Should I Take Testosterone in Menopause?

You probably think of testosterone as a “male” hormone. As in, maybe that boy from high school—the one who planned on becoming a pro wrestler named Smash Gordon—had too much of it. In actuality, women make testosterone, too, and it performs important functions, including influencing sex drive, mood, and energy, as well as bone health. 

During the menopause transition, however, testosterone deficiency can become an issue. That’s where low-dose testosterone for women comes in. There’s strong evidence that testosterone can boost libido, while other research suggests it helps with symptoms like mood, energy, and cognitive function.  
So, if you’ve ever asked yourself, “Can women take testosterone for menopause?” —and even more important—can taking testosterone somehow make my life better, the answers are yes, and perhaps. 

About the Experts

Yves-Richard Dole, M.D., a general OB/GYN at Mercy Medical Center in Baltimore. 

Natasha Spencer, M.D., a general OB/GYN at Orlando Health Physician Associates in Altamonte Springs, FL. 

Jim Staheli, D.O. is the medical director of Broad Health, Hone Health’s affiliated practice. His areas of expertise include metabolic and nutritional medicine, anti-aging, and functional medicine.

What Does Testosterone Do for Women?

Women crank out testosterone from our ovaries and our adrenal glands, in smaller amounts than men produce. It’s thought to play a role in ovarian function, bone strength, and libido. We say “thought to” because as with many aspects of the female body, it hasn’t been studied enough to say for sure (because, women). “While the specifics are uncertain, it’s possible that androgens also play an important role in normal brain function (including mood, sex drive, and cognitive function),” according to a Harvard Health publication. In any event, it is clear that the testosterone we make declines over time.

Women’s level of testosterone declines over time; at age 40 it’s about 50 percent of what you had at age 21 (1). This may have many effects, ranging from annoying to awful, but it’s hard to know whether they are due to low T or something else.

And that’s where the conversation really begins: What happens when you have low testosterone as a woman, and what should be done about it? 

Testosterone for Menopause: It’s Complicated

Let’s start with what everyone seems to agree on: In women with Hypoactive Sexual Desire Disorder (HSDD)—that is, low sex drive in menopause that causes the woman distress—low-dose testosterone therapy can be safe and effective (2). The research on testosterone therapy for sex drive during menopause is extensive and conclusive enough that prominent medical organizations support its use.

There’s research that suggests testosterone can also help other menopause symptoms like energy, mood, muscle strength, and concentration (1, 2, 3), but the evidence so far is limited (again, because women). That’s why organizations like The Endocrine Society, the Menopause Society, and the British Menopause Society don’t currently recommend women take testosterone to treat them. 

Still, many physicians who prescribe testosterone off-label (that is, for symptoms other than HSDD), say patients report numerous benefits. Jim Staheli, D.O., the medical director of Broad Health, Hone Health’s affiliated practice, says women being treated with testosterone tell him, “I’m experiencing more endurance, energy, mental clarity, motivation, drive,” he says. “I’m sleeping better, I feel stronger, my joint pain is less. I have less irritability, depression, and anxiety.  My libido has improved. My headaches have improved.”

More Menopause

What Causes Brain Fog in Menopause—And What Helps? 

8 Signs You Might Need Menopause Hormone Therapy

Do Women in Midlife Need Testosterone?

Beyond anecdotal evidence, some data suggests adding testosterone to hormone therapy (HT) can help with menopause symptoms.

An older study in the medical journal Maturitas, for instance, explains that in women, low T is linked to depression, osteoporosis, increased body fat, and pain during or after intercourse (4). Women with low T can also suffer from reduced vaginal lubrication and difficulty orgasming, according to The Cleveland Clinic. Another bit of research from 2010 found that women (pre- and post-menopausal) who complained of feeling sluggish, sad and depressed, and of other symptoms saw improvement after testosterone therapy (5).  

Here’s what physicians who prescribe it see as benefits of testosterone for women in menopause and perimenopause:

Fatigue and disinterest in sex

“It can increase your energy and libido,” says  Natasha Spencer, M.D., a general OB/GYN at Orlando Health Physician Associates in Altamonte Springs, FL.

Maintaining pelvic floor muscles

“It can also help with some of the muscles in the pelvic girdle [by keeping them strong], and with other muscles as well,” she says. “In addition, testosterone can reduce the chances of incontinence and pelvic floor dysfunction.” 

