The Menosplaining Timeline

2023 – PRESENT

Influencers, Algorithms, the New Hormone Evangelism, Testosterone as the “Third Hormone,” High-Dose Prescribing, and the FDA’s About‑Face

Who’s doing the menosplaining: social‑media influencers, podcast hosts, corporate‑funded “menopause experts,” biohacking doctors, algorithm‑driven platforms, private hormone clinics – and, in late 2025, the U.S. Food and Drug Administration itself, now declaring that the risks it had warned about for over two decades were “misleading.”

What they say: The new hormone evangelism presents as friendly, accessible, and science‑lite. In short clips and soundbites, menopause is described as a “brain disease,” an “oestrogen withdrawal syndrome,” or a “chronic hormone deficiency state.” The cure, invariably, is framed as continuous hormone replacement – sometimes for decades, sometimes “for life” – supplemented by “smart” diagnostics. On social media, risks are downplayed or ignored entirely, and benefits are overstated.

And then came testosterone. From 2021 onwards, the same influencers and private clinics that had normalised HRT began promoting testosterone as the missing “third hormone” that all menopausal women need. While clinical guidelines cautiously permit testosterone only for women with hypoactive sexual desire disorder (HSDD) after HRT has been optimised – and only as a “consider,” not an “offer,” given the uncertain evidence – the online narrative expanded far beyond libido. Testosterone replacement therapy women were told, would fix brain fog, fatigue, low mood, poor sleep, muscle loss, and lack of motivation. It was framed as essential for longevity, quality of life, and even reversing the ageing process.

Prescriptions surged. In the UK, testosterone prescribing for women rose tenfold between 2021 and 2023, driven largely by the “Davina effect” and amplified by social media. Yet there are no licensed testosterone products for women anywhere in the world; all prescribing is off‑label, using male formulations, often without robust evidence for the claims being made. The pattern was starkly socioeconomic: wealthier women in less deprived areas were far more likely to be prescribed testosterone, often through private clinics that initiated treatment earlier and more liberally than NHS guidelines recommended. In January 2026, Women’s Health magazine called it “the Wild West of Testosterone.”

As testosterone was reentering the zeitgeist as the potential missing piece the hormone therapy puzzle, in March 2023, professional medical societies were pushing back. The British Menopause Society issued a public statement warning that promoting testosterone as a routine “third component” of HRT was creating “unrealistic expectations” and spreading misinformation. The Menopause Society in the U.S. explicitly stated that testosterone should not be used for ageing prevention, hair loss, skin changes, or weight gain, and that evidence for mood, cognition, and energy benefits remained insufficient. Yet the online narrative continued, often driven by doctors with undeclared commercial conflicts of interest.

The uncomfortable truth about testosterone in midlife is that it doesn’t disappear at menopause – it becomes more important. Once oestrogen steps back, androgens, especially testosterone, take on a larger share of the work, and studies in older women link higher free testosterone with better bone density and lean mass, underscoring its ongoing role in strength and vitality. Testosterone in midlife comes largely from the adrenal glands – the same glands that make cortisol – so when you’re stressed and firefighting day in, day out, particularly if you’re already in the classic symptom cluster, your adrenals prioritise cortisol and testosterone production inevitably falters. In that context, exogenous testosterone can only ever be a sticking plaster on an overwhelmed system, not a true restoration of health.

Alongside the testosterone evangelism, another pattern emerged: dose escalation. Women whose symptoms persisted on standard HRT were increasingly being told they were “not absorbing” their hormones properly, and that they needed higher – sometimes much higher – doses to achieve “therapeutic levels.”

The logic was seductive: if symptoms remained despite HRT, the problem must be absorption, not the underlying biology or environment. Clinics began routinely prescribing doses well above standard licensed levels – sometimes double, triple, or higher – justified by blood tests showing low serum oestradiol despite treatment. Dr Louise Newson, who had become the UK’s most prominent menopause advocate after appearing alongside Davina McCall, stated that “women who absorb poorly inevitably require higher doses to achieve therapeutic levels” and that this was “fundamental pharmacology, not controversial medicine.”

But absorption is highly variable and influenced by application technique, skin condition, timing of blood tests relative to application, and even whether the skin was washed within an hour of applying gel. Studies showed that nearly one-third of women on standard HRT doses had low blood oestradiol levels – yet many were asymptomatic. Seven women in one study had extraordinarily high levels (over 4,000 pmol/L) that normalised on retesting, suggesting measurement error rather than true excess. Professional societies maintained that HRT should be titrated to symptoms, not blood levels, because hormone levels fluctuate wildly and don’t reliably predict symptom relief.

In April 2023, the British Menopause Society and five other major medical bodies issued a joint safety alert about high-dose oestrogen prescribing, warning of risks including endometrial thickening, bleeding, and inadequate progesterone coverage. The alert did not name individuals, but the BMS had been in correspondence with Dr Louise Newson about prescribing concerns since 2020.

