Steven R Goldstein, MD

11/18/2025

08/22/2025

Testosterone, normally thought of as a male hormone, is produced by women for their entire lives. It peaks in women’s twenties. Then there is a gradual decline over time with an actual rise again in women’s seventies. It is produced both by the ovaries (even after menopause) and by the adrenal glands. Make no mistake – menopause has become big business. Social media in general, and celebrity influencers have brought menopause out of the closet and testosterone therapy for women is one of their topics.

Unfortunately, many of these folks are “selling” something, whether it be supplements, lifestyle, books, access to their mailing lists, and even the ability to obtain hormones easily online without even an examination. There is an especially tremendous amount of “buzz” about testosterone. There are claims that it can boost mood, cognition, muscle strength, and heart health – none of which have been substantiated with good, scientific research. What has been demonstrated is that women who have an entity known as HSDD (hypoactive s*xual desire disorder) have been shown to increase one s*xually satisfying event per month with the use of topical testosterone in doses meant for women.

Let’s take a closer look at HSDD. Many of my menopausal patients will report a diminished interest in s*xual activity. Many of these patients have been with the same partner for many decades. It is essential to find out if part of the couple’s problem may stem from a male factor (prostate issues, ED, etc.) or relationship conflicts (perhaps needing a marriage counselor). The majority of such patients will come in and ask me, “I love my husband. We’ve been married for thirty years. I’m just not that interested in s*x. Is there something wrong with me?” Neither they nor their partner seem upset (the medical term for this is distress). I often find myself explaining that, as higher order primates, now that she can no longer procreate, why would she assume that her urges to copulate would be as great. The society often has her believing that every other couple is “swinging from the chandeliers,” and she is the only one that is not as interested as she was in her youth. I assure her this is not the case.

However, the occasional patient who has diminished desire, and this is causing her distress, constitutes what is known as HSDD. The use of topical testosterone therapy for women has been shown to statistically improve that (as mentioned above to the order of one extra s*xually satisfying event per month). Some patients often complain to me that there are so many medications to enhance male s*xuality, and yet very little for women. They complain that women’s health research is not a priority. When it comes to this issue nothing could be further from the truth. If pharmaceutical companies could invent a female Vi**ra, they would absolutely do so because the profitability of such would be tremendous. The problem is that a woman needs to utilize testosterone in the form of a patch or a cream or gel twenty-four hours a day, seven days a week, whereas men take a blue pill and twenty minutes later have an er****on like they were twenty years old.

In fact, as early as 2004, Proctor and Gamble spent tremendous resources to develop the Intrinsa Patch. The FDA denied its approval in spite of showing that one improved s*xually satisfying event per month in the clinical trials. There were concerns about cardiovascular safety and breast health safety. In 2017, Biosante brought Libigel forward. Although there was improvement in s*xual satisfaction in women with HSDD, it was not statistically greater than the placebo group and thus did not meet requirements for FDA approval.

However, many healthcare providers have resorted to compounded versions of testosterone. Sometimes these are administered as long-acting pellets that are placed under the skin, often by anti-aging providers or sometimes even in day spas. Too much testosterone above the normal range for women can result in some serious and often non-reversable side effects including acne, irritability, aggression, thinning of hair on the head while increasing hair growth on the face and chest, deepening of the voice, and enlargement of the cl****is. Furthermore, since testosterone is converted by adipose tissue to a form of estrogen known as estrone, high testosterone levels can also lead to a thickening of the uterine lining and va**nal bleeding and increase the risk for endometrial precancers and cancers.

Some practitioners are prescribing FDA approved formulations for men and advising women to use one tenth the amount. I have been reluctant to do so because I have seen errors in the amount applied resulting in the above-mentioned side effects. More recently, the FDA in Australia has approved a formulation of testosterone cream specifically for women for hypoactive s*xual desire disorder. This, therefore, is quality-controlled because it is not compounded. It is also formulated specifically for women. Thus, in my patients who will potentially benefit from testosterone therapy, this has been the formulation that I have been utilizing. I feel confident in its safety, both in terms of quality and dosing. It has been my experience thus far that approximately 50% of the patients to whom I have prescribed this seem to have benefit, whereas the other 50% seemed to notice little change.

Hopefully, this is helpful in reducing some of the confusion that has been promulgated by social media and its devotees regarding testosterone therapy for women.

11/19/2024

WHAT IS PERIMENOPAUSE?

Useful information for women in their late 30's to late 40's or even 50. This is an often misdiagnosed condition. This may be helpful to you or someone you know.

What is Perimenopause? It is when a woman’s body begins to slow the production of hormones. The signs and symptoms of Perimenopause usually begins in the forties; however, some women experience symptoms in their thirties. The average transition time to menopause is anywhere from four to seven years, although it can be much longer or shorter.

