Monica’s Question: Hi, I have been prescribed testosterone cream and I have been advised to apply it to my inner thigh. I was wondering, in doing so, will this reverse the results of my laser hair removal on my bikini line? As per you stated that someone had a similar experience to this. Should I apply it there or should I apply in another area? Thank you.
Short Answer: Applying testosterone cream to the mid-inner thigh should not affect the bikini line. However, the hair in the area of where the testosterone cream is applied will get darker. There is no real way to avoid the hair from darkening. Switching thighs can help, but it will probably still darken in both areas.
PYHP 104 Full Transcript:
Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson.
Dr. Maki: So summer is moving along very quickly I cannot even believe it is almost the middle of August already.
Dr. Davidson: I know summertime is so fun in Washington.
Dr. Maki: We have got rain in the last couple of mornings which actually has been– We had quite a bit of rain in June at least it seemed like July was really nice and now the last couple mornings we had a really nice stretch with no rain at all. And now it was kind of nice actually with a little bit of drizzle in the morning. We have got this jungle in the back of our house. I know that you kind of went back there with little clippers and trying to– We have this little trail that leads up to another trail and you are back there a couple of days ago trying to clean up the trail.
Dr. Davidson: Exactly. We have a beautiful trail up there and it is funny because I always laugh with my patients that summertime. It is almost, even though it is beautiful, it seems like it is harder to exercise and eat well because it is almost like you are just having too much summertime fun. Where the holidays, you can be a little bit more diligent because the holidays are one day but it seems like summertime fun. So we have been trying to rain it in and do some more exercise and eating a little cleaner.
Dr. Maki: Yeah a little bit more leisure. There is definitely a different mindset. Summertime, you want to spend time outside like we have been doing a lot of hiking. There is this little place down where we are actually able to walk down to the ocean. Literally. It is a couple mile walk but we take the dog down there. He jumps into the- there are little rocks there and he jumps into the water. It is just adorable to see him dive off this little rock cliff and he is just not afraid of little waves out there and he just dives in it. Then we come back. So we have been doing a lot of those kinds of things. But it is kind of easy because of all that nice weather. It is kind of easy to get distracted on the diet and exercise side.
Dr. Davidson: So yeah, we have been working on that the last couple of weeks. Yes, trying to get up to the trail. It has been really fun. I definitely love summer. I hope- I wish it would never end, but I also love the holidays and all the different seasons. Hey, let us enjoy it while it lasts.
Dr. Maki: We are not going to complain too much about the rain. The least is it does not get cold and snowing. The rain, it gets a little gloomy but not a big deal. We still spend quite a bit of time outside. So we are going to dive into a question. Of course, for those of you that have never listened before, we like to do questions. We get lots of them. We would love to be able to answer all of them. But the more we do these podcasts, the more questions that we get. So we are getting further and further behind. But we are hoping that by answering a particular question written in a particular way by a particular person that had actually is able to help many many people at the same time that are listening. So hopefully, we are able to get to your question. If we do, that is great. If we do not, feel free to send us another email or something. We always like compliments. Not that we are judging or not that we are picking favorites. We like to pick questions that are relatively easy for us to answer. Ones that do not necessarily- We do not have to read too much anyway because we are reading them literally almost verbatim. We would change everybody’s name so we can kind of protect the identity that way. But that way it is in the person asking the question. It is literally in their words and then we can we can just kind of discuss it and talk about it.
Hopefully, that provides some value to everybody else that is listening that may have a similar situation or maybe they have a friend or a family member that is dealing with that and “Hey, go listen to this podcast.” That is how that’s how our business has grown over the years. It has always been through word of mouth. You and I- We are making a joke. I think it is from Ace Ventura. “Damn it Jim. I am already-” I think you originally said I thought that was from Ace Ventura and you said it is from Star Trek because you are a Trekkie and I am not. Right? I never really cared for Star Trek. I thought it was from Ace Ventura. I did not realize it actually came from Star Trek. When he was saying, “Damn it, Jim? I am a pool man.” or something. You and I were joking, saying, “Valorie, we are doctors not marketers.” or something like that.