In September 2024, BBC Panorama aired an investigation titled The Menopause Industry Uncovered, which featured testimonies from former staff at Newson’s clinic raising concerns about women being prescribed very high, off-label doses of HRT without adequate monitoring, and experiencing adverse effects including womb lining thickening and breakthrough bleeding. Shortly after, the British Menopause Society removed Dr Newson from their voluntary register of menopause specialists – a professional directory, not a regulatory body.

Dr Newson strongly rejected the allegations, stating that the General Medical Council – the actual medical regulator with power to remove a doctor’s licence – had investigated and cleared her, and that she had “passed with flying colours.” She and her supporters framed the BMS action as a professional witch hunt driven by jealousy and conflicts of interest, pointing out that many BMS members had ties to pharmaceutical companies whose standard-dose products she had publicly criticised. Others argued that the BMS removal was a necessary patient safety intervention in response to a documented pattern of high-risk prescribing.

The menosplaining effect: The high-dose narrative offered women an explanation for persistent suffering that placed blame on their bodies (“you’re a poor absorber”) rather than on their environments, workloads, trauma, or the possibility that menopause might require support beyond pharmaceutical correction. It also created a two-tier system: women who could afford private clinics accessed escalating doses and off-label prescribing, while NHS patients were held to guideline limits – not because of evidence, but because of cost and access. The Newson controversy became emblematic of a deeper tension: between clinicians who believed guidelines were unnecessarily restrictive and harming women, and those who feared that commercial pressures and celebrity influence were driving prescribing beyond the evidence base, turning menopause care into a lucrative but under-regulated market.

Meno-Washing Goes Algorithmic: alongside the new hormone evangelism, meno‑washing went fully algorithmic: menopause‑branded supplements are now pushed by targeted ads, affiliate links, and influencer codes, turning midlife distress into a recurring revenue stream while still sidestepping the deeper question of what this transition is actually for. In October 2024, a major study in BMJ Open analysed the 180 most visible social media posts about HRT in the UK and found that two out of three were misleading, that the vast majority of content creators had undeclared commercial conflicts, and that more than half of those giving advice were medical professionals. Women on Reddit menopause forums began openly discussing the toxicity of influencer‑driven menopause spaces, describing them as “HRT or die” echo chambers that left no room for alternative approaches or honest discussion of limitations.

Then, in November 2025, the FDA made a historic reversal. After more than two decades of black‑box warnings on HRT labelling – warnings added in the wake of the 2002 WHI study – the agency announced it was removing references to increased risks of cardiovascular disease, breast cancer, and probable dementia. The FDA now cited data showing that when HRT is started within ten years of menopause, it may reduce the risk of cardiovascular disease by 25–50%, Alzheimer’s by 35%, and bone fractures by 50–60%. The agency kept only the endometrial cancer warning for oestrogen‑alone products, and framed the reversal as “restoring gold‑standard science to women’s health.” The latest research shows that HRT does not pose a positive benefit or negative risk on dementia or Alzheimer’s and should not be prescribed as risk reducer.

The agenda: Capture attention and loyalty in a crowded, profitable market. Algorithms reward certainty and drama, not nuance. So complex, adaptive biology is flattened into simple, absolute statements: “Menopause causes dementia unless you take HRT,” “You can’t age healthily without HRT,” “Testosterone is the missing piece,” “Your symptoms persist because you’re not absorbing your hormones,” “If you’re suffering, it’s because your hormones have been ignored.” The background, data‑consistent story – that many women adapt without replacement, that symptoms track lifestyle, stress, and environment, and that menopause evolved as a functional transition – rarely trends. The FDA’s reversal, while based on updated evidence, risks fuelling a new wave of pharmaceutical evangelism that once again positions HRT as default rather than option. And the testosterone narrative, despite lacking robust trial data or licensed products, is now embedded in the menopause playbook – not because the science demanded it, but because the market could monetise it.

Typical treatment: One‑size‑fits‑most protocols sold as personalised medicine. Continuous systemic HRT framed as brain and heart “insurance.” Testosterone added as a “third hormone” for women who can afford private care, often with little biopsychosocial assessment. High-dose prescribing justified by blood tests and “absorption” claims, sometimes reaching several times the licensed dose. Stacks of supplements and tests with little discussion of food, sleep, workload, trauma, or inequality. The adaptive capacities of the menopausal body – metabolic flexibility, intracrine hormone production, neuroplasticity – are almost entirely absent from the narrative.

The menosplaining effect: This is menosplaining in its algorithmic form. It doesn’t just overwrite individual experience; it pre‑writes it. Women arrive in clinics already convinced they are broken without hormones, already afraid of long‑term disease if they “miss the window,” already asking for testosterone because an influencer said it would give them their energy back, already believing their bodies can’t “absorb” standard doses if symptoms persist, and already suspicious of any approach that doesn’t start with a prescription. If they are thriving without HRT, they are told they are “lucky.” If they are struggling, they are told their biology is failing. Either way, the underlying adaptive, evolutionary design of menopause disappears from view.