Testosterone and Menopause: What Happens and How It Affects You

Testosterone is a vital hormone that plays a role in libido, brain processing, energy levels, and overall well-being. Although often labeled as a "male hormone," testosterone is actually the most abundant biologically active hormone in women. However, levels decline during perimenopause and menopause, potentially leading to various symptoms that impact quality of life.

What Does Testosterone Do?

While testosterone is most commonly associated with libido and sexual pleasure, its influence extends far beyond that. Your body has testosterone receptors throughout, meaning its effects are widespread:

Cognitive function: Supports mental clarity, memory, and sharpness.
Mood regulation: Helps maintain serotonin levels, improving overall mood and reducing anxiety.
Dopamine production: Enhances feelings of pleasure and motivation.
Muscle and bone health: Supports muscle mass, bone density, and cardiovascular function.
Energy and sleep quality: Plays a role in maintaining stamina and restful sleep.

What Happens When Testosterone Levels Decline?

Testosterone levels naturally begin to decline in a woman's 30s, but they drop significantly around perimenopause and menopause. Women who undergo surgical menopause (e.g., ovary removal) often experience a more sudden reduction.

Low testosterone can contribute to:

Reduced libido: Less frequent sexual desire and reduced pleasure.
Fatigue and low energy
Brain fog: Difficulty concentrating and memory lapses.
Mood changes: Increased anxiety, irritability, and low mood.
Physical changes: Muscle loss, bone density reduction, and joint pain.
Urinary symptoms: Increased risk of incontinence or recurrent UTIs.

Do I Need to Replace Testosterone?

Not everyone with low testosterone needs replacement therapy. The 2024 NICE Menopause Guidelines state that testosterone can be considered for women with low sexual desire when HRT alone has not been effective [1]. While its use beyond libido issues isn’t officially recommended yet, emerging research suggests broader benefits.

A study on Testosterone Therapy in Women states: "To assume that androgen deficiency does not exist in women, or that testosterone therapy should not be considered, is unscientific and implausible." [2]

NHS data shows an increasing demand for testosterone therapy among menopausal women, with prescriptions rising from 429 in November 2015 to over 4,675 in November 2022 [3].

How Is Testosterone Given?

Testosterone therapy is available in various forms, most commonly as a transdermal gel or cream:

AndroFeme®1: A testosterone cream formulated specifically for women, licensed in Australia but available via prescription in other countries.
Testogel: Originally designed for men but can be prescribed at lower doses for women.
Implants: Small pellets inserted under the skin that release testosterone over several months.

Treatment is typically applied to the upper outer thigh or buttocks, absorbed into the bloodstream. Blood tests are conducted a few months after starting treatment to ensure levels remain within the female range.

Benefits of Testosterone Replacement

Many women find that adding testosterone to their HRT regimen leads to improvements beyond just libido, including:

Increased sexual desire and arousal
Improved energy and stamina
Better muscle strength and bone density
Enhanced cognitive function and memory
Better mood and reduced anxiety
Improved sleep quality

An audit by Newson Health of 1,200 women taking testosterone for at least three months found improvements in libido, mood, and anxiety. Another study of 510 women found significant cognitive and mood enhancements after four months of testosterone therapy [4].

Are There Risks to Testosterone Therapy?

When prescribed correctly, testosterone therapy has minimal risks. Some women experience mild side effects such as increased hair growth at the application site, which can be avoided by rotating application areas. At the recommended low doses, there is no evidence of unwanted effects such as deepened voice, excessive hair growth, or acne.

Blood tests are conducted regularly to monitor levels and ensure safety. If using AndroFeme®1, be aware it contains almond oil and should be avoided if you have an allergy.

Final Thoughts

Testosterone plays a crucial role in women’s health and well-being, far beyond its impact on libido. Although traditionally overlooked, increasing awareness and research highlight its potential benefits for mood, cognitive function, and overall vitality. If you suspect low testosterone is affecting you, consider discussing it with a menopause specialist to explore whether replacement therapy is right for you.

Menopause and Testosterone. The symptoms can be effectively managed.

References

NICE Guidance 2024
Glaser R., Dimitrakakis C. (2013), ‘Testosterone therapy in women: myths and misconceptions’, Maturitas. 74(3):230-4. doi: 10.1016/j.maturitas.2013.01.003
Pharmaceutical Journal, 2022
Glynne S., Kamal A., Kamel A.M. et al. (2024), ‘Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study‘, Arch Womens Ment Health. https://doi.org/10.1007/s00737-024-01513-6

Interested in learning more? WA Menopause Clinic is here to provide expert, evidence-based care for your menopause journey. Book a consultation today!