Understanding Testosterone During Menopause

Just like estrogen and progesterone, testosterone levels drop as women age. Many people associate testosterone with secondary sex characteristics in males, but the female body also produces the hormone. 

Testosterone, a steroid hormone released by the ovaries and adrenal glands, decreases as the function of these organs progressively declines during menopause. While production starts to dip during the late reproductive years, research shows that testosterone levels temporarily increase during menopause.⁽¹⁾⁽²⁾To better understand why these hormonal fluctuations occur, it’s important to distinguish between the different types of testosterone. Total testosterone, or serum testosterone, is the total amount of the hormone in the body, including testosterone that is attached as well as unattached to proteins. Free testosterone refers solely to testosterone that is not attached to proteins. Bioavailable testosterone includes free testosterone and testosterone that is loosely bound to albumin, a protein found in the blood.⁽³⁾

Hormonal fluctuations during menopause can cause significant symptoms, particularly those affecting sexual health. For some people, testosterone can be an important part of hormone replacement therapy (HRT) during this stage of life.

Testosterone Levels in Menopause

Testosterone is highest when women are in their 20s. In contrast, postmenopausal testosterone levels drop to approximately 15% of the levels seen in premenopausal women.⁽⁴⁾ This decline is even more pronounced in women who have undergone surgical removal or partial removal of their ovaries, known as an oophorectomy. Research shows that testosterone levels can be up to 50% lower in women with surgically induced menopause compared to women who experience natural menopause.⁽¹⁾

Low Testosterone in Menopause

Testosterone plays many important roles in the female body. It influences energy levels, cognition, lean muscle mass, and fat distribution.⁽⁵⁾ However, signs of low testosterone during menopause can sometimes be subtle.

Declining testosterone levels can impact women’s sexual health. Decreased libido, difficulty achieving orgasm, and reduced sexual satisfaction are among the most commonly recognized symptoms, all of which are potential signs of hypoactive sexual desire disorder (HSDD). Approximately half of women in menopause or postmenopause in the United States experience symptoms of HSDD.⁽¹⁾ 

Women with low testosterone may also experience fatigue, bone loss, hot flashes, decreased muscle strength, and mood changes.⁽⁶⁾ Because testosterone levels decrease gradually over time, these symptoms can sneak up on women, making it harder to recognize an imbalance. In addition, the effects of low testosterone during menopause may be further compounded by additional hormonal fluctuations, such as changes in estrogen and progesterone levels.

High Testosterone in Menopause

Small increases in testosterone during menopause are related to a protein called sex hormone binding globulin (SHBG). Predominantly produced in the liver, SHBG helps regulate the amount of free testosterone available in the body.⁽⁷⁾ When SHBG levels are elevated, testosterone decreases. During menopause, SHBG levels drop, leading to an increase in testosterone.⁽¹⁾

Increases in testosterone during menopause are minor and temporary, as overall hormone levels continue to decline as women age. This temporary rise does not cause symptoms of high testosterone, such as voice deepening, excess hair growth, or male-pattern baldness, which are typically associated with very high doses of testosterone replacement that exceed physiological levels.⁽⁸⁾⁽⁹⁾

Postmenopausal Testosterone Levels

For approximately half of postmenopausal women, ovarian testosterone production is minimal.⁽¹⁰⁾ For others, the ovaries continue to secrete a fair amount of testosterone, though production is about 50% lower than premenopausal levels. In some women, testosterone continues to decrease for two to five years after menopause, reducing levels by approximately 60%.⁽⁴⁾In contrast, some women may develop postmenopausal hyperandrogenism. The condition is characterized by an excess of steroid hormone production, particularly testosterone. Symptoms are typically mild, including acne or increased facial or abdominal hair growth.

Postmenopausal hyperandrogenism is primarily associated with menopause or polycystic ovary syndrome (PCOS). However, tumors, type 2 diabetes, obesity, and insulin resistance have also been linked to the condition. Depending on the cause and severity of symptoms, treatment may involve medications or surgery.^(11)(12)

Testosterone Replacement in Menopause

Testosterone replacement therapy (TRT) is not currently approved by the U.S. Food and Drug Administration (FDA) for women. In some cases, however, compounded bioidentical testosterone may be prescribed off-label for women during postmenopause.^(13)(14) These hormones differ from synthetic HRT, as they are derived from plants and closely mimic the chemical structure of the body’s natural hormones.

Experts state that transdermal testosterone may be used as a short-term treatment option for postmenopausal women experiencing low libido.⁽¹³⁾ Testosterone may be prescribed along with estrogen or other hormones.

Dehydroepiandrosterone (DHEA) supplementation may also be an option for postmenopausal women experiencing symptoms related to sexual function. DHEA serves as a hormone precursor to testosterone and estrogen production. Supplementing with DHEA may increase natural levels of testosterone.⁽¹⁵⁾While guidelines for the use of TRT primarily focus on postmenopausal women, some research suggests that testosterone may also benefit menopausal women as well as premenopausal women in their late reproductive years who are diagnosed with HSDD.^(6)(16)

Testosterone for Menopause Symptoms

Symptoms commonly experienced during menopause include the following:

• Hot flashes 

• Night sweats 

• Mood changes 

• Changes in sexual function 

• Vaginal dryness

• Low libido

• Decreased sexual satisfaction

• Muscle weakness

• Loss of bone mineral density

Restoring testosterone to normal physiological levels may help alleviate some of these symptoms by improving psychological health, cognitive function, bone and muscle strength, and more.⁽⁶⁾TRT has also been shown to improve the sexual health of postmenopausal women experiencing low libido and difficulty achieving orgasm. A clinical trial published in Menopause similarly found that premenopausal women with low sexual desire who used testosterone cream also experienced improvements in psychological well-being and sexual function.⁽¹⁷⁾

Side Effects of Testosterone for Menopause

When testosterone is prescribed in doses that raise the hormone to normal levels, it’s considered safe for menopause. There is a chance of minor side effects, like mild acne or hair growth, but many women experience no adverse effects.⁽¹⁴⁾ More significant side effects, such as voice deepening, clitoromegaly, and male pattern baldness, are typically seen in women taking testosterone at very large doses — levels much higher than those normally found in the body.⁽⁹

DHEA supplements can help restore testosterone to normal physiological levels. Taking DHEA is a natural way to replace declining testosterone, reducing the risk of overcorrection and excessive testosterone levels.

For some women, testosterone replacement is an important part of HRT in the years surrounding and including menopause. A healthcare provider can help determine on an individual basis if HRT options that address mood, well-being, energy levels, cognition, and sexual health are an appropriate intervention.