The Tip of the Iceberg

Being the Student Again

I’ve spent close to a decade presenting at national and regional meetings. Somewhere in there, the meetings felt more like work than fun. When you’re the one teaching, it’s hard to also be the one learning.

So when I got to go to the Georgia OBGYN Society meeting at Sea Island purely as a participant, no talk to give, it felt like coming up for air. I got to sit in a room and just listen. Take notes. Ask questions. Be a student again.

If I could just be a student forever, I would. Barring that, I’ve decided the plan is to never stop learning. Never stop digging.

Here’s the thing about digging, though. The more you do it, the more you realize how much you don’t know. Especially in women’s health.

The Room Full of Presidents

Three ACOG presidents were at this meeting at once. Steve Fleischman, the immediate past president. Camille Clare, the current one. Mae Blanchard, the president-elect. All three made the trip to little bitty Sea Island, Georgia, to spend time with us.

Mae Blanchard gave a talk on menopause. That’s where my brain caught on something.

The Question I Couldn’t Shake

I work with a lot of mid-level providers, helping people access care. I’m studying for my menopause certification exam right now. So testosterone has been on my radar. It keeps coming up with friends, with colleagues, always a little hushed, a little taboo. The people who’ve tried it say it’s life-changing. They also say it’s nearly impossible to get.

Here’s why: there is no FDA-approved testosterone product for women. Not one.

So I sat there and asked myself the obvious question. Why not?

I went looking for the answer. Nobody wants to study testosterone in women, because there’s no approved product. There’s no approved product because nobody’s done the safety studies. Nobody will fund the safety studies because there’s no approved product.

A perfectly closed loop. Nothing moves.

Then I thought: did we do this to men?

We didn’t. Testosterone for men went to market first. The safety data came later. Men got the treatment, then the reassurance. Women don’t even get the treatment.

Solutions and possibilities are gatekept from women. We tell women something doesn’t work, when the truth is nobody’s studied it. So women go around the system entirely, to the outskirts, to anyone who’ll write the script, because the normal pathway failed them first.

Women were excluded from clinical research until the 1990s. We are still paying for the head start we never got.

What I Wish More People Understood

My favorite part of medicine is the problem-solving. A resident asks a question I can’t answer, and instead of shrugging, I say: let’s find out. Let’s build a project around it.

In women’s health, the questions are everywhere. Nobody’s asked most of them yet.

We are at the tip of the iceberg. We tell women “it doesn’t work” when we mean “we never checked.” The gatekeeping isn’t malicious, most of the time. It’s just easier than doing the work.

Somebody has to keep asking the annoying question. Might as well be me.