24] Dr. Maria Sophocles For sure. There are non-hormonal things — lifestyle hacks — you can do at home. One is exercise and weightlifting. Exercise is one of the most effective ways to prevent many lifestyle-related diseases, and it can actually increase your testosterone levels. There was a 2015 study — done in men, again — looking at men with obesity, and it found that increasing physical activity was more beneficial than anything else for raising testosterone levels. Resistance training, like weightlifting, is what we know boosts testosterone at least in the short term. High-intensity interval training, or HIIT, can be very effective too.
Second is what you eat — that affects testosterone and other hormones. Protein consumption helps maintain healthy testosterone levels and aids in fat loss, which pretty much everybody wants help with. Even consuming healthy fats can support healthy testosterone levels and hormone balance. So — following a nutritious, well-rounded diet. You've heard that so many times, but it actually helps.
[33:52] Katie Fogarty It's so great to be reminded, too. I learned the link between lifestyle choices and testosterone production while researching this episode, so I think it's important to remind people that there are always things we can do to optimize our health that we sometimes know and disregard.
[34:09] Dr. Maria Sophocles We know that minimizing stress and keeping cortisol levels down can keep hormones in balance and limit swings in a lot of our hormones — they often have this reciprocal relationship, where as one goes up, another goes down. So — and I said this in a confusing way earlier — a sudden elevation in cortisol from stress can actually drop your testosterone, which you don't want. So managing stress helps keep testosterone levels balanced.
We also know that having appropriate vitamin D levels matters — low vitamin D has been associated with low testosterone levels, though we need more research on this.
[35:01] Katie Fogarty Would you recommend boosting vitamin D through sun exposure, supplements, or a vitamin D–rich diet? What's the best way — or is it all three?
[35:12] Dr. Maria Sophocles All three, honestly — most of us have slightly low vitamin D because we're pretty sedentary, indoor creatures relative to how humans used to live. If you checked vitamin D levels in every one of our listeners, most would come back slightly low. So: moderate sun exposure in a healthy way, and if labs show significantly low vitamin D, then supplementation should be considered.
I could talk about other supplements too, like zinc — there's some research showing zinc supplements can support healthy testosterone levels. The problem with supplementation in general is that sometimes you're chasing your tail, and remember, some supplements have negative effects. So I believe in keeping it simple, and I think exercise is the number one thing. Strength training has so many benefits, and perimenopausal and menopausal women benefit enormously from working on balance and strength. If you do nothing else but that, you're already way ahead of the game.
Getting good sleep matters too — sleep quality affects testosterone levels, and good sleep helps you in about fifty other ways besides. There's also research suggesting that exposure to estrogen-like chemicals can affect testosterone levels, so the recommendation is to reduce exposure to things like BPA in plastics and parabens. But you can drive yourself crazy trying to control all of that — if you focus on exercise and eating well, you're 90% of the way there.
Last thing: alcohol. Alcohol and testosterone have a funky relationship, and it's best to moderate your alcohol intake anyway — but believe it or not, testosterone levels can drop as quickly as 30 minutes after you drink. So excessive alcohol consumption can decrease testosterone levels — and if you're drinking excessively, there are probably a lot of other health benefits waiting for you if you moderate that.
[37:24] Katie Fogarty Yeah, absolutely — I love this idea of keeping it simple. You've walked through so many accessible tools: protein, exercise, prioritizing good sleep, limiting exposure to things we know are toxic, like alcohol, BPAs, and parabens. It feels really accessible. I also appreciate your clear overview of testosterone's role in our bodies, who can benefit from it, the different delivery systems, and the benefits we can derive from it. Thank you for this 411 on testosterone.
We're nearing the end of our time, so let's head into our speed round — I want to leave on a high-energy note. Quick, one- or two-word answers. First: beyond testosterone, what's a favorite go-to for treating low libido or hypoactive sexual desire disorder?
