Summary 

If you've ever felt like you're running on caffeine and cortisol, struggling with fatigue, low energy, or stubborn weight gain—you're not alone. And no, it’s not just in your head. After 35, hormonal changes play a significant role in how you feel inside and out. That’s exactly why we’re having this important conversation today.

I’m bringing on Dr. Rena Malik, a board-certified urologist and expert in female hormone health, to bust some myths and drop some serious truth bombs about testosterone. Spoiler: It’s not just a hormone for men. We’re digging into what it actually does for women, when lab testing makes sense (and when it doesn’t), and how to approach hormone optimization without chasing numbers down a rabbit hole.

Dr. Rena Malik, a trailblazing urologist who's revolutionizing the way we talk about taboo topics. With over 400 million views on her YouTube channel and 2 million subscribers, Dr. Malik has become a leading voice in dispelling medical misinformation and educating the public on intimate health issues. Named one of the top 10 health influencers by Men's Health Magazine, she's also a renowned expert in sexual medicine, hormone management and urologic health.

Learn more: https://www.burnstressloseweight.com/ 

Get the Hormones Training: https://www.burnstressloseweight.com/hormones 

Dr. Rena Malik’s Links:

YouTube https://www.youtube.com/c/RenaMalikMD

Podcast: https://podcast.renamalikmd.com 

Instagram: http://www.instagram.com/RenaMalikMD 

Twitter: http://twitter.com/RenaMalikMD 

Facebook: https://www.facebook.com/DrRenaMalik 

Tikok: https://tiktok.com/@renamalikmd 

What You’ll Learn from this Episode:

• The surprising role testosterone plays in your body (and why you have more of it than estrogen!)
• Why women’s hormone health has been overlooked in research (and what you need to know)
• When lab testing for testosterone is actually useful—and when it’s a waste of time
• The different forms of testosterone therapy available (and why some options are controversial)
• Why optimizing your hormone health starts with lifestyle changes—before any prescription

Listen to the Full Episode:

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Featured on the Show:

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• Get the Hormones Training by clicking here.

Download the full transcript here.

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  Dr. Priyanka Venugopal: There was a point a few years ago where I felt like I was running on cortisol and caffeine. I felt tired, my energy always had a dip in the afternoon after lunch, if I even had lunch and weight loss and hitting my personal body goals felt near impossible. It turns out if you have ever experienced any of these symptoms where you just feel fatigued and you feel not like yourself, if you find weight loss to be particularly challenging, it's not just in your head. After the age of 35, your hormones are changing and they will very normally and naturally impact how you feel inside out. The best news is being empowered with actual science informed information and data on how to feel better is actually possible for you. This is one of the reasons that I created a free hormones training to talk to you about the three hormone pathways that are most impacting your weight loss and your wellness goals this year. I talk about when and when not to check labs. And my four step approach on optimizing your hormone health so that you can start feeling better inside out so you can have more energy, you can lose the weight you want and hit your personal body goals with a little bit more ease this year. Speaking of hormones, I am beyond excited to bring to you today on the podcast, a very special guest. This is Dr. Rena Malik. She's a board certified urologist who is going to be busting myths and dropping all kinds of knowledge truth bombs on the podcast about testosterone. I love that she's having this conversation because it turns out that testosterone is not just a hormone for men. We are going to get a little technical on this podcast episode and I love that we're getting into the specific details. Rena really breaks down how and when testosterone is actually impacting you when you might want to pursue lab testing for testosterone and treatment and some of those lifestyle changes that might make any medical treatment actually work better. I hope that you enjoyed today's podcast episode with Dr. Rena Malik. And if you are loving this podcast, if you want to really optimize and heal a lot of your hormone health, so you feel better inside out. Don't wait, make sure you go and grab that free hormones training over at www.burnstressloseweight.com/hormones. And I will meet you in your email inbox with 30 minute training. Without further ado, let's talk to Dr. Rena Malik. Hey, unstoppable friend. You're listening to the Burn Stress, Lose Weight podcast. I'm your host, Dr. Priyanka Venugopal, a physician turned a stress and weight loss coach for professional working moms and the founder of Burn Stress, Lose Weight, Feel Unstoppable. This podcast is going to inspire change at the root for you on and off the scale. I've lost a little over 60 pounds while being a busy physician mom with two young kids and an unpredictable schedule. And along my journey, which was full of many, many imperfect moments, I have learned how to scale. skip past the fads and the gimmicks. I am on this mission now to share with you how you can have a real strategy and mindset skills to really have more of the life you want that you have worked so hard for. Let's get into it. Hello everyone. Welcome back to the podcast. I am beyond thrilled. Beyond thrilled is kind of an understatement. I am just jumping out of my skin with excitement to have Dr. Rena Malik on the podcast today. We met like a while ago, I think a year ago, maybe a year and a half ago. This is when you lived in the DC area. We met at a mutual friends event and I just like monopolized your entire time there. We were just enjoying ourselves and we started talking about really our experience as physicians and how we want to talk about empowering women with feeling better. And that was when I learned that you have a YouTube channel. And I did not know anything about you before we met at this party. And after that, I just started like messaging on Instagram and we became friends. And now you are on the other side of the country. But you are on this amazing mission. I have loved following you on how to help women feel better with hormones, which is something we do on this podcast. But we're going to talk about. A hormone that we have not really been talking about on this podcast, which is testosterone. So before we get into the podcast, Rena, tell us about you, introduce yourself, and then we're just going to take it away.

  Dr. Rena Malik: I loved meeting you too. And I think we instantly clicked and it was great to meet you and I'm so glad that we've become friends. Granted, not in person very often, but I'm a doctor, I'm a urologist, board certified urologist at a fellowship in urogynecology and reconstructive pelvic surgery. And then I started practicing and sort of started realizing that like I just didn't have enough time to educate people in my clinic because we could only see so many patients in a day and just wasn't enough time to actually really teach people. And so that's where I started making content on social media to really reach the masses and it took a life of its own and it's been an honor and a privilege to be able to have people take time out of their day to listen to me, to learn about their urologic and sexual health and overall health on my YouTube channel, on my podcast, on my Instagram and a variety of other social media platforms. But really that's sort of where it went and I'm just happy to be here.