We have a lot to learn on the marketing side. But nonetheless, our podcast, I think, is growing in a very similar fashion. Little by little, more people are hearing about it. We certainly do not have millions of downloads like the Joe Rogan podcast or some of the other big ones. But I think little by little it will start to keep growing. So for those of you are listening, we really appreciate it. We want to keep- Because this information is really hard to find and even within the alternative medicine, functional medicine, natural medicine space, it is even still hard to find which is some of the reasons why we are doing this. So this question is from Monica. So why do not you go ahead and read it for us.
Dr. Davidson: Exactly. We love the questions. If you have a question, trust me, there are lots of other women out there that have that same exact question. So this one is from Monica. “Hi, I have been prescribed testosterone cream and I have been advised to apply it to my inner thigh. I was wondering, in doing so, will this reverse the results of my laser hair removal on my bikini line? As per you stated that someone had a similar experience to this. Should I apply it in there or should I apply in another area? Thank you.” And we like this question because hey it is summer time and we are wearing shorts and bathing suits. Also too, laser hair removal costs a pretty penny. You certainly do not want to reverse that with testosterone cream.
Dr. Maki: Yeah, right. One thing she does not tell us is how old she is. It would be kind of interesting, not that that really matters much. But one thing that we do see, especially being in Southern California in Vegas for so long is that women sometimes that are too young are being given or they are not really the best candidate. They are being given testosterone and now from entering female that can- if they are given too much, that can cause some issues.
Dr. Davidson: Yeah, the cream is pretty gentle. Of course, you never do a testosterone orally because that is just really bad for your liver and your digestion eats it up, you do not absorb it. But the cream is pretty gentle. The pellets, I probably ran into more trouble with women doing testosterone pellets, because once you insert a testosterone pellet into your bum, there is no going back from there. It is just, you got to wait it out. And that is where you see- Because all hormones are promiscuous. If they cannot get into its own receptor site, it will find another receptor site. Hence, create more kind of hormonal imbalance. So I will see those pellets causing weight gain, acne, hair loss, anxiety and kind of feeling very anxious and overwhelmed. Two periods in a month, chronic periods, because testosterone and estradiol are almost very similar in molecular structure. But I would say the cream is pretty gentle and I do do cream in younger women that might be- which I would consider more adrenal insufficiency or adrenal fatigue which is a whole another podcast. But I do find that women with adrenal fatigue tend to have a little bit lower testosterone levels. So I would use the cream. And the cool thing is about the cream is if you get negative side effects, you just stop it. Then you can stop those negative side effects. But definitely, if you are going to apply a testosterone cream, where you apply it to if there is a hair follicle there, it can grow that hair follicle into a dark black or kind of hair growth.
Dr. Maki: Yeah. Usually with the cream, like you said, the benefit of the cream is that it is gentle and you can stop and start it whenever you want which is very good. So then it really depends on the dosing. What would you say- This is a rhetorical question. I kind of know this answer but just so for everybody else’s sake. What would you say is a range, a starting range and an ending range for most women that you prescribe testosterone for.
Dr. Davidson: Well, I always feel like less is best. You can always start off low and work your way up. You do too much of a good thing then you are backing out of these symptoms that you are having and you are not really achieving the goals that you are looking for. But definitely, I would start with even like one milligram of testosterone once a day and some women I go up to two milligrams, two and a half milligrams. Even twice a day, I have some women on five milligrams twice a day. It really depends on their blood work and their subjective goals that we are looking for.
Dr. Maki: Yeah, right. I have also find to you- Some women can tolerate a whole bunch of testosterone and some women are very sensitive to it. Now, like you said, with the pellets. There is a whole kind of list of side effects that can potentially happen from the side effects. With the cream, not so much but there are three cosmetic things which is this question is kind of alluding to. There are three cosmetic things that most women, if they are going to use a testosterone cream, they have to be kind of worried about. Why do not you tell everybody what those three things are.
