Testosterone in Menopause: What 99% of Doctors Don’t Know

“By the end of this hour, you’ll know more about testosterone in women than 99 percent of people who finished med school,” promised urogynecologist Ashley Winter, M.D., as she kicked off our Hone Women’s Community webinar. And she delivered.

Testosterone therapy is one of the buzziest topics in menopause right now. Some call it the missing piece of hormone therapy; a game-changer for libido, muscle, and mood. Others worry it’s too risky, without enough research to back its use in menopausal women. 

“The truth,” said Winter, “is that testosterone plays a much bigger role in women’s health than most physicians realize. We know it impacts sexual function, body composition, and even energy and cognition.”

In this Hone Women’s Community webinar, Winter unpacks the research on testosterone in women. From its natural role in energy and sexual function to what happens when levels drop in menopause, she explained where testosterone therapy can help women and how to use it safely. Here are 5 facts about testosterone that Winter says every woman in perimenopause and menopause (and her menopause doctor) should know.

1. Women Have More Testosterone Than Estrogen

Most of us grew up believing estrogen was the defining hormone for women. But women make testosterone in their ovaries, adrenal glands, and peripheral tissues.

When measured in the same units, “the average woman throughout her lifetime has more testosterone in her body than estrogen,” Winter shared. Testosterone consistently outweighs estradiol levels, especially in early adulthood.

Unlike estrogen, which “tanks after your final menstrual period,” testosterone declines gradually over time. This subtle drop leaves many women in perimenopause and menopause with noticeable symptoms like not wanting to have sex, reduced energy, feeling depressed, loss of muscle, or simply a sense of not feeling like themselves. Supplementing with testosterone in menopause can help reduce these symptoms.

2. Birth Control Lowers Testosterone

Another factor most doctors rarely discuss? The effect of hormonal birth control on testosterone. “Across 39 studies with thousands and thousands of patients, they showed that total testosterone goes down a hundred percent of the time in women on combined birth control pills,” Winter said.

Birth control increases proteins like sex hormone binding globulin (SHBG) that make testosterone inactive. The synthetic progestins in the pill also directly block testosterone’s effects.

For some women, the drop in testosterone isn’t noticeable. For others—especially those who started birth control as teens—long-term low testosterone may explain why they’ve never had much of a libido or why sex has been painful.

3. Testosterone Influences Clitoral Size and Sensitivity

“Your clitoris is a testosterone-sensitive organ,” Winter explained. “You can actually see physical changes in the size of the clitoris when you’re given a medication that lowers your testosterone,” she noted, pointing to research where women on hormonal contraceptives had measurable clitoral shrinkage.

Beyond the clitoris, the vestibule (the ring of tissue at the vaginal opening), which is responsible for much of the lubrication during sex, is also highly sensitive to testosterone. When testosterone dips during the menopause transition, it can contribute to pain, vaginal atrophy, and reduced sensation.

The good news: adding testosterone as part of menopause hormone replacement therapy can help reverse the damage. In one study, Winter highlighted, women who applied testosterone gel directly to the vestibule experienced improved comfort and sensitivity during sex.

4. Low Testosterone Affects Brain, Mood, and Muscle

Testosterone receptors aren’t limited to sexual tissues. They’re scattered throughout the brain, muscles, and other systems.

In the brain, testosterone influences neurotransmitters that support desire and energy. When levels decline, women often report anxiety, fatigue, brain fog, or a lack of motivation. “It’s kind of like your tank is empty,” Winter said.

Muscles also respond to testosterone. Women with low levels may find it harder to build or maintain lean mass, even with consistent exercise. “Some women really struggle in their ability to see results from their workouts.” Restoring testosterone to healthy levels can help women feel stronger, more resilient, and better able to keep up with the emotional and physical demands of midlife.

5. Delivery Method Matters

Not all testosterone therapy is created equal. Winter cautioned against testosterone pellets, small implants that release high doses of testosterone over a few months. They can drive testosterone levels too high and increase the risk of irreversible side effects, like a deepened voice. “What you don’t want to do is end up with such crazy high levels that you have a permanent body change,” Winter said.

Safer options include low-dose testosterone creams and testosterone injections, which allow for low, titrated doses which can be adjusted and monitored. Side effects at proper doses of testosterone—like mild acne or hair changes—are usually reversible. The goal isn’t to give women “male” levels of testosterone, but to restore what’s been lost with age.

Watch the Full Conversation

To hear Dr. Winter walk through the full science of testosterone in women and answer audience questions, watch the entire webinar. Even better? Join the Hone Community to watch the next one live.

Community Questions, Answered

Is testosterone only for libido?

No—benefits extend to energy, metabolism, muscle, bone, and even skin hydration.

I’m on birth control. Can I still take testosterone?

Yes. Combined pills lower testosterone, but you can supplement safely under supervision.

Can I stay on testosterone for life?

There’s no universal cut-off. It depends on your perimenopause symptoms, lab levels, and health goals.

What if I want to get pregnant?

Avoid testosterone while trying to conceive. Short-acting forms can be stopped safely beforehand. Pellets should be avoided in reproductive-age women.

What if I don’t feel results on testosterone?

If your blood levels of testosterone have risen but symptoms haven’t improved within six months, it may not be the right therapy. Other options can help with low libido, including a peptide called PT-141.

Interested in reading more about hormone imbalances?

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About the author

Tracy Middleton is the Senior Editorial Director at Hone and an award-winning health journalist and editor with more than 20 years’ experience. She is the former Editor in Chief and Brand Director of Yoga Journal and former Health Director of Women’s Health, and a member of the Association of Health Care Journalists.