  Dr. Priyanka Venugopal: One of the things that I think is fascinating because I think In our circles, we know a lot of physicians. I know a lot of urologists and you're a gynecologist and OBGYNs, but they're not all talking about hormones the way that I have seen you talk about hormones and the way that I've seen you talk about sexual health and testosterone specifically. And we can get into all the hormones, but what do you think it was for you that made you want to put your voice out there? Like, did you see a gap in what people knew in your office, or did you see a gap? That was missing that made you want to fill that void.

  Dr. Rena Malik: Yeah, absolutely. So one, you know, as someone who trained in women's pelvic medicine as part of my training, you know, I was taking care of incontinence and prolapse, these issues that women came in with, but we also, you know, wanted to overlap with, are they having issues with sex and pelvic pain and all those sorts of things. And then when they would ask me about hormones, I'd be like, Oh, you know, talk to your gynecologist. And then I realized like, as I continued on that, I went to see my good friend, Rachel Rubin. And she was like, No one's doing this. She's like, we have to do this. No one's owning the hormone space. And we take care of men so well with hormones. Like we do hormone replacement for men very easily. We manage hormones all the time and you know, we know how to do this. And so I started, you know, really diving deep. I got menopause certified. And realize that one, yeah, it's really not like this enigma of things. You learn the data, you explain it to patients, you treat them like adults and let them make their own decisions. And it's very reasonable and a great way to improve people's quality of life. And so it sort of was like, you know, no, one's doing this. No, one's really owning this space for God knows why. I mean, I think that I know why actually the women's health initiative scared a lot of people, which was this big study that, you know, it's obviously, you know, about, but essentially the study that told people there's an increased risk of breast cancer with hormone replacement therapy. When you dive into the data, there's a lot more nuance there. And so that study did a lot of harm in terms of fear mongering in terms of hormone replacement. And so I just felt like, you know what, it's time and someone has to do it and I have a platform and I should use it for good for education. And then I was surprised when I learned the data that there's so much more there. that I thought there was and that there is really a lot of potential value in hormone replacement therapy in the right patients.

  Dr. Priyanka Venugopal: You know, I think it's interesting because this has been a conversation even in the OBGYN community. So there's like Facebook groups and different social media platforms where OBGYNs will come together and have these conversations around what are you seeing in your offices? What are you seeing in your patients? Like, where is there a gap? And hormones have been a big piece of it. Absolutes because of this one study. And I think other studies as well that has created a level of fear in, you know, just the general patient population. But I think that also had a trickle up effect almost like because patients were afraid almost than the medical community also became a little bit afraid about talking about it, about talking about the data and the science. So I think that it's been, unfortunately, I think it's probably held back women's wellness. Probably for many, many years now, and I'm glad that we're getting back into it. So when it comes to, in terms of like just getting into the data and talking about the role of testosterone specifically, the reason that I wanted to have you on the podcast, because I talk about estrogen and cortisol and I talk about all other things. Testosterone specifically, a lot of people think it is a male hormone. It is something that is for the men, by the men, for the men, and only should be really treated in men. Can you talk to us about the role of testosterone for women and how it is not just a man's hormone?

  Dr. Rena Malik: Yeah. So we have actually four times more testosterone in our bodies than we do estrogen. And so testosterone is a very important sex hormone. It is not a male hormone, it is not just for men, it's an important sex hormone. It is important for us a variety of different things. Just like you'll hear people say, we have estrogen receptors all over our body. Very similarly, we have testosterone, androgen receptors all over our body, our brain, our genitals, our muscles, everywhere. And so it's really important then to make sure that we're optimizing our hormone health, right? And so what happens throughout age, it's not like menopause happens and your testosterone jumps off a cliff. It is a more gradual decline with age, but it certainly continues to decline as you age. Now, for some people, that won't be an issue at all, but first. Some people, their testosterone will become low and for some people that can present as having very often we talk about low sexual desire and that's really what it's been mostly studied in. It doesn't mean that it hasn't been studied in other things. So when we talk about testosterone, I expect that it will probably bear out the same findings when we have more evidence to support it, but it helps with brain fog. It helps with mood. It helps with muscle mass. It helps with decreasing fat gain. Now, this is what we know in men based on the evidence. And so there is small data and women that support some of these findings and some that may refute it. But again, it hasn't been done in very high quality studies. And the thing I like to really say is a lot of doctors, myself included, sometimes follow exactly what the data says. Because that's what we have to rely on, right? That's what has been rigorously studied and tested and we know for sure that it's safe. And guess what? That's our job is to be safe and effective and improve your quality of life. But the other side of it is that there's a lot of bias in research and there's a lot of research that hasn't been done in women because of bias that exists, right? And so women have been excluded for study from studies. Women have not been prioritized in terms of their health. I mean, if you look at the word penis and the word clitoris. And you look at how many times if you type them into PubMed, which is like our Google for research, you're going to find that the penis is there like 50,000 times and the clitoris is there 2,000 times. So it's, there's just this huge disparity on how much research is being done for women's health versus men's health. And so unfortunately, There's going to be stuff that's just not there yet. And hopefully, like I said, we'll see it in the future, but it's not there yet. And that doesn't mean that it's not, doesn't exist, but we have to be cautious in interpreting the data and saying, yes, a hundred percent, this is going to do all these things that are prevent dementia are going to make you lose weight. Like these are things that may happen, but we don't have really strong evidence yet that says absolutely hormone therapy will do this.