Dr. Davidson: Well, the first one like I mentioned is hair growth. There is also acne and then you can have now- This is what everyone says. Well, if it causes hair to grow can I put it on my head and cause more hair, grow more hair?No, it does not work that way. It will grow a hair follicle anywhere on your body but not on your eyebrows or your scalp. And then also there is- So I guess there would be hair growth with hair loss on the head, acne, and then there is a fourth one where the cream if you put it on certain locations on your body, it could potentially get on other humans or other little humans or other pets or little fur creatures we have.
Dr. Maki: Yeah, right? Yeah, we have talked about that certainly with men like we like to use a- More so, me because I do with a lot of the husbands use. You and I see the wife and the husband comes later on. And he might be looking for testosterone and we use exclusively a rhythmic dosing method for men’s testosterone dosing and that the amounts that they use on a monthly basis now varies throughout the month. But that is a really big issue for both the wife, the kids, and the pets based on how much the male is using or the man of the house is using versus how much the woman is using. She is using like I say, you said one milligram that is a starting dose-
Dr. Davidson: Maybe 10, the most.
Dr. Maki: Right. Where men are using if they are using a static dose, it might be a hundred twice a day, a hundred milligrams a day. Might be two hundred milligrams a day, could be up to three hundred milligrams a day. With the rhythmic dosing, it kind of varies. That is a very particular schedule that they follow. But at certain times of the month, they might be doing close to three or four hundred milligrams and that could be somewhat detrimental. Now, this is not to scare anybody. This is not to freak anybody out and become neurotic about it. There are just a few things that a man can do. He can either use surgical gloves, take the gloves off, or just wash your hands with hot soapy water. And then there is no problem after that. If there is-
Dr. Davidson: I am going to apply it to the lower half of the body or someplace that would not come into contact, if you were to hug or shake hands.
Dr. Maki: Yeah, right. So she says here, she was instructed to apply to the inner thigh. We always recommend the inner thigh for women, especially women certainly are not going to have usually a lot of leg hair. For men, it can be a little more challenging because they obviously have a lot more body hair than females do. So we might- If a man does have very hairy legs, we might have him put it on the back of his knee something like that. But usually, for something like this and even estrogen, the inner thighs usually is the only place that we recommend.
Dr. Davidson: Now, in the case of Monica. I do this too. It is causing dark hair growth in that area and after you spent a pretty penny on laser hair removal, I do tell them to put it on the fat pad or the back of their knee. Like for me, I am dark-haired and I have got dark hair. So sure, if you are light, fair-skinned you apply testosterone cream, it could cause like a little more fuzzy like blond hair, fuzzy blond hair to grow. But for somebody that has dark hair like I do, you put it on the inner thigh. It could potentially cause a little bit of dark hair to grow on that inner thigh, which you can shave off, sure. But if you have had laser hair removal, sometimes you do not want that to come back then you have to shave it again because you got rid of it for a reason. So I do think that for those women I do say, you know, be careful put it on the back of your knee because we do have a really nice fat pad. But we do have some hair follicles right above that fat pad of the knee that could potentially cause that hair growth to grow. And just be careful if you are wearing a skirt or a dress or shorts where if you sat down on a chair, you could transmit it to some other inanimate object that someone else comes along sits on it and that could be transferred over.
Dr. Maki: Yeah, right, but the likelihood- Now, granted. It would depend on the dosing right? If you are at one milligram, if you are putting on in your inner thigh, it is not going to change the bikini line. It is just not close enough It needs- Usually that hair color change is going to happen. Maybe the growth and the hair color, the hyperpigmentation of that hair follicle is going to happen right where you apply the cream so the inner thigh in some ways is again and like you said unless you are wearing a skirt or shorts or something it is going to change the color especially like I am blond you are dark-haired. If I were to put testosterone on my inner thigh, it might, it does not happen in every case, but it might darken the hairs there. So now if you are blond hair and blue eyes, you are going to have darker patch of hair where you put that testosterone.