The health of your pelvic floor is kind of a big deal, btw. It influences everything from your ability to poop and pee normally to whether you can become sexually aroused or orgasm (6).

Bone health

A small amount of testosterone actually gets converted to estrogen, and that added estrogen can enhance bone density for women in menopause, according to a report published in the journal Nature (7).

Joint pain

“As women age, some may be subject to inflammatory processes leading to joint pain,” says Staheli. Along with other treatments and lifestyle changes to address the pain, he says, “Anecdotally, I have seen improvement in joint pain and other inflammatory symptoms subside with the use of low dose testosterone in those with testosterone deficiency.”

Mood

Perimenopause and menopause can do a number on your mood and mental health, and Staheli has seen testosterone supplementation help women in menopause deal with these unfortunate obstacles. Because of the various effects the hormone has on the brain,

“Testosterone has neuroprotective effects and improves cognition,” he says. “It also increases vasodilation for better brain perfusion, plays a role in raising dopamine and potentially serotonin, and increases muscle mass, all leading to a happier mental state.”

Should You Ask Your Doctor About Testosterone Therapy for Women?

If you have symptoms that you think may be related to low testosterone, or if you’re simply curious about testosterone therapy for women, talk to your doctor. They should help you decide if you’re a good candidate. 

You should expect your doctor to take a thorough health history and give you a physical, says Yves-Richard Dole, M.D., a general OB/GYN at Mercy Medical Center in Baltimore. 

Then she’ll give you a series of blood tests: “Your overall levels of certain hormones such as estrogen and progesterone are taken,” he says. In addition, he says, your cholesterol levels will probably be measured, as well as your liver function, since hormones can affect both of these. And because hormones are so complex, she’ll likely also test your thyroid hormones and do a full metabolic panel.

Oh, and your doctor will check up on you—not as often as your mom does, but still. Your dosage of testosterone for menopause, which is determined by your baseline levels, often will be assessed at yearly or regular checkups to see if it needs to be adjusted up or down. 

Follow-up is very important, says Stehali. “Most clinicians will have a menopause hormone therapy patient return to their clinic every 3 months for the first year, then every 6 months.”

Do I need a prescription?

In a word, yes, and this can get tricky. “It’s off-label,” says Dole. This means testosterone isn’t officially approved as a medication for perimenopausal and postmenopausal women, except for HSDD. But doctors are free to prescribe it. 

Some doctors are hesitant, however, due to an outdated study that contended testosterone replacement therapy for women was not only unhelpful but harmful. That research has been widely debunked many times. For instance, an analysis of numerous studies, which appeared in the medical journal The Lancet, determined that testosterone has no negative effects on body composition, musculoskeletal health, or cognitive function (8). Another study, which appeared in the journal Veritas, showed that many other fears around low dose testosterone for women are unfounded: It doesn’t make women hoarse, aggressive, or more prone to breast cancer, to name a few myths (9).

If your doctor isn’t comfortable prescribing testosterone to women in menopause, try getting a second opinion. “As medical training is improving regarding hormonal replacement, I’m seeing that more and more people have specialties [in it],” says Dole. He recommends looking for a physician who is a longevity or anti-aging specialist since they are often more comfortable with the idea of testosterone therapy. 

Types of testosterone therapy

Like the many delivery systems you can find for Nutella (pretzels, bagels, a spoon right out of the jar) testosterone therapy can be delivered in several methods, including: 

• Cream
• Pellets
• Injections
• Gels
• Oral pills

If you’re prescribed testosterone for menopause, your doctor can run through the pros and cons of each delivery method to find the right one for you.

What About Side Effects?

Unlike ordering a venti matcha latte at Starbucks, when it comes to testosterone therapy for women in menopause and perimenopause, more isn’t better.

Common side effects include acne or oily skin, facial hair, and thinning hair.

The most serious side effects are generally ones that come from taking too-large doses of the hormone. “Given in higher doses, you can get cardiovascular risks—an increase in heart attack and stroke. And especially in people with preexisting conditions, you can have liver damage and also cholesterol problems, with an increase in the bad type of cholesterol, LDL, and a decrease in the good one, HDL,” says Dole. These, caught early, can be reversed, Staheli says.