  Dr. Priyanka Venugopal: The part that made me really sad was actually to learn that fact. It's so crazy. I, like, went through medical school and residency. Became, like, a full on attending and I did not actually know that information. I did not know that women have been excluded from research for years. There is such a lack of data on this topic. And this is, again, I think, I really am glad you brought up this point. The testosterone is not just about libido and sexual health. It is about wellness. It is about how you are feeling on the inside out. It affects so many systems in our body, just like estrogen. I didn't know that. And I was a doctor. So I think it's one of those things that I'm really glad that you're mentioning that because it is true that there is so much evidence and research for men in the role of testosterone and how to replace it for them, how to test it for them, but it is lacking for women. And I think that touches on the next kind of question slash point, which we can have a lot of fear. around not having this robust arsenal of data for women. And also we can toggle to the other side, which is we get really hopeful. Like, I hope that this one hormone solves all of my problems head to toe. So what would be a useful way for women coming into even this podcast episode or exploring their hormone help to not be in either land, land of fear or the land of all the hope into the hormone basket?

  Dr. Rena Malik: I think one is educating yourself, right? You're here, you're listening, you're learning from experts. And yes, experts will disagree. So you might listen to me say something and you might go on to another podcast and someone else might say, Oh, absolutely. It improves brain health and it improves muscle health. And like I said, the evidence is the evidence, but ultimately. Get empowered with knowledge. That's one first and foremost, and realize that everyone's experience is going to be different, right? Not everyone who eats a lot of sugar is going to get diabetes. Similarly, not everyone who goes through menopause is going to have low libido or going to struggle with these issues. We look at the overall data, 40 percent of women have low libido, but 12 percent are bothered by it. So yeah, you might have a libido, but your partner might have a libido. And I see it all the time in my practice. Like I ask them, are you guys having sex? Are you sexually active? She's like, I know my partner has ED or I know like we have intimacy other ways. Or, you know, we're very happy and that's okay unless you're feeling like. You're not yourself, you don't feel well, there's relationship discord, and you want things to be better. And so that's one, it's like realizing like you know yourself, right? You know when it's a problem. So don't get caught up in like all the nonsense, like just what do you feel? That's what's most important. And two, then finding someone who is well versed and who is not selling you something. I think that's a really important thing. Like doctors are not salespeople. We are people who are trained to give you informed consent for everything, right? Shared decision making, meaning we give you the pros, we give you the cons, we make a decision together what's right for you. And if you feel like that's not happening, then it's time for a second opinion. And so don't You should feel empowered that you know the knowledge that we are in an era where we have experts giving free advice online and you can get access to that and that then you can find a doctor or a person to talk to who will have shared decision making with you who will sit down and talk with you and help you decide the right thing to do thing for you based on the risks and benefits. That's my job, right? To make sure you understand the risks and benefits. And so don't feel scared, but realize that everything has limitations. If there was one thing that could fix all your woes, we would all be on it, right? We would all be on it, right? And we're not right. And you talk about losing weight, like, yeah, losing weight is going to make you feel great, but it's not going to make your self confidence like magically feel better and fix all your problems, right? You have to fix your mindset to do all those. And the same thing is true for hormones.

  Dr. Priyanka Venugopal: You know, one of the things that I'm loving that you're saying this, and I'm curious what you think about it, is this idea of chasing the nonsense. I find that sometimes when we can talk about what you recommend, chasing lab values versus solving for symptoms. So what I would see in my practices in OBGYN is somebody would come in, top three complaints would be low libido, fatigue, and weight gain. And they would say very commonly, can you check my hormones? And it's like a very kind of just generic statement of just check my hormones. It feels like this very broad statement, maybe because they read about it somewhere. They Googled it or TikTok told them to go check your hormones. And one of the biggest conversations that I would have to have with my patients in my office would be. We don't actually treat hormone levels, we manage your symptoms. So let's actually do a deep dive in how you're feeling head to toe. And based on how you're feeling, let's then do testing appropriate, you know, appropriate testing and solve for that problem. So when it comes to chasing labs, I have a lot of thoughts about chasing labs. It's like a rabbit down the deep, dark rabbit hole. What are your thoughts on how you have found testosterone lab values correlate with symptoms? You were saying sometimes you can have a low, Testosterone level maybe doesn't show what, how would somebody know that this is a lab value that I should pursue? This is a lab value maybe I shouldn't pursue or should we not be using lab values at all to feel better?

   