Dr. Davidson: You do not- and just hey, for full transparency, you put on testosterone cream and you have no dark hair and you are still just as fair on with that hair on your legs as it ever was. And you are right. And granted you are putting on a male dose of testosterone and it has not changed. So it really depends on the individual too, I think. But like Dr. Maki had mentioned, the dose one milligram of testosterone for a female, even if you have got as dark hair as I do, it is not going to really do too much of a change on your inner thigh as opposed to if you are doing quite a bit of testosterone. I know maybe now, you know here it is twenty-twenty. They do not- Most docs do not use that much testosterone in their dosing anymore. We are way back. I would say, maybe like two thousand thirteen or fourteen. It was very common for docs to give women twenty-five milligrams of testosterone.
Dr. Maki: I do not know if I agree with that because we still get people all the time that other doctors have put them on testosterone and they always use too much. I want to generalize because I think women doctors do that and male doctors do that. Male doctors tend to maybe do that a little bit more. They think that it is good for men and if a woman is complaining of low libido, they gave me a bunch of testosterone. Sometimes, those we talked on some other podcast, that is usually the worst thing to do because it just kind of magnifies some of their symptoms. But I asked you earlier, what is that range? One milligram to what? What is the upper range that you typically used?
Dr. Davidson: The highest I probably go is ten milligrams. Like you said, maybe I-
Dr. Maki: That is a pretty hefty dose though.
Dr. Davidson: But that is only maybe a handful more in menopausal females. I find that those higher doses where they might do five milligrams in the morning, five milligrams in the evening. They might be somebody that had been fairly competitive, athletically competitive in their younger years that they seem to run really well on those higher levels of testosterone. I mean, you are right. I mean, there are a lot of doctors out there still given women twenty milligrams, twenty-five milligrams.
Dr. Maki: Or inject- the pellets are injected.
Dr. Davidson: Pellet injection. I would like to think the trend is they are realizing that the side effects from that are happening fairly commonly that they would start to reduce. I like to think that the trend is going down. But maybe you are right, maybe docs are still putting a little bit too much. Because too much of a good thing, we all know, is not a good thing.
Dr. Maki: Yeah, right. And testosterone is not the predominant hormone and not to bag on anything else, whatever. We are just talking here and we are just basing all this on what we see and how we see women that come to us and how women play out. You have always said that if you are building a cake, for a woman, it is all about the estrogen-progesterone. The foundation is at the actual cake and the testosterone is always the icing on the cake. It is not the place to start. It is the place to finish. That is kind of the- maybe that is more of the trend is that women are being- and again, it is more problematic for menstruating women. Women that are certainly maybe in their early forties, mid-forties, later forties, testosterone becomes a big much more likely at that case, but I think like you said, it seems almost more appropriate for menopausal women.
Dr. Davidson: Like you would say, where you put the testosterone cream and I had said that earlier too is when it touches that follicle, it has the potential to cause hair growth. So if you are putting it on your inner thigh, down by your knee or kind of between mid inner thigh. That is not going to nest and granted, as we all know, the skin is one big membrane that sure that cream can move and change and maybe go to a different location. But it really, in my experience, I do not find that if you are putting that testosterone cream on your middle thigh, it is not going to migrate up to your bikini line where you had the laser hair removal. I do not find that it is going to migrate that far up there and really cause that hair to come back unless someone is actually applying it to that area.
Dr. Maki: Yeah, right, which they would not necessarily do on purpose. It would be a very unusual place to put it. However, like you said about dosing, now granted, ten milligrams seems- that is a one to ten milligrams. I think you are right. That is a range but the average, I would say would be what one hundred twenty-five?