[38:28] Dr. Maria Sophocles The number one thing isn't a medication at all — it's mindfulness. Pro tip: Dr. Lori Brotto, B-R-O-T-T-O, has a book on mindfulness, and even a workbook. Adopting mindfulness in your life can be so helpful — and believe it or not, it's also really helpful for improved sexual experiences. So many women struggle with keeping their heads clear and staying present sexually, and I find that to be a bigger issue than women simply not having a robust libido.
Women come into my office every day and say, "You need to fix my libido — I have to want sex as often as my husband, who wants it four times a week, and I don't." What we're learning is that that's less what women need. They need less pressure to match a number, and more help putting the brakes on everything else running through their heads. So my number one hack is mindfulness — check out Dr. Lori Brotto's book.
[39:33] Katie Fogarty That's phenomenal. We should be hitting the sack without our to-do list racing through our heads. I love that tip.
[39:40] Dr. Maria Sophocles Yes — hitting the sack, and the sexual sack, without your to-do list. For sleep and for sex, if you think about it.
[39:49] Katie Fogarty I love it, I love it. Okay — we went through some lifestyle choices that can boost testosterone. Is there one we should prioritize?
[39:58] Dr. Maria Sophocles I think exercise and sleep are sort of tied, because if you're exercising regularly, you're going to sleep better, you'll have more energy, and that feeds positively into your self-esteem and then your libido. Sleep and exercise are kind of twins — you can duke out which one comes first.
[40:19] Katie Fogarty Yeah, it's the perfect one-two punch. Okay — you're at work on a book, I know you opened a health clinic in Africa over the summer, you see patients — you have a lot of balls in the air. What's your personal favorite stress-buster?
[40:33] Dr. Maria Sophocles My personal stress-buster is getting out in nature — and I know that sounds very "national park," but I mean even just walking around the block in the city and noticing a tree, appreciating how beautiful it is, or walking through my really beautiful neighborhood in Princeton, New Jersey. If I can see trees, flowers, or something natural, I marvel at it every day, and it does something to my cortisol levels and blood pressure.
[41:01] Katie Fogarty I love it, I love it — and it's simple. Keep it simple, right? Just get outside in nature and take a walk. Last one: your one-word answer to complete the sentence — as I age, I feel...
[41:12] Dr. Maria Sophocles ...more free to be true to myself.
[41:16] Katie Fogarty So beautiful — I love it, and I agree. I feel midlife is a phenomenal, underrated club. We get here, we've been through a lot, and we're excited about this phase of life.
I so appreciate you coming back on the show — we had such a phenomenal conversation the first time Dr. Sophocles was on. If you missed that episode, I encourage you to check it out — we talk about closing the midlife bedroom gap, what it is, how it exists, and how it can impact not just your sex life, but your sense of self. I had such great DMs on that one, and it was downloaded like crazy, so I know listeners are going to be excited for this one too.
Before we say goodbye — how can our listeners follow you and your work?
[42:11] Dr. Maria Sophocles You can find me through my website — Maria Sophocles MD, M-A-R-I-A S-O-P-H-O-C-L-E-S M-D — or on Instagram, same handle: Maria Sophocles MD, probably the easiest. Katie, thank you so much for having me. This is such an important topic, and I hope it inspires a bunch of questions. Please feel free to contact me if you need more info — it's just important to get educated and informed.
[42:42] Katie Fogarty Absolutely — thank you, Dr. Sophocles.
[42:45] Dr. Maria Sophocles All right.
[42:46] Katie Fogarty This wraps A Certain Age — a show for women who are aging without apology. Before I say goodbye, a quick favor: this show deserves all the stars. I'd love it if you could rate and review the episode on Apple Podcasts, Spotify, or wherever you listen. Drop a link to the show into your group text with your girlfriends, your sisters, everyone in your life who needs this important sexual wellness information.
And a quick reminder: A Certain Age now has a sister podcast called The Midlife Book Club. Our latest episode features a conversation with author Chip Conley, who wrote Learning to Love Midlife: 12 Reasons Why Life Gets Better with Age. If you're looking for a dose of midlife inspiration, or help figuring out what's next for you, don't miss this phenomenal conversation.
Special thanks to Michael Mancini, who composed and produced our theme music. See you next time — and until then, age boldly, beauties.