  Dr. Rena Malik: Well, you know, for estrogen progesterone, there's really no value, particularly in the perimenopausal space for checking that because it's on a roller coaster. I mean, you can sometimes check on like the third day of the cycle, but ultimately there's not a lot of value, right? We go by symptoms. So first and foremost, it's when you go to the doctor, just don't say like I'm fatigued and I'm tired and I have loads of lube. like actually tell them, Hey, I've tried X, Y, Z. I've worked on my sleep. I've been working out. I've been monitoring my calories. Like I've been doing all these things. I'm not seeing results that gives, you know, and unfortunately it's a little bit true that you're trying to, you know, advocate for yourself, but you know what? Most people just. think like they think all people are just lazy and they're just getting older and they just want to find the answer. And so if you come armed with evidence, like, Hey, I've done X, Y, Z, I'm really working on my end on lifestyle to improve my quality of life and I'm still struggling. That's important information. And also something we should all be doing, right? Like we are strong, capable. Women who are listening and capable men, if anyone's listening, you're all strong and capable. So I think like really just saying like, yeah, I am strong and capable and I'm going to do those things that are in my power first at the same time as I'm going to see my doctor. So I'm saying, look, I'm committed to improving my quality. If I'm not looking for a quick fix, I'm here doing the work, but if something can help me and make me feel better and help me maybe get the results I want, which is feeling better. faster. I want that, right? And so that's one. Two is in terms of blood work. So for testosterone, I think it's very easy to check testosterone. I check testosterone in men all the time. It's so simple. It's one simple blood test and we get a number right now. What does that number mean? So when we look at the, the reference values, I find that lab companies, sometimes they find like one study and they use these reference values doesn't even make sense. So what really matters is one, is it lower than expected? And so low is, you know, one 10th of what a man would have, right? So a man's low is 300. So I tend to use the number 30, but when you look at the literature, you can find that people range, you know, from five to. A hundred sometimes even hundreds pretty high, but like, you know, in terms of where you land in testosterone for women. So it's not just like this magical number and the same thing, you know, we have a very good number for men because there's been more studies on it, but ultimately what, even when I tell men, it's like, I don't know what's happening at your receptor level. Like when your testosterone attaches to your energy receptor, how sensitive is that receptor, meaning how much is it going to then use the testosterone, make the necessary changes to improve your mood, to clean your, improve your brain for men your nocturnal erections, all those things. Like how many times is it going to be working and what efficacy that we know as we age, the receptor also is not as strong. Now, if you're on the low end of normal, then maybe perhaps adding testosterone will be helpful in terms of improving your symptoms. Now, again, the most studied thing we have is libido in terms of improving desire for sex. And that's in the post menopausal woman. They actually haven't studied it as much. Other demographics, that doesn't mean that it won't work. It just means that it wasn't studying those demographics. What I say is you could try it for a period of time, usually one to three months and see if it improves your desired outcome. So whether that's libido or something else, if you don't see a difference at that point, I would say, okay, it's reasonable to start tapering off of it because it's probably not helping you because if you stay on it for long periods of time, it will then shut off your endogenous production or your normal production of testosterone. And so now you're reliant on this medication because your body. And it will, if you decide to stop it, it will, you know, kick back up, but it will take a while and you'll feel pretty crummy during that time period. And so it's ideal to just kind of figure out early on, is this helping me or not? And so, yeah, I think really it's about just being aware and then also knowing what types of testosterone are available to you and what might be better for your lifestyle. So the most, we don't have a FDA approved female testosterone formulation in the United States. And so what options do we have?

  Dr. Priyanka Venugopal: Can we just say that again? Yes. Friends, can we just, I have so many thoughts on this. Can we just say that again? You say it again say that just if you, if you zoned out my friends, come back because I want you to hear this again. Go ahead.

  Dr. Rena Malik: There is no FDA approved testosterone formulation for women in the United States. None. Yes. And so yeah, it's really, it's really important to know because no matter what you take, it's going to be an off label. treatment of your symptoms. And so off label just means that, you know, the evidence is not there and the formulation has not been tested in women and not been used in that way. So typically what I do for a lot of my patients is I'll take the male androgel. I'll tell them to put it in a syringe. I actually have a syringe sitting right here, shockingly enough. Yeah, there we go. Some syringes. Yes. Yeah, I'll put it in a syringe and I will pour the gel in there and then I'll give myself half a cc every single day on your calf or your inner thigh. Now, the important thing, and whereas a guy would take that whole packet and put it on their, on their, on their arm or their leg, upper arm. And so you're taking one 10th, you're taking one 10th of that every single day. So it's a small amount, but you do need to be careful that you can transfer it. So if you apply this gel and then you rub your leg on your kid by accident, now you've transferred some testosterone to your calf. You're growing child who doesn't need testosterone at this time. And so you have to be very careful. If you're going to put it on your leg, then make sure you're wearing pants for 20 minutes at least after you put it on so that it gets absorbed and it's no longer at worry for transfer. So that's really important. And you know, it is something to do every single day. So if that's not something that like, you're like, Hey, I know myself, I'm really bad Doing stuff every day, then I would say maybe that's not for you. But I tell people we, a lot of people do skincare every day. So you can easily incorporate that into your routine, right? Like just like, Oh, something else I have to do during my skincare routine. So that's one, two, there's injections. Now these, you could also get compounded creams as well that are, well, you. a little easier to apply, like maybe just a click or turn of the compound and it'll give you just the exact dose you need and you apply that. So that's an option as well. The androgel can be very cheap, which is why I do it, because you can get coupons and get male androgel for very, very affordably. You can also do injections that again are compounded, because you can't take the male testosterone siponate and give it to a woman because it's so much stronger. So it needs to be compounded to a lower dose. And then you can inject. that every week or twice a week if you prefer, if you like lower doses, and that works as well. Now, pellets are very controversial, one, because they're generally not recommended. I do know people who use them, they love them, they swear by them. It is a different way to insert testosterone, it's a pellet that's inserted into your backside, it absorbs on its own, and it lasts for three to four months. Now the beauty of it is you set it and forget it, right? It's there, you don't have to think about it again. The bad side is it tends to make your testosterone go really, really high after you insert it immediately, and then it tapers down over time, and so we don't know how high it's going to get. We don't want you to have the negative symptoms of having supraphysiologic testosterone, which would be things like hair growth in other places like your chin or other parts of your body. You don't want clitoral megaliths, your clitoris to get enlarged. You don't want necessarily to have a deeper voice or to get acne or to get irritability, which are some side effects potentially with having really high doses of testosterone. Now, typically in the physiologic range, most people don't have those side effects, but when you get a little high, you can see those issues. And then what, what does it mean when it goes that high? Right? We don't know. We don't have that data. I'm like, what happens if you have super physiologic testosterone for weeks at a time, and then it goes down. We just don't know. And so that's why it's really not recommended.

  Dr. Priyanka Venugopal: You know, with the, with the gel or with the injectable, you can stop it very quickly, but a pellet, it's like the pellets in there. Yeah. Yeah.

  Dr. Rena Malik: So for that three to four months, you're going to be getting testosterone, whether you like it or not that's sort of the downside of that. So those are sort of the, the formulations that are available to you. There's no patches. I think there's a patch in Australia. But there's no patches or anything available here. And so, yeah, those are the options that we have for women with testosterone. And those are, again, things to talk about if, if you decide you want to have testosterone checked and it is low and you're symptomatic and then talking about which one would be the best for you.