It is important to understand that Perimenopause is not “early menopause”. Early menopause means that you cease menstruation completely for a period of twelve months after age 40 but before you reach the age of forty-five. Premature menopause is one that occurs prior to age 40. Unlike natural menopause, this is very different and really is a medical condition that requires evaluation and intervention.

To make matters more difficult, Perimenopause cannot be strictly defined and proven with laboratory tests because in Perimenopause, a woman has fluctuating hormone levels. Perimenopause can actually be defined as having “irregularly irregular” hormone levels. Perimenopause varies greatly from woman to woman and is one of the least understood, most misdiagnosed and most confusing stages of a woman’s life.

Existing patients, I cannot dispense medical advice on FB, and your case is unique, so please contact the office if you would like to learn more about Perimenopause.

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04/19/2022

In keeping with my philosophy of educating my patients about their health, here is some information for you regarding menopause and heart disease. Share with your friends and family.

After menopause the risk of heart disease for women increases dramatically. In a Nurses Health Study of 120,000 women which took place over a ten year period, researchers found that women who took estrogen after menopause had about half the incidence of fatal heart attacks as the control group. The reason? Estrogen replacement improves a woman’s “good cholesterol” (HDL) while lowering the “bad cholesterol (LDL).

Women who took combination therapy, which included Progestin as well, reduced their risk of heart disease by 61 percent.

I cannot dispense medical advice on FB, and each case is unique. It is not “one size fits all.” Any questions about this, please contact the office.

Are you experiencing symptoms of menopause? Dr. Goldstein is the Best Menopause Specialist in New York, NY. Get Relief & Schedule an Appointment Today!

03/30/2022

On this National Doctor's Day, I am often asked. Are you going to retire? I love what I do, I like being on top of my game, speaking, writing, and teaching. I love my patients and I will do this indefinitely. So in response to the question, am I going to retire. I am not going anywhere.

01/04/2021

Dear Patients,

Usually I send these email blasts in response to some medical news article that needs “fine tuning.” But at this time of year I, like many of you, reflect on the year past and the year ahead. I need not tell any of you how overwhelmingly surreal the circumstances of the past 10 months have been. The hardships of this pandemic medically, emotionally, and economically are truly a once in a century occurrence. No one has been left untouched, although obviously some much more than others.

At the height of the pandemic our floor at NYU was closed from March 20 to May 4. Realizing the magnitude of the situation, I decided to close one week earlier and delayed reopening an extra week after. For those of you who have expressed concern, we are not “the hospital” but merely a doctors office building physically two blocks from Tisch Hospital and four blocks from the new Kimmel Pavilion.

I have seen or spoken to many many of you. But too many others have begun to “fall through the cracks”, some out of fear of coming in. As I write this the test positivity rate in our ZIP Code is 2.39%, and although it seems inevitable that this will rise some, the Eastside of Manhattan remains one of the safest places in the country. Yes, the vaccine is coming. It is being given to healthcare workers and staff as you read this. It is unclear when it will reach the majority of you. I implore you, if you have any qualms,PLEASE take this vaccine when it is offered. I did. It is extremely safe,especially in light of the potential severity of the disease it protects against.

In closing, if your care in our office is overdue, call us. We employ extreme measures to keep you safe. Much has been written about the increase in non-Covid medical problems because of delay in diagnosis out of fear on the part of patients. Don’t let that happen to you.

Hoping 2021 will be a better year for all of us.

Gynecologist in NYC - Dr. Steven R. Goldstein MD: A Top New York City Obgyn Gynecologist in Manhattan for abnormal uterine bleeding, menopause bleeding, perimenopause, menopause, HRT, in his New York City office in Manhattan NYC. Best Obgyn NYC for fibroids, ovarian cysts, miscarriage, heavy bleedin...

09/03/2020

To my patients,

Last week, Jane Brody, in her column, wrote about screening for breast cancer and early detection with mammograms as well as the confusion about who should get mammograms and at what frequency. This week, as the second of a two-part series, her article is entitled, “How to Reduce Breast Cancer Threat.”

Much of what she writes about is absolutely true and not necessarily new. The relationship of alcohol to breast cancer is well known, although, moderate consumption of wine seems to result in reduced cardiovascular risk. Being overweight, since adipose tissue makes a weak form of non-ovarian estrogen called estrone, puts such patients at slightly increased risk of breast cancer.

