Friday Q&A: bloating; testosterone gel for libido; ferritin levels; & correcting hypoglycemia

Let’s dive in!

ICYMI 👉

• Does Tylenol Cause Autism?

• Is Your Blood Pressure High? Or Are You Just Happy to See Me

• What is “Pre-diabetes” anyway?

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In this week’s reader-submitted Q&A, we’re tackling these questions:

• What causes persistent bloating and how can I fix it?

• Can testosterone gel help with low libido in postmenopausal women?

• Should I be concerned about low ferritin levels if I feel fine?

• What should I eat before bed to prevent low blood sugar?

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📣 Send me your questions for future Q&As! Click here to write me. ✍️

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: PERSISTENT BLOATING

I’ve been dealing with persistent bloating for months now. It happens almost every day, regardless of what I eat, and it’s starting to affect what I can wear! I’ve tried cutting out gluten and dairy, but nothing seems to help. What could be causing this and what should I try next? -Amanda

Dear Amanda,

Daily bloating that doesn’t respond to dietary changes warrants a proper medical evaluation. The fact that it happens regardless of what you eat suggests we need to look beyond simple food intolerances.

Common culprits of persistent bloating are small intestinal bacterial overgrowth (aka “SIBO,” where bacteria in the wrong place ferment your food and create gas), gastroparesis (delayed stomach emptying), and functional dyspepsia, where your stomach becomes hypersensitive to normal amounts of gas or food. For women, hormonal fluctuations significantly affect gut motility and can cause cyclical bloating patterns. Also consider that stress and anxiety directly affect gut function. Your gut has its own nervous system that communicates constantly with your brain, so if you’ve been worried about the bloating itself, that anxiety might be perpetuating the problem. Many of my patients find their symptoms improve when they address underlying stress.

More serious possibilities to rule out include Inflammatory bowel disease (Crohn’s or ulcerative colitis); true celiac disease; and, in women, ovarian cysts or, rarely, ovarian cancer which can cause persistent abdominal distention. Ascites (fluid accumulation) from liver, heart, or other conditions can also masquerade as bloating.

I suggesting seeing your primary care doctor first. They should check for red flags (weight loss, blood in stool, severe pain, bowel habit changes) and order basic blood work including inflammatory markers and celiac antibodies. If normal, a gastroenterologist can do specialized testing like SIBO breath tests or gastric emptying studies. Women may need pelvic imaging.

While you are waiting, keep a detailed symptom diary tracking timing, stress, sleep, and menstrual cycle—not just food. Try the low-FODMAP diet with a registered dietitian’s guidance. Pay attention to eating patterns: large infrequent meals, poor chewing, and stressed eating can all overwhelm your digestive system.

I hope that helps!

QUESTION #2: TESTOSTERONE GEL

I’d love to hear your measured and science-based response about whether testosterone gel behind the knees can potentially work to boost libido in older women. When I visited an ob/gyn who supposedly specialized in women’s health, she basically scoffed at the idea, told me there were too many side effects, and made fun of me. It was an awful experience! - D

Hi D,

I’m so sorry you had that dismissive experience! No patient should ever be scoffed at for asking legitimate questions about their health. Your question about testosterone therapy for women is quite reasonable and reflects an area where the evidence is evolving.

Testosterone therapy for postmenopausal women with low libido does have some scientific support, though it’s more limited than for men. Several studies have shown that testosterone can improve sexual desire, arousal, and satisfaction in women, particularly when other factors like relationship issues and general health have been addressed. The challenge is that testosterone therapy for women isn’t FDA-approved in the United States, so it’s considered “off-label” use.

Regarding the application site, testosterone gel is typically applied to areas with good absorption like the shoulders, upper arms, or abdomen rather than behind the knees. The location matters less than consistent absorption and avoiding transfer to partners or children. The side effects your gynecologist mentioned are real but often overstated. Potential concerns include acne, hair growth, voice changes, and theoretical cardiovascular or liver risks. However, when used appropriately in low doses with proper monitoring, serious side effects are uncommon.

