Testosterone Matters In Women’s Health Research And Clinical Practice Need To Catch Up

U.S. healthcare maintains no FDA-approved testosterone product for women, exposing a persistent research and clinical disconnect. Harvard experts and clinical leaders warn that women face profound diagnostic gaps, including normalized symptoms, extended hospital pain wait times, and a frequent dismissal of serious health conditions as mere aging.

Testosterone is widely recognized as a male hormone, yet women produce it throughout their lives, relying on androgen receptors distributed across the body. Despite this biological reality, the United States offers no FDA-approved testosterone treatment for female patients.

The Long Shadow of the Women’s Health Initiative

The reluctance to study and prescribe hormone therapies for women traces directly to the fallout of the 2002 Women’s Health Initiative. The initiative’s initial findings were widely interpreted as proof that hormone therapy broadly increased women’s risks of adverse events, causing healthcare workers to abruptly halt prescriptions. While contemporary guidance recognizes a favorable benefit-risk profile for appropriately selected women, testosterone has lagged behind.

Current studies support testosterone therapy specifically for hypoactive sexual desire disorder in appropriately selected postmenopausal women. Emerging data also point toward potential improvements in bone density and reductions in cardiovascular risk. Yet, because the medical establishment has historically treated hormone physiology as a peripheral issue rather than a central pillar of lifelong well-being, clinical practice has been slow to adopt these findings.

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Dismissal of Pain and the Myth of Hysteria

This clinical disconnect extends far beyond hormones into how medical providers evaluate physical pain in female patients. A patient named Vivian visited an urgent care clinic after experiencing an excruciating post-sex headache, only to be sent home by a doctor who attributed the symptom entirely to perimenopause according to an analysis published by Harvard Health. The pain escalated, leading to vomiting and a subsequent hospital trip where imaging scans revealed three brain aneurysms requiring immediate surgery.

This is a vivid example of ‘we’re not going to do any testing to look further’ and the problem turned out to be very serious, said Samantha Meints, a pain psychologist in the Department of Anesthesiology, Perioperative, and Pain Medicine at Harvard-affiliated Brigham and Women’s Hospital, highlighting a pervasive diagnostic flaw.

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Medical dismissal of women’s physical complaints is reinforced by both history and modern societal bias. The term hysterical derives from the Greek word hystera, meaning womb. Contemporary research, including a study published in November 2023 in the Journal of Experimental Social Psychology, highlights a gender-pain exaggeration bias that leads some people to assume women overstate or dramatize their discomfort.

Disparities in Hospital Care and Chronic Pain Burdens

Statistical evidence confirms that these biases alter clinical outcomes. An international analysis published in the August 13, 2024, issue of PNAS demonstrated that clinicians treat male and female patients differently when they present at a hospital with pain. Women wait an average of 30 minutes longer than men to be examined and are less likely to receive pain relievers for the same complaints as detailed in the Harvard report. Furthermore, among patients reporting nonspecific pain, nurses are 10% less likely to record women’s pain scores than men’s.

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Nearly a quarter of American women live with chronic pain, a higher proportion than men. Women also shoulder a higher prevalence of specific conditions such as migraines, irritable bowel syndrome, fibromyalgia, and other conditions involving the joints, muscles, and bones. When clinicians attribute these warning signals solely to aging or hormonal transitions, the diagnostic process stops prematurely, leaving patients bouncing between specialists without a cohesive care plan.

Broader Societal Costs of the Women’s Health Gap

The failure to adequately evaluate and treat women’s health concerns carries severe economic and societal consequences. This disparity amounts to roughly 75 million disability-adjusted life years annually worldwide. Closing the global women’s health gap could add at least $1 trillion annually to the global economy by 2040, making improved research, standardized clinical pathways, and validated therapeutics an urgent economic and medical imperative.