“plausible biological mechanisms do not guarantee clinical benefit, and enthusiasm for hormone therapies should not outpace the strength of the evidence supporting them.” 👏👏👏I want to leave this comment all over the internet on every influencer post touting testosterone, peptides or whatever the latest craze is as the panacea of wellness. Your enthusiasm and ability to turn a profit does not equal a body of evidence. I take people off testosterone all the time and don’t get me started on DHEA.
"Levels don’t tell the whole story. Testosterone has a rich intracrinology, meaning we don’t know what is happening inside the cell. There may be a myriad of adaptations inside the cell which we simply can’t measure, so what is going on in the blood many be meaningless."
YES.
I try to explain this to people and it never quite gets through. You've summarized it so well. We need to appreciate the complexity of hormone dynamics while recognizing that we have little to no basic biological research on that exact complexity during this phase of life. We don't have animal models to study menopause and... well... we science doesn't exactly have a great track for focusing on the female body or funding research that does focus on it.
Thanks for such a great essay! I loved how you both discussed this specific article and also put it in the context of the literature as a whole... many science communicators miss that second part.
Can you do a post about testing estradiol levels to help establish a sufficient level for bone and cardiovascular health (see post by mary Claire haver where she reviewed articles on this topic). Thnx.
thanks for your response Jen. this is her latest post (I'm guessing you have already seen it)- I was wondering if you would specifically address the articles she references. I realize checking levels is solely research based at this time, but what are you thoughts on future estradiol level evaluation if more studies support this? I realize you addressed it in the past, but was hoping to hear your in depth dissection of the studies mentioned- you always offer incredible insight. thanks Jen. https://drmaryclairehaver.substack.com/p/why-i-check-estradiol-levels-after
None of those articles were considered compelling for any professional society to recommend levels. And we heard at the menopause society meeting in October in 2025 at the osteoporosis lecture that levels are not recommended. Levels can't tell us accurately what is going on as they don't reflect what is happening inside the cell. In addition, many women who take oral estrogen have elevated estrone levels, so estradiol does not reflect their total estrogen activity.
“plausible biological mechanisms do not guarantee clinical benefit, and enthusiasm for hormone therapies should not outpace the strength of the evidence supporting them.” 👏👏👏I want to leave this comment all over the internet on every influencer post touting testosterone, peptides or whatever the latest craze is as the panacea of wellness. Your enthusiasm and ability to turn a profit does not equal a body of evidence. I take people off testosterone all the time and don’t get me started on DHEA.
"Levels don’t tell the whole story. Testosterone has a rich intracrinology, meaning we don’t know what is happening inside the cell. There may be a myriad of adaptations inside the cell which we simply can’t measure, so what is going on in the blood many be meaningless."
YES.
I try to explain this to people and it never quite gets through. You've summarized it so well. We need to appreciate the complexity of hormone dynamics while recognizing that we have little to no basic biological research on that exact complexity during this phase of life. We don't have animal models to study menopause and... well... we science doesn't exactly have a great track for focusing on the female body or funding research that does focus on it.
Kinda feels like we're flying blind, right?
Thanks for such a great essay! I loved how you both discussed this specific article and also put it in the context of the literature as a whole... many science communicators miss that second part.
Can you do a post about testing estradiol levels to help establish a sufficient level for bone and cardiovascular health (see post by mary Claire haver where she reviewed articles on this topic). Thnx.
I wrote about it here a couple of years ago and nothing has changed, no one recommends in in the medical societies and at the menopause society meeting in October it was not recommended https://vajenda.substack.com/p/are-there-optimum-estrogen-levels
appreciate your thoughtful and speedy replies!! thanks.
thanks for your response Jen. this is her latest post (I'm guessing you have already seen it)- I was wondering if you would specifically address the articles she references. I realize checking levels is solely research based at this time, but what are you thoughts on future estradiol level evaluation if more studies support this? I realize you addressed it in the past, but was hoping to hear your in depth dissection of the studies mentioned- you always offer incredible insight. thanks Jen. https://drmaryclairehaver.substack.com/p/why-i-check-estradiol-levels-after
None of those articles were considered compelling for any professional society to recommend levels. And we heard at the menopause society meeting in October in 2025 at the osteoporosis lecture that levels are not recommended. Levels can't tell us accurately what is going on as they don't reflect what is happening inside the cell. In addition, many women who take oral estrogen have elevated estrone levels, so estradiol does not reflect their total estrogen activity.
Also Professor Sue Davis wrote this excellent piece on levels a last year and she is one of the world experts https://theconversation.com/im-a-woman-approaching-middle-age-do-i-need-to-get-my-hormones-checked-263541?utm_medium=article_clipboard_share&utm_source=theconversation.com