Dr. Davidson: Yeah, exactly. Probably about two and a half, maybe three. But then on a side note about laser hair removal because I think it is really cool and it does work because shaving your legs, especially when your dark hair can be a pain. But some women will actually do laser hair removal to their entire leg. They do not just do it to the bikini line. They will do it to the entire leg. Sure, it is a process. It is pricey but it works that if you were to do like your entire thigh for that laser hair removal. it could potentially- I have had a couple of patients that have done that and that it started to come back.
Dr. Maki: Right. Now, the bigger issue to be concerned about. I think the inner thigh for Monica’s situation is still the best place to put it. It is not going to affect the bikini line.
Dr. Davidson: Or maybe the back of the knee or that fat pad on the back of the knee-
Dr. Maki: Or the back of the knee. Yeah. Those two places are fine. However, the thing that she has to worry about, as every woman using testosterone has to worry about, which is what we are trying to get across here is that it is about the dosing. And it takes usually about four to maybe even up to eight to twelve weeks for those three things to show up. The hair growth, chin, upper lip, sideburns, around the areola and abdomen below the belly.
Dr. Davidson: If it is too high.
Dr. Maki: Yeah, but the abdomen below the belly button. Those are the kind of the male secondary sex characteristics that are predominant in men. That is what happens from that androgen testosterone is an androgen even DHEA. So women that have PCOS, we have talked a lot about PCOS on here. We are going to talk about it in the future. That when a woman is producing her own with the what we call endogenous production for whatever reason her physiology is in a way, usually related to stress and insulin and all these things will talk about later on as well. That her own body is producing too much androgens, DHEA, and testosterone. Both of those can cause those three or four symptoms that we are talking about, hair growth, hair loss, acne. All those things that really women do not want. Those are- In some ways socially unacceptable. I am glad you do not have a beard, right? I am glad you do not have a five o’clock shadow. That would not be something appealing for a woman to have those things necessarily. So like I said, it can happen. If you are experiencing those, they call that hirsutism. That is a direct consequence of having that increase androgen production whether it is endogenous. Like I said, your body is producing it because of a imbalance in the physiology. Or it is exogenous, meaning that it is coming from outside. In this case, it is a prescription that is being prescribed by somebody.
Dr. Davidson: Exactly. So I would say, like you said, the dose is probably number one important. So if it is too high, it is going to cause some of those secondary characteristics you had and side effects you had mentioned, probably the dose. But do not- For females, ladies do not ever put your testosterone in your arms. That skin is too thin. It goes right into your bloodstream and then it is out. You need a nice fat pad to really- because all hormones or have a steroid or a cholesterol backbone, so they are all fat-soluble and trust me, I have seen a few women that came in as new patients sit down in front of me and they got hairy arms. I said, where are you- They are getting testosterone from another doctor. They are switching for whatever reason. I said, “Well, you need to stop applying your testosterone to your arms because that is why they are kind of dark and hairy.” One patient I had, she would only apply it to one arm apparently. So she had one hairy arm and one non-hairy arm. And she could not figure out why. I was like, “It is the testosterone cream.”
Dr. Maki: Well, the unfortunate part is some doctors tell them to do that. Even the pharmacies sometimes tell patients to do that. So we know that is- we are trying to do our public services. You just keep it to your inner thighs. You can alternate. You do not have to rotate too many locations. You can go back and forth. That is fine. You do not have to be changing locations all the time. The inner thighs, you can be a fairly covered area anyway. So if there is a little bit of hyperpigmentation to those hair follicles, you can, like you said, you can shave it off or no one is going to see it. Unless you want them to see it, whatever. But you are right. Even the estrogen cream biased and estradiol and all those things even progesterone, do not apply to your wrist. Some say will kind of rub it on your wrist like you are going to rub in perfume or something. We do not recommend that. The forearm, the upper arm, none of those locations are necessary. I have heard people even say rubbing it into their abdomen. I do not really like that idea much either. The leg is pretty much fat and muscle. As you said, all those sex hormones, DHEA, testosterone, estrogen-progesterone. Those are all steroid hormones. They all have that, like you said, cholesterol backbone. And so they absorb very well into that fatty tissue. Not to say everyone’s got fat thighs, but it is-
Dr. Davidson: There is a fat there.
