Should Women 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?

Testosterone plays a central role in ovarian function, bone strength, and libido. While women’s ovaries and adrenal glands crank out less testosterone than men, it’s not as closely studied, so it’s less understood (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.

Why women need testosterone

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 testosterone or something else.

There’s research that suggests testosterone can also help other menopause symptoms like energy, mood, irritability, 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. 

Women with low testosterone 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). 

More Menopause

What Causes Brain Fog in Menopause—And What Helps? 

8 Signs You Might Need Menopause Hormone Therapy

7 Benefits of Testosterone Replacement Therapy for Women in Menopause

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 (10).  

One study in the British Journal of General Practice indicates that testosterone therapy can offer several benefits for menopausal women, particularly in enhancing sexual function, overall well-being, and musculoskeletal health (3). Furthermore, the safety of testosterone use in women has been evaluated for the past 80 years to treat concerns like sexual function, osteoporosis prevention, brain protection, and breast protection (11).

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

Sexual function

Low-dose testosterone therapy can be safe and effective in women with Hypoactive Sexual Desire Disorder (HSDD)—that is, low sex drive in menopause that causes the woman distress (2). The research on testosterone therapy for sex drive during menopause is extensive and conclusive enough that prominent medical organizations support its use.

“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.

Muscle mass

As women age and go through menopause, estrogen levels decrease, which can result in muscle loss (aka sarcopenia). A double-blind randomized trial demonstrated that androgens (a group of hormones that includes testosterone) also affect muscle mass and strength (11). Testosterone therapy can help mitigate this muscle loss by improving overall strength and physical function, and promoting muscle protein synthesis, which is crucial for muscle growth and maintenance.

“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). There is also evidence to support the use of physiologic doses of testosterone for osteoporosis prevention, as adequate levels of testosterone are important for the maintenance of musculoskeletal health (3, 11). It does this by stimulating the production of osteoblasts (cells that form bone) to enhance bone mineral density (BMD). This is important for menopausal women, as the decline in estrogen levels during menopause can lead to decreased bone formation and increased bone breakdown, contributing to osteoporosis.

Mood and cognition

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, it can improve mood, reduce symptoms of anxiety and depression, enhance cognitive function, and promote an overall sense of well-being, helping women better cope with the emotional and psychological challenges that often accompany this stage of life (12).

“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.”

Heart Health

Menopausal women are at higher risk for heart disease due to declining estrogen levels, but testosterone therapy may counteract some of these effects. There was once concern that it would have adverse effects on cardiovascular health, but that has since been debunked (13).

In fact, there is overwhelming biological and clinical evidence that T is cardiac protective and adequate levels decrease the risk of cardiovascular disease (10). Testosterone may improve the lipid profile by increasing HDL (good cholesterol) and reducing LDL (bad cholesterol), to balance cholesterol levels. It also enhances blood vessel function by improving the flexibility and dilation of blood vessels, which supports better blood flow and reduces the risk of hypertension (high blood pressure). Both benefits combined can also help reduce the development of atherosclerosis, the hardening and narrowing of the arteries, which can lead to heart attack or stroke (14).

Immune function

Yes, testosterone even has the ability to bolster your immune system to fight infection and inflammation. It has a modulatory effect on immune response, helping to enhance the body’s ability to fight infections and prevent autoimmune conditions, which can increase in postmenopausal women due to hormonal changes (15).

Testosterone also has anti-inflammatory properties that may help lower chronic inflammation, which is linked to various diseases such as cardiovascular disease, diabetes, and autoimmune conditions. Reducing inflammation is important for maintaining overall health and preventing disease (16).

Reduce body fat

Though not necessarily prescribed as a weight-loss solution, T can help menopausal women lose excess belly fat and visceral fat by promoting the use of fat as an energy source to break it down and improve fat distribution.

Testosterone levels also drop during menopause (3). While testosterone doesn’t directly regulate weight, it does play a role in maintaining muscle (11).

Although total testosterone levels decrease with age, a dip in sex hormone-binding globulin (SHBG)—a protein that regulates sex hormones including testosterone—may slightly boost the amount of free testosterone in your system during menopause (16). Elevated free testosterone is associated with belly fat in women at various stages of the menopause transition (16). 

Side Effects of TRT in Women

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.

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.