So the paper shows up at the doctor's offices. This is why I mentor so much because it truly, this cannot die with the people above me and it cannot die with me. It's pain from the abrasions and the irritation from the act of intercourse itself.
When we tell women to do it, you use bigger than a pea size, sort of a glob of testosterone. This costs about $8 per month because a tube of this generic testosterone, my male patients would use the whole tube every day. What does that have to do with women's health? It feels scary because, okay, again, politics again, in the 1990s, there was a big doping scandal where all these bodybuilders got testosterone in trouble and these body- Actually, I believe very strongly that when you give women information about how their bodies work, they make just excellent healthcare decisions for themselves. I often start with estrogen and progesterone for many people because the hot flashes are so bad, the sleep is so bad. And as long as the total testosterone was not astronomically high, then you would qualify for a trial of testosterone therapy.
And as Dr. Rubin just said, you get one life and I really want you to be proactive about advocating for yourself and doing what you need to do to feel good in your life and in your body. Thank you for caring enough about yourself and the other women in your life for listening to this, for sharing this. You're changing medical care for women. And they go on this spiritual journey to learn everything they can about perimenopause and hormones.
So sexual symptoms, energy symptoms, mood symptoms. So if you have any symptoms of testosterone deficiency, like I just described, you should get a blood test. You've got full body estrogen, full body progesterone, you've got vaginal estrogen and full body testesterone. And the fourth bucket we've talked about is vaginal hormones, which is separate from all the other three.
So it doesn't even matter if you're sexually active or not. This is fixing the ph, fixing the microbiome, fighting infections, preventing UTIs, making sex not painful, helping with your natural lubrication. And so because the tissue responds to both estrogen and testosterone, any changes to estrogen and testosterone can affect this tissue.
This is an issue called the genitourinary syndrome of menopause or GSM. None of my patients are book answers, right? And sometimes it's a nice smooth ramp and sometimes it is chaos. And what's happening there is the same thing that was happening in puberty where your estrogen is going super high and super low, and it's this chaos. Now it's 35 days, then it's 18 days, then I'm bleeding all the time.