  Dr. Priyanka Venugopal: There's a couple of things I've noticed coming up just kind of in general in women communities is this idea of going to, I'm going to. put provider in quotes, but they go to someone that says that they can check their labs. And then they start following the labs and start chasing, you know, rabbit hole. They start chasing the labs to improve the labs and they may or may not feel better, but we're chasing labs. One of the things that I'm kind of curious about your thoughts on is who should people Um, I would be going to specifically to really help manage this because in my just my experience is you want to find someone that is actually trained in this, that is a physician that knows what they're doing in the space, but I've seen because I've seen so many sad stories of people going to not certified providers and then now we're Now we're kind of going down a really dark rabbit hole. So I'm curious about your thoughts on that.

  Dr. Rena Malik: Yeah. I mean, I think absolutely. It's really important and it's easy to chase numbers. Like it's really like, Oh, here's a number. This is where we want you to be. It's not here. Oh, let's go higher. Oh, it's not here. Let's go higher. Oh, it's too high. Let's bring it back down. Look that a monkey can do my, my eight year old can do that, right? Like that's not as. a certified provider, someone who like, okay, what does this mean? Right? If someone's actually talking to you about how are your symptoms and not just saying, here's your lab work, here's a result, here's what you need. And they're not actually talking to you about like, Oh, how are you feeling? Like where are your symptoms at? Because you might be at say you're at 35 and they may want you at 40, but you might be like, you know, I'm feeling a little irritable. I'm not sleeping really well. Or, you know, I've noticed a little bit of hair growth or I got some more acne. I never used to have acne, but they never asked right? And you never told them because you were nervous and you were in a doctor's office and you were like, Oh, whatever you say, which is so normal, by the way, don't feel bad if that's you. We've all done it. But now you're like, Oh, I guess I need more because my blood work's not right. Like there's something off there, right? Like you need to go with your body. You are the CEO of your body and you know what you need and what you don't need. Right. And sometimes just having someone that listens and understands that and knows that like, this is not about chasing numbers. It's never been about chasing numbers. It's always been about chasing your symptoms. Same thing goes for men. When I treat men, a lot of them get fixated on the numbers. I tell them, look, once I get above a certain number on your testosterone, like more is not better. More is not going to make you feel better. Like, yeah, maybe there's some muscle growth, like why people, why people use anabolic steroids. But like, beyond that, there's no benefit to all the other symptoms. organ systems when we give you more. And so similarly for women, when I go beyond a certain level, you're not going to get more benefit. And so I think that's really the most important thing is just realize like, it's not about chasing numbers. It's about making sure your symptoms are better and then keeping you stable.

  Dr. Priyanka Venugopal: Yeah. You know, for anyone that's listening, because I've definitely been that person that thinks more is better. I've, I mean, historically, I can think back to when I'm six years old and I'm just like, more A's better, right? More is better. And so if you've ever thought that way about chasing labs, like it's, if my labs are a little bit more perfect, or if my labs are a little bit more in the normal range, or if my testosterone is higher or my estrogen levels are better, More is better. I think that it's normal because so many, especially busy, professional working moms are so busy that they just want a lab value. They just want to be able to check it off the list. Can we just cross this off the list already so I can move on and live my life? So if you've ever wanted that, the message here is this might be a bitter pill to swallow, but the wellness. Just feeling better inside out does require more than that. And if you have been the person like me who wants to follow all the numbers and feels like more is better, just know that it might be taking you down the wrong road, which is, I love that you brought that analogy and where you might be having symptoms where this is not actually a good fit for you. But if we keep chasing numbers, we'll just never know.

  Dr. Rena Malik: And there's a lot of like discussion about optimal, what's optimal, right? Like I don't want normal. I want. optimal. But like, we don't know what optimal is, right? Just because the higher end of normal, does that mean it's optimal? No, we don't know that. It's never been studied for like high performers versus regular people, right? It's never been looked at that. It's never been looked at for your gender, maybe for your ethnicity, for your race. Like there's so many factors that go into that. And so I think like people are like, Oh, I always want to be in the top turtile of normal. And I'm like, okay.

  Dr. Priyanka Venugopal: This is the overachiever guys. This is so the overachiever.

  Dr. Rena Malik: But does that mean it's better? We don't know. It's not a, it's not, it's not a grade, right? It's like, we don't know that that's better for you. But what I do know is how you feel. What I do know is how your symptoms are. And I think the one thing about busy people is we don't take time to take an inventory of how we feel. Like you, like I asked you when we got on this podcast, how are you? And you're like, wait, wait, I'm not going to say I'm good. I'm going to give you a true answer. I was like, let me just tell you, hold on one second. Yeah. Right. And that's something like we just go about life. We're just like, let's move on. This is a basic ass question. How are you? I'm gonna say, I'm good. I'm going to keep going. But reality is like, take a second, like do an internal audit. How do I really feel? I'm like, I was talking to my husband about this the other day. I was like, you know, I really I'm trying to do some introspection on how our weekend went. And I want to talk to you about it. And like, I was really trying to like, look, I feel this way. And like, I don't know why I feel this way. And like, we really had a conversation about it. And I was like, okay, this is good. Like I need to like Take a second to acknowledge what I'm feeling inside and actually say it out loud. And whether I figure something out or not, it's just important to like, say like, Hey, there's something going on. I'm not sure what it is. And I want to talk to you about it. Or I want to like, just put it on paper or I want to whatever it is. But there's so much value in that. And the same thing goes for when you're treating your hormones or treating any problem in your, in healthcare is like, how do I feel? Because when I give the same medication to 10 different people, and I'm probably going to have maybe eight that feel great and one that it doesn't work for. And one that feels really crappy on that same dose of the same medication. Right. And that same thing can go for hormones.

