Testosterone and Menopause: What Women Need to Know

Nov 7

Testosterone is a hormone that is naturally produced by women as well as men. Although often thought of as a male hormone, it has important roles in women's health throughout life.

There is increasing interest in testosterone therapy for women experiencing menopause, and you may have heard it discussed as a treatment for low energy, brain fog, reduced muscle strength, low mood and general wellbeing, as well as low libido.

But what does the research actually tell us, and should testosterone be considered a routine part of menopause hormone therapy?

Testosterone and women

Women naturally produce testosterone in their ovaries and adrenal glands. Levels gradually decline with age, but unlike oestrogen, testosterone does not fall dramatically at menopause.

There is also no established testosterone blood level below which a woman can be diagnosed as having testosterone deficiency. Blood levels alone do not reliably predict sexual desire or determine whether someone will benefit from treatment.

When can testosterone be helpful?

The strongest evidence for testosterone therapy in women is for the treatment of hypoactive sexual desire dysfunction (HSDD) in postmenopausal women.

HSDD describes a persistent reduction in sexual desire that causes significant personal distress. It is more than simply having a lower libido than you previously experienced. It is important to consider the many factors that can influence sexual desire, including relationship issues, stress, sleep, mental health, medications, vaginal discomfort and other menopausal symptoms.

For appropriately assessed postmenopausal women with HSDD, research has demonstrated that testosterone can improve sexual desire, arousal and sexual satisfaction, and reduce distress associated with low sexual desire.

In Australia, AndroFeme 1 is a testosterone cream specifically formulated for women. It is approved by the Therapeutic Goods Administration (TGA) for the treatment of HSDD in postmenopausal women.

What about the other proposed benefits of testosterone?

This is where the discussion becomes more complicated.

There is growing interest in whether testosterone might have benefits beyond sexual function. Some women report improvements in energy, motivation, concentration, mood, muscle strength and their general sense of wellbeing when using testosterone.

There is also ongoing research into the potential effects of testosterone on bone health, muscle mass and cognitive function.

These are important areas of research, and it is understandable that women are interested in whether testosterone might offer additional benefits during midlife and beyond.

However, it is important to distinguish between reported improvements, biological effects and benefits that have actually been demonstrated in good quality clinical trials.

At present, the evidence remains insufficient to recommend testosterone for:

Fatigue or low energy
Brain fog or impaired memory
Low mood, anxiety or depression
Improving general wellbeing or motivation
Increasing muscle mass or physical strength
Preventing or treating osteoporosis
Cardiovascular health or disease prevention

Some studies have explored these potential benefits, but results have been inconsistent, and there is not yet convincing evidence that testosterone therapy produces meaningful clinical improvements in these areas.

The 2019 Global Consensus Position Statement on Testosterone Therapy for Women, and more recent international menopause recommendations, continue to identify postmenopausal HSDD as the only evidence-based indication for testosterone treatment.

This does not mean that further benefits are impossible. It means that we need better research before recommending testosterone for these purposes.

Is testosterone suitable for everyone?

No. Testosterone is a prescription medication and is not a routine component of menopause hormone therapy.

For women considering treatment for HSDD, a thorough assessment is important to identify other factors that may be contributing to reduced sexual desire. Treatment should be individualised, and testosterone is not appropriate or effective for everyone.

Before starting treatment, baseline testosterone levels should be measured. These tests are not used to diagnose testosterone deficiency or determine eligibility, but to ensure levels do not become excessive during treatment. Regular monitoring is also required.

Potential side effects include mild increases in acne, oily skin and increased growth of body or facial hair in some women. Excessive doses can cause more significant androgenic effects, some of which may not be reversible.

Long-term safety data in women are also limited, particularly beyond two years.

An approach to testosterone therapy

I think it is important to remain open to emerging research while being careful not to overstate the benefits of treatments before we have adequate evidence.

Testosterone has an established role in treating postmenopausal women with HSDD, and for appropriately selected women it can be a helpful treatment option.

However, it is not currently recommended to use testosterone as a general treatment for fatigue, brain fog, low mood, reduced muscle strength or simply as a way of improving overall wellbeing.

There is considerable interest in this area, and hopefully future research will help us better understand whether testosterone has a broader role in women's health.

For now, I believe women deserve clear, balanced advice about what we know, what we don't know, and where the evidence is still evolving.