Testosterone is often thought of as a male hormone.But women produce it throughout life, and it acts on androgen receptors across the body. Still, the United States has no FDA-approved testosterone product for women
That disconnect reflects a larger challenge in women’s health: what women experience clinically and what medicine has rigorously studied are not always aligned. The distance between the two reflects decades of research funding gaps, regulatory decisions, clinical education, and healthcare systems that have not consistently considered hormonal health as part of the broader picture of women’s health across an entire lifetime
Dr. Komal Bajajis a board-certified OB/GYN and clinical geneticist who previously served as an enterprise chief quality officer and is now Chief Medical Officer at Biote. I spoke with her about what the evidence supports today, the legacy of the Women’s Health Initiative and what it will take to responsibly expand women’s options
Q: You have built your career around quality, patient safety and diagnostic excellence. What connected that work to women’s hormonal health?
Across my career, the core question has been remarkably consistent: how do we design systems that close the gap between evidence and practice? I have worked on the outcomes health systems measure and are held accountable for – hospital-acquired infections, falls, readmissions and wound complications. Improving those outcomes saves lives
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More recently, I’ve become focused on how hormone physiology impacts those outcomes. Hormones are known to interact with many of the systems involved in health and recovery, including muscle, bone, sleep, inflammation, metabolism, and immune function. Understanding the nuances of that impact is where the work needs to go next
Q: Women produce testosterone, yet there is no FDA-approved product for them in the United States. How do you make sense of that gap?
I’ve spent years studying where healthcare systems struggle to get to the right diagnosis at the right time and working to fix it. This is one of the more striking gaps I’ve encountered
It’s important to place the lack of FDA-approved testosterone therapy for women in the broader history of hormone therapy. The 2002 Women’s Health Initiative fundamentally changed the trajectory of menopausal hormone treatment. Its initial findings were widely interpreted as evidence that hormone therapy broadly increased women’s risks of adverse events and as a result, healthcare workers abruptly stopped prescribing it. Over the following two decades, longer-term research and nuanced analysis gave us a more clearer understanding. Hormone therapy is not a single intervention. Benefits and risks vary according to factors including the hormone and formulation used, route of administration, a woman’s age, timing relative to menopause, and her individual risk profile. For appropriately selected women, contemporary menopause guidance recognizes a favorable benefit-risk profile.
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Testosterone deserves that same careful attention, since we already know it plays a real, measurable role in women’s health. Studies today supports testosterone therapy for hypoactive sexual desire disorder in appropriately selected postmenopausal women and there is emerging data around bone density improvement and decrease in cardiovascular risk in women
Limited research funding, inconsistent clinician education, and no standardized clinical pathway have predictably led to fragmented care and no approved therapeutics. It’s crucial to identify what research questions remain unanswered and invest in answering them
Q: You’ve described women’s hormonal symptoms as being normalized, fragmented across specialties, or sometimes dismissed altogether. What does that actually cost a woman when her symptoms have been explained away for years?
The cost can be significant. When symptoms are attributed solely to aging without an adequate evaluation, the diagnostic process can stop prematurely. A woman may move between clinicians and specialties, with each addressing one component of her experience without anyone necessarily seeing the whole picture. That matters clinically and the consequences extend beyond the exam room. Persistent symptoms can affect well-being, relationships, the ability to work, caregiving responsibilities, and quality of life.
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There is also a broader societal cost. According to research from the World Economic Forum and McKinsey Health Institute, women spend approximately 25% more of their lives in poor health than men. The global women’s health gap represents an estimated 75 million disability-adjusted life years annually, and closing that gap could add at least $1 trillion annually to the global economy by 2040
Those numbers make an important point: underinvestment in women’s health is a research problem, a patient-care problem, a workforce problem, and an economic problem
Q: If a woman recognizes herself in this conversation but still does not have clear answers, how should she approach the next discussion with her clinician?
The most important thing I would say is that those symptoms deserve a thoughtful, comprehensive clinical evaluation. Even common symptoms can have a variety of root causes. A productive clinical conversation should help a woman understand what has been considered, what has been ruled out, and what the appropriate next steps are. Hormonal health may be part of that evaluation depending on her age, symptoms, medical history, menopausal status, medications, and other clinical factors. Estrogen, progesterone, thyroid function, and testosterone may all be relevant in the appropriate context.
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Patients should feel empowered to ask questions. What could be contributing to these symptoms? Are there medications or medical conditions that could be playing a role? Is hormonal health relevant in my case? What does the evidence support, and where is it still evolving?
Many clinicians are practicing within evidence gaps that reflect decades of limited research and investment in women’s health. That is not a failure of individual clinicians. It is a reminder that science advances through continued discovery and that clinical practice must evolve alongside it. I’m optimistic about where the field is headed. Investment and scientific interest in women’s health are growing. With stronger research, better tools, and better clinician education, we have an opportunity to give women something medicine has too often struggled to provide in this area: clearer answers and more informed choices.
This article was originally published onForbes.com