  Dr. Priyanka Venugopal: I just love that you're talking about this because I think. And again, ask me how I know, friends, because I've like literally done all these things. But this idea of slowing down long enough to check in with yourself with how am I feeling? What is working well? Is this right for me? I think that for me, part of the reason the block for me was I wanted to just get there. What is there? Like, you know, there is better than here. So that would look like when I hit my goal weight. That will be better than here. Me at 200 pounds, or when I am fit, then that is better than here. When I get the eight plus, when I pass oral oral board exams, when I pass oral board exams, that will be better than here. It's this perpetual chase. And then I see, and I see it specifically for. overachievers that have these like perfectionist tendencies and type A personalities where there is better than here. And we get so addicted to the rush of getting there that we deprive ourselves of being here, like the actual point of our life. And before you know it, you're 40 years old and you're like, wait a second. What just happened? I'm supposed to be an adult living my best life and this is definitely not my best life so something is amiss. What is happening? And I think that this is a testament to that, of actually being willing to slow down. I know that we feel impatient to have results, but being willing to slow down and do this piece of the process is going to help you, I think, From what I'm hearing you say, it's better actually navigate your journey with hormones, how you want to treat, medically treat or well, you know, with your lifestyle changes, how you can actually start to feel better.

  Dr. Rena Malik: Yeah, absolutely. And I think, you know, you make a great point is that like, we're always like, what's next? And I've been in my life, really thinking about like how I'm like content, like people be like, Oh, what are you working on? I'm like, I'm keeping going. And I'm actually pretty content with it. And it's weird. I think as someone who's an overachiever to be content with where you're at and to realize like, hey, maybe it's okay if I prioritize just cuddling on the couch with my kids and like spending time with my family and like, that's okay. And so I think, you know, those moments are really important because part of what's going on during the hormone phase of like perimenopause and menopause, it's like you're going to this crazy rollercoaster of emotions. And if you can really say like, Hey, you know, where do you differentiate from the rollercoaster of light, things that are being thrown at you and life is crazy versus like, what's hormonal. And like, when you can sort of at least understand that, you know, this part of it, I have. control over and I've been doing like I've done the mindfulness side of it and I've worked on fitness and exercise and eating right and doing all the right things for my body and nourishing and fueling my body correctly. Now I'm like, okay, now I can really like focus on are these other things helping me and will they help me? And you know, how could I use them to augment my life?

  Dr. Priyanka Venugopal: Yes, I'm so obsessed with this and I know that it's hard. So if you're listening to this and you're like, Oh, I want that. I want you to just like decide to choose the challenge. We're just challenging you to be willing to slow down. I know that it's hard because you're such a go getter and like, let's go to the next thing. So what we're saying is hard. I'm not even going to try to sugar coat it, go to land on like rainbows and daisies, which sometimes I tend to do on this podcast. Just accept that it is hard. One of the things I have been talking a lot about is. Stress and cortisol levels. Again, please don't check your cortisol levels, friends, unless you have an adrenal problem with your doctor. But cortisol, it's one of those things when we have these like very busy, stressful lives, and you can tell, you know, that this is you, if you are fatigued all the time, if you're constantly ruminating and overthinking and worrying, and what if this, and what if that with every single part of your life, so you likely have very high levels of cortisol, and then you try to solve that problem with testosterone, estrogen like All these, we try to like, it's like, I think about this like as a festering wound that we're just slapping on a bandaid. So I love that we're talking about the willingness to actually treat some of your wellness, you know, if you want to feel better inside out to actually get to the root of addressing your stress, actually prioritizing your sleep, slowing down, being mindful of what is happening in your life. Where are you trying to fit 24 hours of work into a 12 hour workday? All of these kinds of things. At least in my experience is it starts to help you feel better. So when you do pursue hormone replacement therapy or testosterone, I mean, testosterone is a hormone. So hormone replacement therapy in any form, it can actually sink in to your body and actually be more impactful. I'm curious if you, what you think about that.

  Dr. Rena Malik: Yeah. I mean, look, I think that testosterone is not going to fix your life stress. Testosterone is not going to fix the children aging, the parents aging, the. Demands of, you know, having a relationship or a partner that you've been with for a long time that's starting to feel like very use comfortable and, and, but not as novel and exciting. It's not going to fix those things. Right. And so you've got to fix those things as well so that the testosterone can work on the other things. Right. And, and it will work on those things, but it's not going to magically fix the other parts of your life. And I think the other big important thing is like, you hear people like us talking, you think we've got it all together. We don't have it all together. Like we are constantly a work in progress. but you know we share the things that have helped us and I think that like you know there's days where I eat crap and I come home and I'm like I feel like crap and I did this to myself and I know I did it to myself and I feel bad about it but guess what tomorrow is a new day and like we're going to continue to be trying to improve our lives with whatever power we have in our day and like. That's the most important thing. But yeah, like I think that hormones are great. I think they, I'm so glad we're having these discussions. I'm so glad that people are learning about these things, but you know, you got to do your part. Like if you think about diabetes, right, I can give you medication for diabetes, but you still have to work on your lifestyle. It's the same thing. Same with Blood pressure, same thing with cholesterol. Like we can give you medications for all these things and they will make you better, but they're not going to fix your diet. They're not going to fix your exercise. They're not going to fix your sleep. I mean, they may help a little bit with sleep in terms of hormones, but like you've got to work on the things that you're doing that might contribute to those things. And unfortunately, yeah, it sucks. We're all doing it. I scroll on my phone before bed. Should I know, shouldn't I go to, shouldn't I go to sleep?

