With hormone replacement therapy (HRT) becoming more accessible to women, there’s growing interest in one hormone that’s often overlooked: testosterone. Here’s why it could be a game changer for your menopause journey. 

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Why Is Testosterone Suddenly Part of the Menopause Conversation?

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One of the most common online questions about menopause is: What can I do when nothing seems to relieve my symptoms? While estrogen and progesterone are the usual stars of HRT, testosterone is now stepping into the spotlight.

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Often referred to as “the male hormone,” testosterone actually plays a vital role in women’s health. In fact, it’s the most abundant biologically active hormone in women, present at levels three times higher than estrogen. Just like estrogen, testosterone begins to decline during perimenopause — and that drop can contribute to some of the most common symptoms.

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So, What Is Testosterone Exactly?

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Testosterone belongs to a group of hormones called androgens. While commonly associated with male biology, women produce testosterone too — just in smaller amounts. In women, it plays a role in sexual desire, bone and muscle strength, mood and cognitive function and menstrual cycle regulation.

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What Happens to Testosterone During Menopause?

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As the ovarian function declines in perimenopause and menopause, so does testosterone production. This decline can be further accelerated by certain medical treatments, such as surgical removal of the ovaries or certain cancer treatments. For some women, this testosterone drop contributes to symptoms like low libido, fatigue, and decreased motivation.

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How Can Testosterone Help During Menopause?

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Currently, the most evidence-based use of testosterone therapy in women is for low sexual desire, specifically a condition called hypoactive sexual desire disorder (HSDD).

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According to the American College of Obstetricians and Gynecologists (ACOG), testosterone may be considered in postmenopausal women with persistent low libido, but only after other causes (like medications or psychological stress) have been ruled out.

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In some cases, testosterone can also be used to improve bone health, brain fog and mood swings — the research into those effects is still ongoing.

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What Types of Testosterone Are Available in the U.S.?

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Currently there are no FDA-approved testosterone products for women in the U.S. However, doctors can prescribe testosterone off-label, most often in the form of topical creams or gels (custom-compounded by pharmacies). Oral testosterone is not recommended for menopause treatments.

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What About Side Effects?

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When used at doses appropriate for women, testosterone therapy is generally well tolerated. However, potential side effects include acne, unwanted hair growth and weight gain. However, all of these adverse effects are very rare when testosterone levels are monitored and kept within a normal physiological range.

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Do All Menopausal Women Need Testosterone?

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Not necessarily. Many women with low testosterone levels don’t experience symptoms and don’t need treatment. Testosterone therapy should be reserved for those with clear symptoms affecting their quality of life — especially sexual function — and after other potential causes have been ruled out.

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It’s also important to note: There’s no universal standard for “normal” testosterone levels in women. In fact, two different laboratories may report different testosterone concentrations for the same sample. That’s why treatment decisions are based more on symptoms and history than lab numbers alone.

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How Do I Know If Testosterone Is Right for Me?

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As with all HRT treatments, it’s important to ask a menopause specialist for the best options available to them. 

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At Gliss Wellness, we offer testosterone therapy (for Hawaii residents only) as part of our holistic, personalized approach to menopause care. You can schedule a free 15-minute virtual consultation to meet our doctors and explore whether testosterone — or another HRT option — might be right for you.

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Check out this podcast episode from Peter Attia and Dr. Rachel Rubin to know more about the role of testosterone in women’s sexual health and the barriers preventing its broader use in female healthcare in the U.S.

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Sources:

American College of Obstetricians and Gynecologists. (2019). Female sexual dysfunction: ACOG Practice Bulletin No. 213.

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Credits: Paige Harakuni and Gliss Wellness