Understanding Testosterone in Menopause: What You Need to Know

When we think about menopause, the first hormones that come to mind are usually estrogen and progesterone. But did you know testosterone also plays a crucial role in women’s health, even during menopause? While testosterone is often associated with men, it's equally important for women, especially when navigating the transition through perimenopause and menopause.

Let’s dive into what happens to testosterone levels during menopause, what symptoms low testosterone can cause, and how it can be used to help women regain their vitality.

What Happens to Testosterone Levels During Menopause?

As women transition through perimenopause and menopause, hormone levels begin to shift. Most of us are familiar with the decline of estrogen and progesterone, but testosterone levels drop as well. In fact, a woman's testosterone levels can begin to decrease in her early 30s, and by the time she reaches menopause, testosterone levels may have dropped by as much as 50%.

Symptoms of Low Testosterone in Women

While we often associate testosterone with men, this hormone plays a significant role in a woman’s overall health and well-being. When testosterone levels decrease during menopause, women may experience a variety of symptoms, including:

Low libido (reduced sexual desire)

Fatigue or lack of energy

Mood swings or irritability

Reduced muscle mass and difficulty building muscle

Decreased strength and stamina

Brain fog or difficulty concentrating

Weaker bones (risk of osteoporosis)

If any of these symptoms sound familiar, low testosterone might be part of the reason.

When and Why We Use Testosterone for Women

Testosterone therapy is not for everyone, but for some women, it can be life-changing. According to the North American Menopause Society (NAMS), testosterone therapy may be recommended for women experiencing hypoactive sexual desire disorder (HSDD), which is characterized by a low sex drive that causes emotional distress.

However, it’s important to note that testosterone therapy isn’t the first line of treatment for most menopause symptoms. Instead, we usually start by optimizing estrogen and progesterone levels through Menopause Hormone Therapy (MHT). Once these are balanced, testosterone can be introduced as a "cherry on top" to address more specific symptoms, particularly related to sexual function and overall well-being.

How Testosterone Is Used in Women

Testosterone therapy is highly individualized. It usually begins with a low dose, often in the form of creams, or gels, which are absorbed through the skin. The goal is to introduce just enough testosterone to restore balance without causing unwanted side effects.

Your healthcare provider will monitor your symptoms and testosterone levels closely, adjusting the dose as needed to ensure it’s working effectively for you. It’s important to note that there are no FDA-approved testosterone products specifically for women, so dosages are often adapted from formulations designed for men—hence why careful monitoring is essential.

Benefits of Testosterone Therapy in Menopause

When testosterone therapy is used appropriately, the benefits can be profound. Women may experience improvements in:

Sexual function: Increased libido, arousal, and overall sexual satisfaction.

Energy levels: Enhanced stamina and reduced feelings of fatigue.

Muscle strength: Improved muscle mass and strength, which can help with physical performance.

Mood: Reduced irritability and better mood balance.

Cognitive function: Enhanced focus and concentration.

Bone health: Testosterone can contribute to maintaining bone density, helping to prevent osteoporosis.

Long-Term Benefits of Testosterone Therapy

Over time, testosterone therapy may offer more than just symptom relief. By improving bone density and muscle mass, testosterone can help reduce the risk of osteoporosis and age-related muscle loss, conditions that are more common after menopause. In this way, testosterone may play a role in maintaining long-term physical health and quality of life.

Risks and Things to Be Aware Of

As with any hormone therapy, testosterone comes with some potential risks. These can include:

Acne or oily skin

Unwanted hair growth, such as facial hair

Deepening of the voice

Clitoral enlargement

Mood changes such as irritability or aggression

Adverse changes in cholesterol levels

Liver function changes

It’s also important to avoid testosterone levels becoming too high, which is why regular monitoring with your healthcare provider is crucial. Testosterone pellets, which are implanted under the skin, are generally discouraged because they can cause testosterone levels to spike, and they are difficult to adjust once inserted.

Testosterone and Vaginal Health

Testosterone doesn’t just improve energy and libido—it can also benefit vaginal health. The tissues of the vagina, vulva, urethra, and pelvic floor all contain androgen receptors (the receptors that respond to testosterone). As testosterone levels decline during menopause, these tissues can become more sensitive and prone to issues like vaginal dryness, discomfort during intercourse, and even recurrent urinary tract infections (UTIs).

Did You Know? Testosterone may also help improve the sensation in the clitoris, which can lead to enhanced sexual pleasure and more satisfying orgasms.

For some women, vaginal DHEA (like Intrarosa) is another option. DHEA is a hormone that gets converted into both estrogen and testosterone within the body, which helps rejuvenate vaginal tissues and improve sexual function without needing systemic hormone therapy.

Is Testosterone Therapy Right for You?

Testosterone therapy is not a one-size-fits-all solution, but for the right person, it can offer significant benefits. If you’re experiencing symptoms of low testosterone, it’s worth having a conversation with your healthcare provider to explore whether testosterone therapy could be an option for you.

As always, it’s essential to weigh the benefits against the risks and ensure you’re being closely monitored by a professional who can adjust your treatment as needed.

Final Thoughts

Testosterone plays an essential role in women’s health, even during and after menopause. While it’s not always the first step in treatment, it can be a powerful tool for improving sexual function, energy, and overall well-being. If you’re curious about testosterone therapy, talk to your healthcare provider to see if it’s the right choice for you.

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