The bigger picture is that decreased libido in postmenopausal women is complex, involving not just hormones but sleep quality, stress levels, relationship dynamics, body image, and overall health. Testosterone might be one piece of the puzzle, but it’s rarely a magic solution on its own.

Consider seeking a second opinion from a provider who specializes in menopause or sexual health and is comfortable discussing all treatment options without judgment.

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QUESTION #3: FERRITIN LEVELS

My last three ferritin tests [the measure of one’s iron stores] since 2022 have been 13, 12 and 10, but the rest of my blood counts are good - no anemia. This was never flagged because the “normal” range goes as low as 8, but now I’m told that anything below 30 is considered deficient and I need to start supplementing with iron. Was this a serious oversight? Why don’t lab ranges reflect this ideal? I’ve had no symptoms and can exercise quite hard - should I be concerned? -Thalia

Hi Thalia,

You’ve stumbled onto one of the most frustrating aspects of lab interpretation—the gap between “normal” reference ranges and optimal levels. Your experience perfectly illustrates why numbers without context can be misleading, even when they’re technically “normal.”

Here’s what’s happening: traditional lab ranges are based on statistical distributions of what’s found in the general population, not necessarily what’s optimal for health. For ferritin, labs often set the lower limit around 8-12 because that’s where you start seeing frank iron deficiency anemia. But for some patients, ferritin levels below 30 can cause symptoms like fatigue, brain fog, restless legs, or exercise intolerance, even when your hemoglobin and other blood counts look fine.

The fact that you’re asymptomatic and exercising hard actually tells us something important: your body might be efficiently using the iron it has, or you might have adapted to lower stores without realizing it.

Was this a serious oversight? Not really. Your doctors were following standard reference ranges and looking for anemia and true iron deficiency, which you don’t have. But it does highlight how our healthcare system sometimes misses subtle deficiencies that could affect quality of life.

Whether you should supplement depends on more than just the number. Are you experiencing any fatigue, mood changes, or decreased exercise performance? Are you a menstruating woman, vegetarian, or frequent blood donor? These factors matter more than hitting an arbitrary target. Does that help?

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QUESTION #4: HYPOGLYCEMIA

My continuous glucose monitor reveals some episodes of hypoglycemia, especially in the night. What could I eat before bedtime to regulate blood sugar and won’t give me indigestion? - Angie

Hello Angie,

Nocturnal hypoglycemia can be really concerning, and you’re smart to address it proactively. The key is finding foods that provide steady, sustained energy without causing digestive upset when you’re trying to sleep.

The most effective bedtime snacks combine protein with complex carbohydrates and a small amount of healthy fat. This combination helps maintain stable blood sugar throughout the night by providing both immediate and sustained energy sources. Think of foods that digest slowly and release glucose gradually rather than causing spikes and crashes.

Some gentle options that work well for most people include a small handful of nuts with half an apple, Greek yogurt with a few berries, or whole grain crackers with almond butter. The protein helps stabilize blood sugar while the complex carbs provide sustained energy. If dairy bothers you at night, try a small portion of oatmeal made with unsweetened almond milk and a sprinkle of nuts.

The timing and portion size matter as much as what you choose. Eating about 30-60 minutes before bed gives your body time to start processing the food without being too close to sleep. Keep portions small - you’re aiming for about 150-200 calories, not a full meal.

Also consider what might be causing the hypoglycemia in the first place. Are you taking diabetes medications that might need adjusting? Are you eating dinner very early or skipping evening snacks? Sometimes the solution isn’t just adding bedtime food but looking at your overall eating pattern throughout the day.

Your CGM data is invaluable here - track which bedtime snacks correlate with more stable overnight readings and adjust accordingly. What works perfectly for one person might not work for you, so use that real-time feedback to find your sweet spot.

Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.

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ICYMI, check out my recent Q&As on:

• Bone broth; relaxation techniques for insomnia; probiotics; & colonoscopy fears

• Seed oils; avoiding cancer screenings (e.g. mammograms); gum disease and heart health; & caregiver burnout

• Vitamin D and anti-aging; health advice for men; how to get more dietary protein; & pelvic organ prolapse