Testosterone replacement therapy (TRT) for women is gaining popularity as a way to address menopause symptoms like low sex drive, muscle loss, and mood swings. On TikTok, testosterone is often hyped as a miracle fix for anxiety and depression—but the reality is more complex.
While some women report mood improvements from taking testosterone, research on its role in mental health during menopause remains limited. Experts say it’s a delicate balance: low or high testosterone levels can disrupt mood and even contribute to depression.
Having a higher testosterone-to-estrogen ratio is linked to increased depressive symptoms (1). At the same time, low testosterone may also affect mood (2). What remains unclear is the exact threshold where testosterone levels start to influence mental health during menopause (3, 4).
The rising interest in testosterone for menopause depression and other mental health symptoms highlights its potential—but also its complexities.
Mary Poffenroth, Ph.D., a neuro-hacking biopsychologist and author of “Brave New You: Strategies, Tools, and Neurohacks To Live More Courageously Every Day.”
Jane Mackay, a certified menopause health coach who is accredited by the International Practitioners of Holistic Medicine.
James R. Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice, and a family medicine doctor specializing in men’s hormone health.
How Testosterone Shapes Women’s Mental Health
In women, testosterone levels play a key role in regulating mental health. Produced by the ovaries, the hormone helps with:
Research shows testosterone has anti-anxiety and antidepressant effects for both men and women (5). But for women, the hormone’s impact on mental health is particularly nuanced, and scientists are still piecing together exactly how it all works (10).
For example, a 2021 analysis of existing studies found testosterone levels are significantly different in women with depression compared to those without. And here’s the kicker: the way testosterone influences mood appears to shift with menopausal status.
The 2021 study found that:
In premenopausal women, higher testosterone was linked to depression.
In postmenopausal women, lower testosterone was associated with depression (10).
Does this data mean that testosterone is the culprit? Maybe. The researchers couldn’t say for sure, but the findings suggest that staying within your body’s ideal testosterone range—neither too high nor too low—might be crucial for mental health (10).
High testosterone has also been studied in women with polycystic ovary syndrome (PCOS). The condition increases androgen production—including testosterone—which may explain why women with PCOS have higher rates of depression. Still, more research is needed to fully understand this connection (11).
Mood swings, anxiety, and worsening or new bouts of depression are common during menopause (12). Chalk up these emotional changes to higher activity in the amygdala, the part of the brain in charge of emotional processing, says Mary Poffenroth, Ph.D., a neuro-hacking biopsychologist and author of “Brave New You: Strategies, Tools, and Neurohacks To Live More Courageously Every Day” (13).
“The amygdala reacts more to emotional cues as estrogen levels change and drop,” says Poffenroth. “From a neurobiologically standpoint women often have notable emotional liability during perimenopause.”
During its reproductive years, your body maintains a delicate balance of estrogen to testosterone, through various mechanisms (14). But during perimenopause, this balance is disturbed (1).
“For women, especially those in menopause, the ratio of testosterone and estrogen is incredibly important,” Dweck says.
While declining or fluctuating levels of estrogen and progesterone are often the root cause of perimenopausal symptoms, low or high testosterone levels are also at play (15). Typically, women experience a 50 percent drop in testosterone production by the time they reach menopause (16).
Testosterone, depression, and anxiety
During perimenopause and menopause the risk of depression spikes, rising two to four times higher than before (17). Anxiety can also rise during the menopause transition (18). Research suggests these mental health changes could be tied to testosterone (19).
A 2021 study of 50 women between the ages of 45 and 55 who didn’t have depression found a higher testosterone-to-estrogen ratio was associated with higher depressive symptoms (1). While the study didn’t specifically explore anxiety, it was one of the depressive symptoms reported.
As estrogen drops during menopause, the optimal ratio of testosterone to estrogen can shift, potentially leading to depression and anxiety. This is because our bodies have androgen receptors all over, including in the brain’s limbic system, which regulates emotions and anxiety (20).
Testosterone is directly related to both pituitary and adrenal function, which influences stress hormones like cortisol, Dweck says. When this balance is disrupted, “women may experience poor concentration or depression.”
Life stressors
Midlife often feels like a perfect storm of challenges. Stressors like raising kids, sending them off into the world, navigating relationship struggles, and caring for aging parents can pile up, making it harder to pinpoint if mood changes stem from life circumstances, or hormones like testosterone, says Dweck (21).
Physical changes during perimenopause like muscle loss, fat gain, or low libido, can also take a toll on self-esteem and body image, contributing to depression and anxiety (22, 23).
Low Dose Testosterone for Depression in Menopause
Testosterone replacement therapy isn’t FDA-approved to treat mood disorders in women, but some physicians prescribe it off-label to help with anxiety and depression during menopause (24). It makes sense that testosterone is gaining attention as the next line of defense in treating depression during menopause, according to men’s hormone specialist James Staheli, D.O.
“Knowing the positive effects of testosterone on the brain and other areas leads clinicians to further evaluate the patient through lab analysis and potential the positive effect testosterone has on the brain,” he says.
Testosterone therapy is also prescribed off-label to treat low libido during perimenopause and menopause—which can impact mood. Feelings of low self-esteem, hopelessness, and fatigue can lower your libido. In a person who is depressed, sex-related chemicals are out of balance. In turn, sexual desire, or libido is low (25).
In countries like England and Australia, testosterone has been prescribed to women for decades, with guidelines recommending it for hypoactive sexual desire disorder (HSDD) if menopause hormone therapy (MHT) alone isn’t effective.
After ruling out other variables that can impact sex drive like relationship issues and underlying medical conditions, Dweck says she typically prescribes compounded testosterone cream to women, since it’s easier to get more precise dosing. However, it’s usually not covered by insurance, she adds (26).
Side Effects of Testosterone
Testosterone replacement therapy (TRT) isn’t recommended for women with heart, blood vessel, or liver disease or those with a history of breast or uterine cancer. TRT can lead to high androgen levels, increasing the risk of side effects like (27):
acne
weight gain
unwanted facial and body hair growth
Although rare, more severe side effects like hair loss, a permanently deepened voice, or clitoral enlargement may also occur.
The Bottom Line
Although declining estrogen and progesterone levels are often to blame for menopause mood swings, testosterone can also impact anxiety and depression. More research is needed, but having too much or too little testosterone can impact mood, making getting the right level critical. Testosterone isn’t FDA-approved to treat mood swings, anxiety, or depression in menopause, but some doctors prescribe it off-label. If you’re experiencing mood changes in menopause, talk to your doctor about appropriate treatments to manage your symptoms.
Jennifer Chesak is a freelance science and medical journalist and editor who covers the pandemic, chronic health issues, medical rights, healthcare, and the scientific evidence around health and wellness trends. Her work has appeared in Washington Post, Prevention, Healthline, Health, The Daily Beast, Runner's World, Greatist, Real Simple, and more.
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