Testosterone and Menopause: What Women Deserve to Know

Testosterone is often thought of as a hormone associated with men, but it plays a crucial role in women’s health too. In fact, women have 4 times more testosterone than estrogen when pre-menopausal. For (peri)menopausal women experiencing low sexual desire and other symptoms of androgen deficiency, testosterone therapy may offer significant benefits. However, the decision to use testosterone requires understanding its effects, potential risks, and the best methods of administration.

Testosterone deficiency in menopausal women

What the Research Says

A systematic review and meta-analysis of 36 randomized controlled trials, involving over 8,000 women, sheds light on the role of testosterone in improving various aspects of women’s health. The key findings are:

Sexual Function

Testosterone significantly improved several domains of sexual health for postmenopausal women:

• Increased sexual desire: Women reported a notable boost in their interest in initiating sexual activity.

• Enhanced arousal and pleasure: Studies documented improvements in arousal, sexual pleasure, and frequency of satisfying sexual events.

• Better self-image and reduced distress: Women felt more confident about their sexuality and experienced fewer sexual concerns and distress.

  
  

These findings emphasize testosterone’s ability to address low sexual desire, a common but often overlooked symptom of menopause.

Cardiometabolic Effects

The impact of testosterone on cholesterol levels and other cardiometabolic factors varied by the method of administration:

• Oral testosterone: Associated with an increase in LDL (“bad” cholesterol) and reductions in HDL (“good” cholesterol) and triglycerides.

• Non-oral testosterone (e.g., transdermal patches or creams): Showed a neutral lipid profile, making it the preferred route of administration.

Other Health Measures

While testosterone could was shown to potentially cause weight gain in the form of increased lean muscle mass and fluid retention, there is not good evidence to show that it improves:

• Body composition

• Musculoskeletal health

• Cognitive measures

  • sense of well-being, improved depression

    
    

However, data on these outcomes were limited, dose-depentent, and further research is needed. Anecdotally, some women report improvements in cognition, lean muscle mass, and exercise recovery times while on testosterone therapy. Though these claims are not strongly supported by evidence, they remain intriguing and warrant further study.

Potential Side Effects

Testosterone therapy is generally well-tolerated, but if levels rise too high, some women may experience side effects such as:

• Greasy skin and acne

• Increased hair growth (hirsutism), male pattern baldness

No serious adverse events were reported in the studies, though long-term safety data remain sparse.

Who Might Benefit from Testosterone Therapy?

Testosterone therapy may be most beneficial for:

• Postmenopausal women with low sexual desire causing distress

• Women with surgically-induced menopause: Testosterone levels drop by about 50% after oophorectomy (removal of the ovaries).

• Women with symptoms of androgen deficiency: These may include low libido, persistent fatigue, diminished motivation, and a reduced sense of well-being, even when estrogen levels are sufficient.

• Women unable to take estrogen and progesterone: Those with health conditions such as hormone receptor-positive breast cancer may be candidates for testosterone therapy, often combined with hormone replacement therapy (HRT) alternatives and vaginal estrogen.

How is Testosterone Administered?

Non-oral routes, such as transdermal patches or creams, are preferred for their neutral effects on lipid profiles. In the USA there are no testosterone formulations specifically designed for women. Instead, we use formulations for men and give at a 3-5mg dose rather than a typical 50mg dose used for men. In Australia, there is a testosterone cream approved for use in women that is essentially the same as what we prescribe here in the USA.

Key Considerations for Testosterone Therapy

1. Individualized Care: Testosterone therapy should be tailored to a woman’s specific symptoms and health profile.

2. Monitoring and Follow-Up: Regular monitoring by a healthcare provider is essential to evaluate the effectiveness and manage potential side effects.

3. Long-Term Safety: Although the short-term benefits are clear, more research is needed to understand the long-term safety of testosterone therapy.

Testosterone at Dragonfly Menopause Care

At Dragonfly Menopause Care, testosterone is a safe topic, and we often discuss it after addressing your needs with estrogen and/or progesterone. For many women, these hormones are all that’s needed to improve symptoms like brain fog, joint pain, and sleep disturbances. Once you’re feeling better overall, you may find that your libido naturally improves as well. If low libido persists, we can explore whether testosterone therapy might be the right option for you.

Some patients have mentioned to me that some menopause physicians are opposed to prescribing testosterone, and one can presume that it may be due to the lack of long-term safety data. My approach is to advise patients about this lack of long-term data, and if they understand the information, complain of low libido, and would like to proceed with testosterone, an educated patient can make her own decisions. If we do consider testosterone therapy, baseline labs are required in order to avoid prescribing it for women who have high or borderline high testosterone levels to prevent the effects of hyperandrogenism.

Conclusion

Testosterone therapy offers a promising option for postmenopausal women struggling with low sexual desire and other symptoms of androgen deficiency. Administered via non-oral routes, it can improve sexual function without significant impacts on lipid profiles. However, as with any treatment, it’s essential to weigh the benefits and risks and to work closely with a knowledgeable healthcare provider to determine the best approach for your needs.

At Dragonfly Menopause Care, Dr. Waymire is dedicated to providing evidence-based, personalized care to help you navigate the complexities of menopause. If you’re considering testosterone therapy or have questions about your symptoms, she is here to guide you every step of the way.