In 1966, an American pharmaceuticals company called Wyeth secretly paid gynecologist Dr. Robert A. Wilson to write a book called Feminine Forever. Referring to menopause as an “estrogen-deficiency disease,” Wilson claimed that postmenopausal women are doomed to become “castrates” unless they replenish their flagging estrogen levels with hormone replacement therapy (HRT). Not only would HRT ensure that a woman’s “breasts and genital organs [would] not shrivel,” but it would make her “much more pleasant to live with” and prevent her from becoming “dull and unattractive” (without making her more inclined to commit infidelity against her husband). Feminine Forever was a bestseller, and within a decade Wyeth’s conjugate estrogen medication, Premarin, became the fifth-most-prescribed drug in the United States. By 1992, it was the most prescribed drug in the United States.
This was the first era of popular HRT, and it died as it was born: with the media. Premarin remained a flagship product for Wyeth until 2002, when the NIH’s Women’s Health Initiative (WHI) announced that it had halted a long-term estrogen study because the adverse effects of menopausal HRT — such as increased risk of cancer, heart disease, and other conditions — “outweigh[ed] and outnumber[ed]” the drug’s benefits. Shortly after, the Today show ran a segment presenting the WHI results in a way that made them “[sound] more alarming than was appropriate,” wrote the New York Times reporter Susan Dominus. As ob-gyn and Yale scholar Dr. Mary Jane Minkin told her, “I remember where I was when John Kennedy was shot. I remember where I was on 9/11. And I remember where I was when the W.H.I. findings came out. I got more calls [from patients] that day than I’ve ever gotten before or since in my life.”
Without the wider context of the study’s design flaws and narrow scope (for example, much of the WHI data focused on older women, who are at higher risk of breast cancer and other conditions), people panicked. Between 1999 and 2020, HRT prescriptions for postmenopausal cis women went from about 27 percent to about 5 percent; the nearly 50 percent of menopausal cis women taking HRT plummeted to lower than 5 percent. Women’s health care was affected institutionally, too: Following the WHI announcement, medical schools began abandoning menopausal education. In her 2023 piece for the New York Times Magazine, “Women Have Been Misled About Menopause,” Dominus reported that “about half of all practicing gynecologists are under 50, which means that they started their residencies after the publication of the W.H.I. trial and might never have received meaningful education about menopause.”
Menopausal HRT’s reputation has been slow to recover, although a 2017 follow-up look at the WHI study reported that cis women ages 50 to 59 who took HRT had a lower mortality rate than those in the control group; in fact, they were “less likely to die of heart disease, cancer or any other cause.” But in 2024, a new study found that cis women who began HRT at least 10 years before their last menstrual period had 60 percent lower odds of developing breast cancer, heart attack, and stroke — suggesting that when one begins menopausal HRT matters. As Dr. JoAnn Manson, a neuroendocrinologist and chief investigator of the study, told journalist Rachel E. Gross, “Timing is everything.”
And for estrogen HRT, a new time has come. Last July, an expert panel convened by the FDA urged the agency to remove the “black box” warning label that had been on all menopause treatments containing estrogen (including Premarin) since 2003. When the FDA announced that it would remove the label, commissioner Dr. Martin Makary pronounced estrogen HRT’s 20-year exile to be “an American tragedy.”
“With the exception of vaccines or antibiotics,” he told MSN, “there’s no medication that can improve the health of women on a population level more than hormone replacement therapy … [W]e want to put that fear machine in its proper context and let people know that there are tremendous long-term health benefits.”
Instead of veiled allusions to “castration,” there’s a new way to scare cis women about being unsexed.
With Feminine Forever, Robert A. Wilson was paid to covertly market a new medication to aging cis women by threatening them with literal ungendering if they did not take the drug and therefore adhere to their institutionally assigned gender and patriarchally ordained sexual orientation. (That Premarin appeared to have had generally positive health effects was clearly secondary to its manufacturer’s profits.) Sixty years later, Makary’s outgoing administration is in the process of inscribing this strategy at the policy level in order to control another marginalized demographic’s access to health care: trans people’s. Now, instead of veiled allusions to “castration,” there’s a new way to scare cis women about being unsexed. Cis women can be menaced with the failed gender status created and targeted by anti-trans laws and executive orders. This is not to say that gender-nonconforming people had it easier in the mid-twentieth century, but that today our oppression is being legislated in a novel, and far more explicit, way. As historian Jules Gill-Peterson wrote in 2021, “The state has never been cisgender, but it is desperately trying to identify as such now, making cisness a prerequisite to be a participant in public and political life.”
With estrogen HRT in the midst of a comeback, it’s understandable to wonder whether there are other agendas at play if the institutions throwing their weight behind it, like Trump’s FDA, are otherwise scornful of or apathetic toward cis women’s health. Why now? Timing, as they say, is everything.