She then delves into hormone replacement and quotes the recent article in JAMA that looked at long-term effects on breast cancer risk of hormone replacement. I have discussed these studies with many of you. It is well known that the women who took Prempro (that’s Premarin and Provera) had an increased risk of developing breast cancer as well as a trend toward increase rate of death from breast cancer (this was not quite statistically significant). She also mentions that the use of estrogen by itself resulted in a reduction in breast cancer risk. I have been clear to you and anyone that I lecture that there is no such thing as estrogen! There are estrogens. Premarin comes from pregnant horses’ urine and consists of estradiol (the natural ovarian estrogen) as well as a multitude of other substances. It becomes obvious that Premarin, unlike plain estradiol, has some constituents in it that have SERM-like properties. SERMs are selective estrogen receptor modulators like Evista or tamoxifen that are anti-estrogens in breast but estrogenic in bone. That is why women on Premarin alone had a reduction in breast cancer. Estradiol has not been shown to reduce breast cancer like Premarin did.

She does not mention a new paradigm, which should revolutionize hormone replacement therapy but never will because of the constraints of the FDA labeling process. Pfizer figured out how to protect the uterine lining (endometrium) with a different SERM called bazedoxifene. It has thus paired Premarin (which has been shown to reduce breast cancer risk and breast cancer death) with that SERM bazedoxifene. All of the SERMs are anti-estrogen in breast. From a scientific point of view, combining Premarin with a SERM will result in a reduction in breast cancer risk. The magnitude of such a reduction, however, is not studied and probably never will be. Such a test would be a massive expense, which has caused Pfizer to decide there is not enough return on investment. This compound, Duavee, is approved for treating menopausal symptoms (hot flashes, and night sweats) and preventing the bone loss that occurs with menopause. It also, undoubtedly, will have benefits in va**na as well as, mentioned above, reduce breast cancer risk. It is unfortunate that this new paradigm is one of the best-kept secrets in medicine. It has been around since 2013! It seems that only the key opinion leaders (often known as KOLs) are aware of the science of this compound. This is frustrating. It is so irritating when a mammography doctor tells one of my Duavee patients, “are you crazy to take hormones. You are going to increase your risk of breast cancer.” Nothing could be further from the truth.

Finally, she does mention drugs that are used to prevent breast cancer and are approved. These include the SERMs Evista and tamoxifen. However, she also mentions the other class called aromatase inhibitors. Although these are approved, I feel strongly that it would be fool hardy to take an aromatase inhibitor for prevention of breast cancer. These drugs totally reduce any estrogen circulating resulting in the increased likelihood of osteoporosis, often with joint pain, and making va**nal atrophy worse. Women at high-risk for developing breast cancer, in my opinion, should take SERMs like tamoxifen and raloxifene. I would not suggest aromatase inhibitors for prevention. They are very effective drugs in women who have anything beyond Stage 1 breast cancer.

Hoping this is valuable to you or someone in your family.
Dr Goldstein
https://www.goldsteinmd.com/

08/27/2020

There was an article in yesterday’s New York Times by Jane Brody entitled, “Older Women, Mammograms and Confusion.” I’ve always enjoyed reading Jane Brody as I usually find her to be extremely on point and accurate. However, I found this article to be exactly as the title implies – confusing. I agree with her that one cannot go by the recommendation of various Societies because they are conflicting. The United States Preventative Services Task Force, which, I believe, in many other domains, is extremely draconian, recommends stopping routine mammograms at age seventy-five regardless of a woman’s remaining life expectancy. I could not disagree more. The American Cancer Society suggests continuing mammography indefinitely as long as a patient has the life expectancy of ten or more years. That begins to make some sense.

One of the studies that she quotes, however, found that two-thirds of women over seventy-five who were found to have cancer had a tumor, “of a grade that should get treated.” This is in contrast to those who believe that the tumors found in older women are relatively low-grade and patients would die with them not from them. They go on to say, “the age to stop screening should be based on each woman’s health status and not determined by her age.” I could not agree more.

It is important to realize that the five-year survival for Stage 1A breast cancer is 99%. Yes, 99%! The key is early detection. I expect quality breast imaging sites to detect breast cancer at least four years before I or you could palpate it. Early detection allows a lumpectomy and a single sentinel lymph node. These are not very invasive surgeries and, as I have told many patients, the psychology of such a diagnosis often is much worse that the physical reality. The word cancer is scary. If you’re old enough, you’ll remember when people thought of breast cancer as a potential death sentence. I talk to many of my patients about early detection of breast cancer should and can result in nobody dying from the disease. Most patients can avoid a disfiguring mastectomy and can be treated, as I mentioned, with simple lumpectomy and a single lymph node.

