Estrogen and progesterone are the primary sex hormones in women, whereas testosterone is the primary sex hormone in men. However, the female body also produces testosterone, which plays a vital role in women’s health and well-being.
Supplementing testosterone can be an important part of hormone replacement therapy (HRT) for some women. However, there is no FDA-approved testosterone replacement therapy (TRT) treatment for menopause symptom relief. In some cases, the hormone may be prescribed off-label with dose modifications or, more commonly, in combination with estrogen for postmenopausal women experiencing decreased libido.(1) While testosterone is a controlled substance, DHEA is a non-controlled option for increasing natural testosterone levels.
“At Winona, we do not offer testosterone treatment on our telehealth platform, as it is a controlled substance. Instead, we offer DHEA at 25-50mg capsules as a great way to safely and gently increase testosterone levels in perimenopause without the side effects that may accompany testosterone replacement therapy.”
In women, testosterone is mainly produced by the ovaries, with levels peaking during their 20s and then decreasing by approximately 50% as menopause approaches.(2) When women have both ovaries surgically removed via a procedure called oophorectomy, levels drop precipitously. Because testosterone has many important functions in female physiology, those functions can suffer when testosterone decreases.
Some of the areas where testosterone plays a key role include the following:(3)(4)(5)
Libido, sexual response, orgasm, and overall sexual satisfaction
Lean muscle mass, metabolic rate, and weight maintenance
Energy levels and fatigue management
Brain function: concentration, clarity of thought, and overall cognition
Bone health
Breast health
Skin, hair, and nail health
Replenishing the body’s diminishing reserves of testosterone can ensure that these functions continue uninterrupted and improve quality of life and sense of well-being. This article aims to educate on the risks and benefits of TRT.
Benefits of Testosterone Replacement Therapy
Testosterone plays an important role in many systems and functions of the female body, and supplementation can help address the declining levels of this hormone as women reach menopause. The following are some of the key areas that can benefit from TRT.
Sexual Well-Being
While decreased sex drive or libido can occur for various reasons, low testosterone levels have been found to be a major risk factor for women over the age of 40. Studies have shown that supplementing testosterone can help restore healthy sexual desire.(3)
Additionally, low testosterone levels can reduce the size and sensitivity of the clitoris, which can make it more difficult to reach orgasm or even lead to loss of orgasm potential. Replacing testosterone to reach normal levels can reverse these changes and help maintain the ability to achieve orgasm.(6)(7)
Women who undergo TRT report increased overall sexual satisfaction and an improved quality of life. Sexual satisfaction can affect women’s contentment in other areas of life, especially in intimate relationships. This, in turn, can lead to improved mood, a boost in self-image, and decreased anxiety.(8)(9)(10)
Lean Muscle Mass, Body Weight, and Energy
Testosterone is important for increasing lean muscle mass — muscles that are densely packed with contractile tissue rather than with higher amounts of fat and connective tissue. Maintaining and increasing lean muscle reduces the risk of injury to ligaments and tendons and improves posture by strengthening the core and back muscles. As a precursor to testosterone, DHEA can also support muscle strength.
Since testosterone is responsible for increased muscle mass and leaner body mass, it may help with weight maintenance. With greater muscle mass comes a boost in metabolism. Although this increase is minor and won’t significantly increase the number of calories burned, a small boost in metabolism may support weight management efforts when combined with other healthy habits.(11)
TRT can also improve energy levels. Women with low testosterone are more prone to low energy and fatigue. Research studies show that testosterone treatment can increase muscle tone and strength, as well as boost energy.(3)(12)
Bone Health
Loss of bone mineral density (osteopenia and osteoporosis) is associated with increased risk for bone fracture and is a significant health concern for women as they age. Osteoporosis can lead to life-threatening bone fractures, especially in the hip. It’s also responsible for compromising the integrity of the spine, leading to a loss of height, vertebral fractures, back pain, abnormal curvature of the spine, and even nerve damage.(13)
Low testosterone has been found to be an important risk factor for bone mineral density loss in women. Restoring testosterone to normal levels can help support bone density, both directly and by increasing lean muscle mass, which helps protect weakening bones.(3)
Brain Health
Normal testosterone levels support clarity of thought, concentration, and overall cognition. As testosterone decreases during the menopause transition, it can result in brain fog and other mental health concerns like mood changes, irritability, anxiety, and depression. Returning testosterone to normal levels may help reduce brain fog, restore optimal brain function, and support mental health.(14)
Misconceptions Associated with Testosterone Replacement Therapy
When testosterone replacement, whether by testosterone or DHEA, is used solely to return testosterone to normal physiological levels, side effects are rare and usually mild if they do occur. The side effects sometimes associated with TRT include voice deepening, clitoromegaly (enlarged clitoris), and male pattern baldness. However, these effects are usually associated with very large doses, where testosterone levels are much higher than the threshold normally found in women.(15)
Because there are unwanted side effects associated with taking high doses of testosterone as a performance-enhancing drug, there are common misconceptions about the general use of supplementing testosterone:(16)
Testosterone is a male-only hormone.
Testosterone is actually produced by the ovaries and even found in larger concentrations than estrogen. It’s essential for women’s health and well-being and performs many important functions in the female body.(3)
Testosterone replacement will give a woman masculine characteristics.
It’s only when testosterone is administered in very high doses that there’s a risk of side effects like voice deepening or male pattern baldness. Replenishing testosterone to normal levels results in very few negative side effects for women, with some experiencing mild acne or hair growth, and most experiencing none at all.(17)
Testosterone replacement causes disproportionately large muscles.
Women who take large doses of testosterone and train to increase muscle mass can transform their bodies, but this does not occur with normal replacement doses used for combatting symptoms of the menopause transition.
Testosterone replacement makes people aggressive.
Replacing testosterone to normal levels will not change a woman’s personality. It can, however, help improve mood and address other symptoms for improved quality of life.(16)
Testosterone replacement is dangerous for liver health.
Oral testosterone is metabolized by the liver, and women with preexisting liver conditions like hepatitis should not take hormone replacement. While it’s true that high doses of testosterone can negatively impact the liver, using testosterone or DHEA at doses indicated for treatment during perimenopause or menopause is unlikely to affect liver health.(16)
Using DHEA to Increase Testosterone Levels
Dehydroepiandrosterone (DHEA) supplements may be recommended as an alternative to TRT. Produced in the adrenal glands, ovaries, testes, and brain, DHEA is a hormone precursor that gets converted into the sex steroid hormones estradiol (a type of estrogen) and testosterone.(18)
As women age, levels of DHEA decline. DHEA has weak androgenic effects and oral supplementation has been shown to increase women’s natural testosterone levels.(18) As a result, women may experience improvements in common menopausal symptoms, including skin changes, vaginal dryness, and brain fog. DHEA supplements and other hormone replacement alternatives are accessible online with a medical provider’s prescription.