More than 80 percent of cis women are thought to experience perimenopause symptoms, some of which can persist even after menopause is complete (thanks to the modern era’s longer lifespans, the peri- and postmenopausal periods can now comprise up to 40 percent of a cis woman’s life). HRT makes this hormonal transition more comfortable by treating hot flashes, depression, and genitourinary issues such as vaginal dryness, but it can also mitigate effects of aging, like cognitive decline and stroke risk. As estrogen HRT makes its comeback, testosterone HRT is also on the rise. Increasing numbers of middle-aged cis women are using off-label testosterone for the same reasons that others use estrogen, like low energy, as well as for the low sex drive and low mood symptomatic of perimenopause and postmenopausal life.
Last October, Dominus returned to the New York Times Magazine with a new feature: “‘I’m on Fire’: Testosterone Is Giving Women Back Their Sex Drive — and Then Some.” Instead of destigmatizing testosterone HRT, as her earlier piece “Women Have Been Misled About Menopause” did for estrogen, “‘I’m on Fire’” fans the flames with a breathless portrait of hornswoggled cis women too lost in the hormone’s “romantasy” to understand the overall negative effect that it’s having on their minds and bodies. While Dominus’ reporting on estrogen HRT describes the cis women affected by a menopause-driven lack of estrogen as “suffering,” “‘I’m on Fire’” paints them as practically jonesing for T — until they receive their “miracle drug,” after which they’re “messianic” and “amped up.” In the earlier article, Dominus only uses the word “drug” to describe HRT in the distant past or in clinical contexts; in the later piece, she describes the experience of taking supplemental testosterone as a “high.” While the ostensible focus of “‘I’m on Fire’” is the overprescription of testosterone for cis women, particularly among those who haven’t been educated about “unpleasant — and possibly irreversible — side effects” like a deeper voice, Dominus interviews a range for whom these side effects’ so-called unpleasantness and irreversibility are clearly up for discussion. “I have a good magnifying mirror. I just pluck,” one said of unwanted facial hair growth caused by her supplemental testosterone; another interviewee, urologist Dr. Rachel Rubin, told Dominus that some of the cis women she treats actually enjoy the larger, more sensitive clitoris that testosterone has given them. Regardless, the dangers of the testosterone “megadose,” as Dominus puts it, seem to go without saying, and it’s strongly suggested that those who profess otherwise are confused about what’s best for them or have an agenda greater than a desire for a stronger libido or less fatigue. “Testosterone is like a religion,” said Rubin.
Cis women can be menaced with the failed gender status created and targeted by anti-trans laws and executive orders.
Dominus isn’t the only cis journalist to render such a binaristic and sensationalized framing of testosterone HRT for cis women, though her coverage is more balanced than most. In late 2024, Dr. Akshay Syal for NBC News asked, “Do women have a testosterone problem?” Syal investigates the relationship between the growing popularity in topical testosterone among cis women and the social media influencers who promote it, quoting ob-gyn Dr. Rebecca Dunsmoor-Su’s description of it as “[feeling] almost like an epidemic.” Dunsmoor-Su does have a conflict of interest, however — she is the chief medical officer for Gennev, a digital health platform for menopause patients that only prescribes estrogen. Her fearmongering re-emerges a year later in a piece by Melissa Dahl for The Cut, “‘That Is Not What It Used to Look Like,’” with a lurid subheader: “Women are taking testosterone to treat menopause symptoms. An enlarged clitoris is one potential side effect.” Never mind that this may be a perfectly welcome side effect for some. The article dismisses any positive outcomes cis women might experience on testosterone HRT: “If I give people enough cocaine,” Dunsmoor-Su said, “I can make them feel great for some period of time, too.”
This is not to say that testosterone isn’t or can’t be overprescribed for cis women (or anyone else, for that matter). In January’s “Welcome to the Wild West of Testosterone,” Rachel Epstein reported that the lack of an FDA-approved formulation of testosterone HRT for cis women has driven many to seek dosing information from Reddit forums, influencers, and online clinics, which doctors warn has led to an uptick in hormonal mismanagement. In early 2025, ob-gyn Dr. Risa Kagan told Danielle Friedman at the New York Times that “people are trying to take testosterone for everything — it’s become the new feel-good drug.” But for any symptoms beyond a low libido, she cautioned, cis women should be wary. “[I]f you really delve into the data, it’s just not ready for prime time,” she said.
But given that prescriptions for this “feel-good drug” increased 66 percent between 2019 and 2024 among both cis men and cis women, it’s notable that these articles tend to focus on testosterone’s “masculinizing” side effects rather than any increased risk of health problems like cancer. When Friedman addresses the potential for negative health outcomes that aren’t cosmetic, she reports that high testosterone levels in cis women can increase their risk for endometrial cancer — without citing her source. But limited studies of both cis women and transmasculine people on testosterone HRT remain inconclusive at best. For transmasculine people, many of whom take much higher doses of testosterone than the cis women that Dominus et al. are writing about in these articles, there is no evidence that our risk for cancer is elevated enough even for additional screening. (There’s plenty to show that transphobic bias limits our access to competent cancer-related health care. One such nightmare is depicted in Southern Comfort, a 2001 documentary about Robert Eads, a trans man who died of ovarian cancer because cis doctors refused to treat him.)