What patients should be concerned about is bone health. Nationwide, if one suffers a hip fracture, the statistics show that 25% of women will not live independently again and 30% of women will be dead within a year (some short term from pulmonary embolism or pneumonia, others, long term, simply failure to thrive). Admittedly, many of my patients who are in better physical shape with less comorbidities (that’s “medicalese” for other medical conditions) might not suffer such extreme numbers as those just quoted, but a fall with hip fracture later in life can be much more debilitating and, perhaps, even fatal compared to Stage 1A breast cancers.

Finally, I often have patients of advanced age who say, “why bother getting a mammogram, I wouldn’t do anything anyway.” I find this mentality disturbing. There is a saying in medicine – “don’t perform a test, if it will not change your management.” I explain to patients that if they had a very small, early tumor and could undergo a simple removal of a lump and a single lymph node and get on with their lives, of course they would undergo such therapy. It is not the same as saying to a patient, if they had an 8 cm tumor around the head of their pancreas, would they undergo a seven-hour Whipple operation and chemotherapy afterwards. For this situation, I understand the concept of, “I wouldn’t do anything anyway.”

In summary, I don’t think that this situation about mammography in older women needs to be confusing. I believe that annual screening in a quality imaging site is important indefinitely, although, as stated above, I do believe that a decision to stop should be based on each woman’s health status and, certainly, not determined by age alone.
https://www.goldsteinmd.com/

08/11/2020

Check out Dr Goldstein's interview with the North American Menopause Society regarding Tissue Specific Estrogen Complexes (TSEC) for use in menopausal women

Doctor Steven R. Goldstein MD is one of the best menopause and perimenopause gynecologists in New York with offices in Manhattan NYC. He is menopause specialist, past President of North American Menopause Society and a Certified Menopause Practitioner. He is considered a menopause expert across the....

04/15/2020

A bit of information for those of you suffering from hot flashes.

You can sleep in a cool room. If you’re already in a thermostat war with your partner, point out that while a person can always cover up in extra blankets to get warmer in a cold room, a woman going through a phase of hot flashes can do nothing to ease those waves of warmth in a hot room with no ventilation. A cooperative mate should understand why the thermostat needs to be turned down during this time-limited period. You may need separate blankets you can kick off without disturbing another person’s sleep. Forget the top sheet. Regardless of the thread count, it usually doesn’t breathe and you can wake up feeling like you’re wrapped in a plastic pool of sweat.

Avoiding chocolate, red wine, caffeine, white sugar, and alcohol is also something you can do. These are well known hot flash triggers for many women. Go without them for two weeks and see how you feel. More to follow in later posts. Be safe.

Dr Steven R. Goldstein MD is one of the nation's top gynecologists. Visit https://www.goldsteinmd.com/ for more information.

03/31/2020

There are several situations which can cause heavy bleeding during periods. First, women who have had several children will see an increase in the surface area of their uterine lining, resulting in heavy bleeding during periods without any abnormality.

Secondly, a condition known as adenomyosis may also cause heavy bleeding. This too is a benign, non-cancerous cause.

Thirdly, some women may have fibroids which cause growth of the uterine cavity and increased bleeding due to more surface area.

Fourthly, uterine polyps which are in tandem with the menstrual cycle can result in heavy bleeding also.

Women with heavy menstrual bleeding or any va**nal bleeding can be evaluated with a painless, non-invasive transva**nal ultrasound or Sonohysterography by Dr. Goldstein and avoid painful D&C procedures or hysterectomies as the first means of diagnosis.

If you are suffering from unusual or heavy va**nal bleeding, you may schedule a consultation with Dr. Steven R. Goldstein, a top gynecologist in Manhattan.
Visit his website at www.goldsteinmd.com for more information and to make an appointment.

01/23/2020

As women approach menopause, there are some practical things they can do to help alleviate symptoms of menopause (hot flashes, night sweats, etc.) when they come:

a. If you smoke, you must find a way to stop
b. Exercise regularly
c. Reduce stress through relaxation. Massage, hot baths, and meditation can all be helpful on a regular basis
d. Modify your diet to reduce fat intake, instead eat plenty of carbohydrates which may boost serotonin levels and thus steady mood swings
e. Reduce or eliminate liquor, coffee, chocolate, soda and salt. Caffeine increases the loss of calcium. Chocolate and other high fat items contribute to weight gain and heart disease. Salt raises blood pressure, not to mention its water retentive powers
f. Take vitamins such as vitamin D, vitamin C, vitamin A and 200 mg time release B6
g. Increase calcium
h. See your doctor for routine checkups
i. Do monthly breast exams
j. Talk to your parents or other relatives about your family history

Feel free to forward. Dr Steven R. Goldstein MD is regarded as one of the nation's top gynecologists.
https://www.goldsteinmd.com/services/best-obgyn-manhattan/