Can Testosterone Help with Perimenopause Symptoms?

Though it’s commonly associated with male hormones, testosterone production isn’t exclusive to men. 

In fact, testosterone plays a vital role in supporting bone health, mental wellbeing, and reproductive functioning among women.¹ Given the benefits of testosterone in proper amounts, researchers have examined whether or not testosterone therapy could help women experiencing certain menopause symptoms. 

In this article, Dr. Alyssa Dweck, Chief Medical Officer at Bonafide, weighs in on testosterone use and perimenopause, and whether or not testosterone therapy may help those navigating symptoms of the menopause transition.

Why is Testosterone Important for Women?

In women, testosterone is primarily a sex hormone produced in the ovaries and adrenal glands, which are the endocrine glands located at the top of each kidney.² And according to Dr. Dweck, the proper balance of testosterone throughout a woman’s body helps drive several important functions. 

“Testosterone is an androgenic hormone produced primarily by the ovaries in women,” explains Dr. Dweck. “It’s associated with sexuality, including libido— or sexual drive – and physical arousal. Testosterone also contributes to musculoskeletal health, cognitive function, and cardiovascular health.”

It’s possible to have too much or too little testosterone in the body. In fact, high testosterone levels in women are thought to be a main driver in developing polycystic ovary syndrome (PCOS), a disease affecting up to 10% of premenopausal women.³

Testosterone and Menopause - What to Expect

Women with low testosterone levels, on the other hand, may experience low sex drive, depression, weakness, and more.⁴ If you’re perimenopausal and these symptoms sound familiar, Dr. Dweck offers insight into why. 

“Testosterone production in women peaks during their twenties and declines steadily with age starting from when one enters their thirties,” says Dr. Dweck. “Decline is more notable during perimenopause and menopause.”

She adds that certain medications, like hormonal contraceptives and corticosteroids, can alter testosterone levels, too.⁵ 

“Testosterone levels can be diminished with use of oral estrogen including the birth control pill,” explains Dr. Dweck. “In fact, the ratio of testosterone and estrogen is of importance; as estrogen declines in menopause, higher relative testosterone related symptoms, such as acne or facial hair, might be notable.”

Perimenopause Low Testosterone Symptoms

While a blood test is the only way to confirm low testosterone levels, there may be symptoms to key you in that levels may be off.⁶ Symptoms of low testosterone can include:^7,8

• Low libido (sex drive)
• Low energy
• Loss of muscle mass
• Trouble conceiving
• Vaginal dryness
• Low mood/mood disorders like depression or anxiety
• Thinning hair
• Dry skin
• Trouble sleeping

Menopause and Testosterone Therapy

Knowing the importance of hormonal balance, it’s not unusual for women to wonder— can testosterone therapy help during perimenopause and beyond?

Unfortunately, research is mixed. Many experts believe testosterone may boost libido for women in postmenopause, but the data is unclear on how safe it is for long-term use.⁹ Additionally, it may not be safe for women with heart, blood vessel, or liver disease.¹⁰ 

For some women, however, testosterone therapy during menopause may be beneficial.  The International Menopause Society advises practitioners to measure testosterone levels closely when administering testosterone therapy, which can be effective in improving sexual wellbeing, arousal, orgasm, and pleasure.¹¹ Testosterone supplementation during menopause can come in the form of prescription gels or creams, where they’re then absorbed into the bloodstream.^{12, 13}

Testosterone therapy has been used for decades across England and Australia to alleviate symptoms of perimenopause, but it’s still considered off-label in the United States.¹⁴ Dr. Dweck adds that while it’s not yet FDA approved, it’s not uncommon for women to explore testosterone treatment for improving menopause symptoms especially those that are related to sexual response and wellness. 

“Testosterone is not an FDA approved drug for women; however, it is commonly prescribed for HSDD (hypoactive sexual desire disorder) or low libido and efficacy is supported by The Menopause Society and endocrine societies for such,” says Dr. Dweck. “Research suggests that supplementation [with testosterone] may improve musculoskeletal health and cognitive function in the postmenopausal woman but further long-term safety data is still needed.”

Is Testosterone Therapy Right for You?

If you think you may be experiencing symptoms of a testosterone imbalance or are interested in incorporating testosterone into your symptom management regimen, the first step is to schedule an appointment with your healthcare provider. A physician can assess your symptoms and order necessary blood work to determine your hormone levels and, from there they can discuss options for addressing menopause symptoms like low libido, mood disorders, and more. 

It's also important to note that testosterone supplementation during menopause doesn’t come without potential side effects or risks. Common side effects from testosterone use may include:^15,16

• Acne
• Hair growth on the face and body
• Hair loss on the head
• Weight gain
• Clitoris enlargement
• Headaches
• Deepening of the voice
• Headaches

If you’re interested in exploring testosterone therapy during menopause, be such to reach out to your healthcare provider so you can determine the best course of action for your unique needs. 

Resources:

1.  https://www.webmd.com/women/normal-testosterone-and-estrogen-levels-in-women
2.  https://www.health.harvard.edu/staying-healthy/testosterone--what-it-does-and-doesnt-do
3.  https://www.health.harvard.edu/staying-healthy/testosterone--what-it-does-and-doesnt-do
4.  https://my.clevelandclinic.org/health/diseases/24897-low-testosterone-in-women
5.  https://my.clevelandclinic.org/health/diseases/24897-low-testosterone-in-women
6.  https://www.medicalnewstoday.com/articles/322663
7.  https://my.clevelandclinic.org/health/diseases/24897-low-testosterone-in-women
8.  https://health.clevelandclinic.org/low-testosterone-in-women
9.  https://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/testosterone-therapy/faq-20057935
10. https://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/testosterone-therapy/faq-20057935
11.  https://pmc.ncbi.nlm.nih.gov/articles/PMC7098532/#
12.  https://pmc.ncbi.nlm.nih.gov/articles/PMC7098532/#:~:text=They%20concluded%20that%20testosterone%20can,concerns%20and%20distress%20about%20sex.
13. https://www.healthline.com/health/low-dose-testosterone-for-females#menopause-care
14. https://www.healthline.com/health/low-dose-testosterone-for-females#menopause-care
15. https://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/testosterone-therapy/faq-20057935
16. https://www.healthline.com/health/low-dose-testosterone-for-females#side-effects