What’s striking about these pieces is their inclusion (or lack thereof) of trans people at a time when our access to these same drugs is being obsessed over by lawmakers and the media. While Syal’s NBC News piece doesn’t mention trans people, Dominus and Dahl both use trans men to support the idea that testosterone HRT for cis women ought to be regarded with suspicion. In “‘I’m on Fire,’” Rubin told Dominus that “trans men take testosterone in much higher doses than even the highest-dose pellets” prescribed to cis women and “are not thought to be putting their health at risk.” Dominus doesn’t corroborate this claim, though it runs counter to the scaremongering about trans HRT that’s been normalized in the mainstream media and political policy, perhaps most famously at the New York Times, where she’s a staff writer. For years now, the New York Times has been building its anti-trans brand with frankly eliminationist propaganda from writers like Pamela Paul, Andrew Sullivan, and Emily Bazelon; on the first day of the year, the Trans News Network published an interview with former New York Times editor Billie Jean Sweeney, who explained how the paper’s anti-trans bias comes from top of the organization. (“[C]ritics might note the irony of the NYT rapturizing over the benefits of hormone therapy for cisgender patients after it’s spent years fearmongering about similar treatment for transgender people,” noted Rae Witte for science and tech news website Futurism.) As for Dahl, she mentions trans men twice in her piece for The Cut: 1) as a brief point of comparison in a description of testosterone dosing, and 2) in a quote from — yet again — Dunsmoor-Su, with a curious illustration of testosterone’s irreversible side effects: “You give [trans men] testosterone at a male level. They transition. They develop male features. If they lose their insurance coverage and lose their testosterone for some period of time, those features don’t go back.”
Reading through the recent spike in coverage of HRT for cis women, a pattern emerges: In pieces sounding the alarm about the use and alleged overuse of testosterone among cis women, transmasculine people only make an appearance in order to de-normalize said cis women while simultaneously having our own medical needs downplayed or overlooked. (In “‘I’m on Fire,’” Dominus does mention speaking to proponents of testosterone HRT for cis women, who hypocritically oppose allowing transmasculine people the freedom to take these same medications.) In conflating cis women’s so-called overuse of testosterone with substance abuse, disease, and an infantile vulnerability to social media trends, Dominus, Dahl, and other writers could easily be taking a page out of the New York Times’ anti-trans playbook — or fear machine, if you will. This rhetoric insists that misinformation and pseudoscientific concepts like the “social contagion” of transness (the non-evidence-based hypothesis that trans adolescents are socially influenced into rapid-onset gender dysphoria) are deployed out of thoughtful concern for trans people’s health rather than coordinated animus. In 2020, Abigail Shrier’s Irreversible Damage: The Transgender Craze Seducing Our Daughters rejected the consensus of the American Psychiatric Association, the American Academy of Pediatrics, the Endocrine Society, and other organizations that gender-affirming medical care is appropriate for trans minors, by claiming that trans kids and young adults are just confused (they aren’t) and that medical transition is physically and emotionally riskier than not transitioning (for the vast majority of us, it isn’t); it was named a Best Book of the Year by The Economist and a Best Book of 2021 by the Times of London and the Sunday Times. The warning is unmistakable: If they don’t want to be lumped in with the likes of us transgenders and suffer the social and legal consequences of twenty-first-century gender failure, these cis women had better watch their step.
Transmasculine people only make an appearance in order to de-normalize said cis women while simultaneously having our own medical needs downplayed or overlooked.
So why would a famously misogynist administration come out swinging for a hormonal medication that new research suggests has been needlessly maligned? And why would journalists on the women’s health beat at nominally progressive publications support it so strongly while playing it against another hormonal medication that seems to have its own advantages? Money. Health care providers that offer testosterone HRT to menopausal cis women are in direct competition with telemedicine startups that can only offer estrogen HRT — like Dunsmoor-Su’s Gennev, or Elektra Health, whose chief medical officer recently told National Geographic that “[testosterone is] inappropriate for now because we don’t know whether, like, you know, what the real story is.” (While insurance covers testosterone clinics for cis men, it doesn’t for cis women). Were one inclined to look for ways to discredit a competitor’s alternative hormone therapy, the New York Times’ helpful anti-trans rhetorical scaffolding would be a good place to start.
But as satisfying as such a simple explanation might be, no one writing at the New York Times today is old enough to have started, much less engineered, the fear machine in question. It’s been 60 years since Robert A. Wilson called menopause “the end of … womanhood” and “one of the saddest of human spectacles” in Feminine Forever, thereby binding cis women’s very gender to a hormonal regimen that could only be provided by the good people of Wyeth pharmaceuticals. Better that, the logic went, than suffer the “staggering catastrophe” of being “suddenly desexed.” Though they aren’t intended for someone like me, these threats of ungendering touch on fears from which none of us are immune. What’s changed is that more of us, including cis people, are finding ourselves vulnerable to them than ever before.
Davey Davis is the author of the novels Casanova 20: Or, Hot World, X, and the earthquake room. They write DAVID, a weekly newsletter on sex and sensation.
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