  Dr. Priyanka Venugopal: Yes. You're like watching reels and I'm like watching reels from what was the, what was this? With Elle Woods. What movie was that? Legally Blonde, Legally Blonde. What am I doing? I've watched this movie. I know every scene in the movie. I've watched it multiple times. Who knows from times past, and I'm watching reels, which is clips from this movie until midnight. I don't even know. We know this is ridiculous. And yet here we are just scrolling our phone. So I love that you're sharing this because this is so important that there, again, there is no, there, there is no perfect way of being, but I do think it is so important that we start to catch our habits with kindness, catch it with compassion. I talk to my clients a lot about catching it with humor. Like, look at me, there I go again, watching legally blonde clips in my bed until midnight, just catching it with humor and kindness, because that is how we get to get. Understand why I wonder why even, why am I doing that? Why did I overeat? Why did I scroll my phone? Why am I not prioritizing my lifestyle in a way that will help some of these therapies and medical managements to feel better actually work? So I'm just curious, just as we are wrapping up, how would somebody know, let's say they're 35 to 55 and they are starting to have some symptoms of low libido. What are some other top few symptoms that they might might be a red flag for them in your experience? It's like, you know what? I'm doing sleep. I'm doing the exercise and doing lifestyle, but maybe it's time for me to see someone that can check testosterone specifically. Is there any other red flag symptoms that you would tell them to? Go see their physician.

  Dr. Rena Malik: Again, I think libido is a big one, but certainly we know that like it can help potentially with muscle growth. So if you're like doing all the things in the gym and you're not seeing muscle growth, that's a good reason. We know that it may help with brain fog. It may help with mood a little bit. Now we don't know that for sure. This is all sort of anecdotal, but I would say libido is an important one. And I think, let me just talk briefly about libido. I think libido is very multifactorial, right? You have to have. sex that's worth having, right? So you have to have a desire for sex that's worth having. So if sex hurts, or sex is not fun, or you're not orgasming, or there's a variety of different things going on that's making sex less desirable, we have to fix those things too. It's not just that you're broken because desire is not there. Like it's because There's no sex that's worth having. So that's really important. Also, you have to have a relationship that you enjoy. Like you have to be in a good place with your partner and there has to be time for arousal. Right? So like, if you're used to having quickie sex, because you're a busy person and you're like, let's just go, well, you know what? It takes time to get aroused. Foreplay begins in the morning. Like, you know, foreplay happens throughout the day. And so like. Focus on that, like pick those things and those things are really important to investigate, work out, talk to your partner, add novelty into your relationship, and especially if you're having pain with sex, don't suffer in silence, like there's so much we can do to help. So those things are really important. Then I think there's three things that I. Technically, the three things are available to you medically that can help with low libido. So we talked about testosterone replacement. There's also two medications that have been studied for premenopausal women, but they also work for postmenopausal women. They just were not studied in that population for low libido. These are medications that we have for low libido. One is called flibanserin or Addy is the brand name. It's a pill you take every single night and creates a slow increase in desire over three months. So after three months, you start noticing, okay, it's really working. I'm starting to notice that things that did not give me desire before are now giving me a little bit of desire. And so that's sort of exciting. And so we have that medication. It works in about 60 percent of women. So it's not a home run for everybody, but it does work. The other option is Vialisi or Bremelanatide. It's an injectable medication. You inject it before you want to want. So 45 minutes before sex or so you inject this medication. It's like an EpiPen and it very acutely increases desire. Now this also works in about 60 to 70 percent of women. It does have a high side effect of nausea. So make sure to ask your doctor for an anti nausea medication at the same time, cause you don't want to be nauseous and horny, but they do work and they're helpful and they're available to you and they're worth trying if you're struggling in addition to testosterone, those two medications work on the brain. So they try to basically increase pro desire met signals in your brain in a variety of different mechanisms. One is through serotonin receptors, the other one is through melatonin receptors, but essentially that's how they work. And so they're basically saying, hey, let's fix the brain a little bit to improve the signals for desire. And so they work very well. They're great options that we have. I can't believe we only have two medications plus testosterone for like all of women's sexual arousal disorders. But those are the three things that we have and can be very helpful.

  Dr. Priyanka Venugopal: Yeah. And I love that you're also bringing up this idea because there are so many phases to desire, but I love that you're bringing up that arousal starts in the morning. It's not just right before you want to have sex with your partner, it starts in the morning. It starts with the relationship that you want to actually be having a deeper relationship with that person. So I love that you brought that up. The other thing I also want to add is vaginal estrogen. For those of you that have painful intercourse, that's another one that is, it is actually very well studied. So it is one of those that can be really, really helpful for women that are having painful sex. Of course, see your physician and have them evaluate you. But that's another one I wanted to just throw in there because I know that painful sex can be a big issue for so many women.

  Dr. Rena Malik: I love vaginal estrogen. I feel like everyone should be on vaginal estrogen. There is very few contraindications. Like if you have active breast cancer, that's probably the only one. It doesn't get absorbed systemically. Very minimal amounts do. So you're not going to have the side effects of systemic hormone replacement. It's going to help with increasing lubrication, increasing the thickness of the vaginal epithelium. It's going to improve lubrication and it's going to prevent UTIs, which is a huge problem as women go through menopause. And it's a correctable problem because it's hormonally mediated for a lot of people. And so I love vaginal estrogen. You can get it very, very affordably using coupons through Mark Cuban's pharmacy, or usually nowadays insurance is covering it a little better than it used to, but very great option. And then of course, if you're having pain. Get evaluated because there's other things that could be causing pain, like pelvic floor issues or God forbid, like a cyst or something else that you see underneath the urethra. Things like that, that you might find when you go to an expert who can do an exam.

