Doctors who are concerned about potential health risks sometimes find that they have a hard time persuading women to drop their levels once they’ve experienced a testosterone high. Jennifer Key, a writer in Oxford, Miss., went on high-dose testosterone about five years ago, and found it both fascinating and alluring to feel, as she put it, “like a teenage boy.” “It was interesting to be like, Oh, this is what people talk about when they talk about wanting sex and being into sex and missing sex,” she said. Her doctor insisted that she lower her dose when she saw the levels Key was reaching; but that doesn’t stop Key from trying to negotiate her way back to where she was. “I have a good magnifying mirror,” she said. “I just pluck.”
Enthusiasm for testosterone cuts across political lines. Several of the women I interviewed belong to religious communities that strongly oppose gender-affirming care, and yet were taking testosterone in amounts comparable to those taken by some trans men. Marcella Hill, one of the most popular testosterone influencers on Instagram, was a member of the Church of Jesus Christ of Latter-day Saints when she first started experimenting with high-dose testosterone and proselytizing about its powers. Although she has since left the church, in part because of the way she says it shames women about their sexual desire, she has many friends still there who take high doses of the hormone. “I’d never really sat with myself and thought about what I think about gender-affirming care,” Hill said. “But I think everyone should get to decide how they want to live in their body.”
President Trump’s commissioner of the F.D.A., Martin Makary, has signaled his enthusiasm for hormone therapies for middle-aged women, and the company Marius Pharmaceuticals is in conversations with the agency about clinical trials it intends to start on a standard-dose testosterone pill for women. The conversations so far suggest that “it won’t be easy by any means, but I think the new F.D.A. will be reasonable,” said Marius’s chief executive, Shalin Shah, “which represents a step in the right direction.” In the past, he said, the agency’s response to hormones for postmenopausal women has generally been “like running into a brick wall.” (The F.D.A. declined to comment on its past decisions regarding testosterone, citing the government shutdown.)
In July, Makary convened a panel on hormone therapy that included Kelly Casperson, a urologist with more than 400,000 followers on Instagram, who is a passionate advocate for making standard-dose testosterone available to women. Her support for an F.D.A.-approved product is mainstream among doctors who specialize in menopausal care, but the promises that she makes about the hormone alarm some of her colleagues.
When women go on testosterone, Casperson said on the panel, “they start businesses!” They report, she said, that their math skills improve; one woman told Casperson that she started suddenly remembering how to speak German, her first language. Although there are “signals,” Davis says, that standard-dose testosterone might benefit women’s cognition, mood and bone and muscle strength, the research is still not there. “I just don’t like women being promised things that haven’t been proven true.”