Dr. Maki: Yeah, there is. There is a certain layer of subcutaneous fat underneath the skin and it absorbs very well. And it is relatively close to the uterus or the testicles. They are the ovaries, right? So you are close but your- I have had a lot of men too. They think, “Well, if I put on my inner thigh should I just put it on my testicles?” Men can be a little dumb sometimes. They should not be putting those things directly on the genitalia. That is just a really bad idea but sometimes you have to kind of- They think they have this wonderful idea but it ends up being a little bit counterproductive at the end.
Dr. Davidson: And just a quick note because I do not want to drone on here for you guys but are for everyone. But the fat pad, sure, that is important. So people say, “Well, hey, I got a little fat on my stomach. Why do I not put my hormones there?” But I think abdominal fat is so different than adipose or fat tissue elf everywhere. It has just a different effect. I think- So I do not like anything on the abdomen. And then just on a side note, it is just for females. It is just too close to the breast tissue. I do not want testosterone, even attempting to migrate or getting on the breast tissue just like even putting it on your arms or people put it on their inner upper arms and let us say, you put it on after a shower. And you might not put on your shirt or your top yet. And your arms can touch your breasts and I just do not wan any kind of testosterone or estrogen or those kinds of hormones touching the breast tissue. Just because that tissue in itself has got its own- But I kind of, I do not consider it volatile but it has got its own harmony that we do not need to have right there.
Dr. Maki: It is not that those hormones are directly dangerous. Right? Our body makes those hormones for good reason. We are very healthy when we are twenty-five. We have lots of hormones. As those hormones begin to decline is when disease shows up. So we are not saying that those things are directly dangerous but just like men putting testosterone on their testicles. We do not want to put those hormones on a hormone-sensitive tissue.
Dr. Davidson: That is a great way of saying it, a hormone-sensitive tissue.
Dr. Maki: Yeah. You would not want to put it right over the abdomen where your uterus is. You would not want to put it on the breast tissue directly. We would not want to put it on all those kinds of areas. So the leg is kind of in some ways like an inert body structure. There is nothing too vital around it. It can still get into the bloodstream which is what we want. And then it can have its kind of subtle effect on the different tissue types in the body. The brain, the breast, the testicles, muscle, whatever the case might be, without having that direct contact with that particular hormone. So now people can be safe and assured that they are doing it the right way. And then there is not all this confusion of all these different locations on where they are supposed to put it. So I think in Monica’s case, I think we have kind of decided or have hopefully communicated well, the inner thigh is still the best place to put it and your bikini line or I am sorry or the back of the knee. And the bikini line should be safe.
Dr. Davidson: I agree.
Dr. Maki: Okay. So again, if you have any questions, you do not want to post it on our- everyone kind of finds our different episodes or blog posts and they write comments. You do not feel comfortable with that, you can always send us an email at firstname.lastname@example.org. Again, that is email@example.com. No, one thing we have not asked before, if we do answer your question on the podcast, please we have not asked for much necessarily, but we would like, if we do answer your question to come back and give us a review on iTunes or whatever platform it is that you are using. That will as it says on our outro, most people do not listen to intros and outros very much. They might skip past them but it does help us kind of grow organically and you find this useful, share with your girlfriends or your family members and we will kind of grow together. And the more that happens, the more people we can help. And that way everybody benefits.
Dr. Davidson: Thank you so much.
Dr. Maki: All right, until next time. I am Dr. Maki.
Dr. Davidson: I am Dr. Davidson.
Dr. Maki: Take care. Bye-bye.