  Dr. Priyanka Venugopal: Yeah, I love that. I was just at a conference in Hawaii, it was amazing, with another speaker who was talking about vaginal estrogen, Shiva Goprani. She was saying, and I love this, I'm just sharing here because we're talking about vaginal estrogen. She was saying, I hate calling vaginal dryness. It's vaginal dryness because when you think about dryness, you think that the solution to that is lubrication. So you just think you can just throw on more lubrication because I have vaginal dryness when in fact, when you, when you actually have atrophy, atrophy, I know it sounds like a scary word. It's not so scary. The skin is changing a little bit. That's all. You know, if you have vaginal atrophy, the treatment is actually different. It's not just slapping on some more lubrication. And I just, this is, we're getting technical guys today and we're getting real technical with the lingo, but I think it's so important that we understand what is the actual problem because then we can treat it with the right solution. So I love that. I think if you are, if anyone listening to this is having any of these things that we're talking about, it's so worth Number one, knowing that you are worth really taking the time for yourself. I know you're making dentist appointments for your kids and planning the next family vacation, but please put yourself on your own calendar because your wellness matters, feeling your best matters. And I love Rena that you are here to talk to us about how to do it. So tell us any last minute things you want to share and how can people find you to learn more?

  Dr. Rena Malik: You hit it on the head. Just you are worth it. That's it. Like you are worth taking the time and you can offload some of those responsibilities. Like stop planning the vacation, like let your husband or partner plan the damn vacation. Okay. Let your husband call the dentist or have your. hire someone to ask your assistant to do it. I don't know, figure out someone else to do these menial tasks that will offload your brain because you're never going to really see like the, Oh, thank you for doing this. Like, unfortunately it's just done. Right. And so you're not going to see the thank you. So offload those things. It's okay. It doesn't mean you're less of a person. It means you're smarter. So that's one, two, where can you find me? I'm on YouTube and my podcast, Rena Malek, MD podcast. I'm on Instagram, Facebook, TikTok everywhere. It's Rena Malik MD, so feel free to follow me anywhere you like. I talk a lot about men's health, but obviously women's health too. And so great for you and your partners if they're having issues to learn about sexual health.

  Dr. Priyanka Venugopal: I love it. We'll put all of those links in the show notes. I think it's one of those things I really want everyone to remember because a lot of women especially are socialized to want to help other people. Even as a physician, I think I kind of went into my life as an OBGYN because I wanted to help other people. And. It's been celebrated when you help other people. You're considered generous and a team player and that awesome person for being a helpful person in the community. But the one kind of lesson I've had to learn again and again, and I hope everyone listening here can really, really hear me when I say you are a part of your community too. You are a part of your family too. So just like you care about your kids getting the absolute best experiences and your partners and your families, you deserve that too. So yes, Bitter Pill, it does take some effort. It does take a little bit of time and some patience, but Again, I think it's one of those things that is so worth it and you will thank yourself 10 years from now when you take the time now. I want to be when I, we know when I'm 90, we're not going to ever say, I wish I had worked more or I wish I had more money. It is going to be. I'm so glad that 40 year old me took care of myself at that age because it's going to pay off in just life experience.

  Dr. Rena Malik: Yeah. Yeah. And you know, I think the other thing is letting go of perfection. Like we think we do everything perfectly and no one can match our expectations and they can't, right. You've been doing it for so many years. You have your systems down patch. You're really good at it. And if you have your partner do it, it's not going to be as good, but like, okay, isn't C plus work. Okay. It's okay. It will get the job done. And that's okay.

   

  Dr. Priyanka Venugopal: When I went on this trip to Hawaii, my husband had to take care of the two kids and he often forgets to comb my daughter's hair. Like in the morning, she's six and a half. So she's going to school and her hair, like I've, I've just FaceTime with them and her hair is like, not to hear. And so I remember having that moment where I wanted to nag him, like, remember, like, I wanted to put a post it note on the garage door. I want to put a post it note on the alarm clock, like, remember to comb her hair. And I remember thinking, like, I had to go through this experience of letting his way be enough. She got to school. She got to school with a lunchbox. She was fed breakfast. He loves her. Maybe that's enough. And girl will, will say, you know, when it matters to her, she'll say, daddy, can you please comb my hair? She'll figure it out. It's one of those things. It's like letting go of the control and like proving to yourself. You're not going to die. If your daughter's hair is not combed, it's all good. It works out just right.

  Dr. Rena Malik: Exactly. Exactly.

  Dr. Priyanka Venugopal: Yep. Rena, thank you so much for being here. I just love this conversation. I hope you guys all enjoyed this conversation and really take a moment for yourself to just reflect on what it is that you want to feel better in and go make it happen. Thanks, friends. I'll see you around next week. Bye. I hope you loved today's podcast conversation with Dr. Rena Malik. I know that I love talking to her and hearing a lot of her wisdom around how and when testosterone is playing a role in our life. I really loved understanding and really emphasizing that we don't need to chase lab values to feel better, but working with a physician who is really certified and experienced in this area Actual realm in you feeling better is going to be essential, but it won't work until we individually put in the work and know that we deserve to feel our best. If you're loving this conversation about hormones, if you love this conversation today, make sure you go and grab my free training. It is the hormone secrets to weight loss and wellness, where we get into the three hormone pathways. That really are impacting how you feel with your energy and with your weight loss efforts this year. You can grab it for free over at www.burnstressloseweight.com/hormones. I hope you guys have an amazing week, and I will see you at the next one. Thanks for spending this time with me on the Burn Stress, Feel Unstoppable podcast today. I hope that you are leaving today's podcast episode feeling a little lighter and more inspired than when we started it turns out. that you don't need to have a stress free life to hit your goals on and off the scale. But when you feel more empowered to respond to your real life stresses with true strategy, we will game change how we show up and how we hit our goals. If you want to take what you're learning here on the podcast and put it into real life implementation, it might be time for us to work together in the Burn Stress, Lose Weight, Feel Unstoppable group coaching program. Head over to burnstressloseweight.com and you can learn all of the details, the nuts, the bolts, when the next group is starting and exactly how you can join. Okay, friend, I'll see you next time.