Journal / Testosterone for Women

What You Should Know About Testosterone During Menopause

Dr. Green

Medically reviewed by Dr. Green OB/GYN

Written by Winona Editorial Team

Last updated November 25, 2021

What You Should Know About Testosterone During Menopause

When people think of hormones responsible for menopausal symptoms, estrogen and progesterone typically come to mind. But testosterone levels also drop during menopause and can have significant symptoms for women. It is important for women to consider testosterone during menopause and not just estrogen and progesterone levels when thinking about hormone replacement.

Testosterone is often referred to as the “male” hormone but it is also present and essential in females. In fact, testosterone levels in women are about 10 times higher than estrogen levels.1 Testosterone has many important roles for women. It is critical for energy levels, as well as sexual desire and response. It plays a crucial role in muscle mass and fat distribution, which makes it important for metabolic rate.

More so, testosterone influences cognition or mental acuity.2 Testosterone peaks when women are in their early twenties and continues to decline through the menopausal years. The average testosterone levels fall by about 50% by a woman’s mid-’50s. This decline is even more marked for women who have undergone surgical removal of their ovaries (oophorectomy).3

Low testosterone in women can manifest in many ways and can sometimes be subtle. Decreased energy, low libido, loss of orgasms, and decreased sexual satisfaction are the most commonly recognized symptoms. Women with low testosterone can also experience fatigue, weight gain, muscle weakness, and mood changes.

Because testosterone levels often decrease gradually over time, these symptoms can sneak up on women making it harder to recognize that there is an imbalance. Although these symptoms can occur throughout a woman’s life, low testosterone while at the menopausal stage tends to be more problematic as estrogen and progesterone levels also decrease. 

Testosterone replacement has been shown to improve the sexual health of women who suffer from decreased libido, and for women with trouble achieving orgasm.4 On average, women reported only 50% of sexual events were satisfactory, which rose to 80% after testosterone treatment. There is a 115% increase in orgasms for women taking testosterone replacement therapy.4

Testosterone plays an important role in the development of lean muscle mass. When testosterone declines, muscle mass can decrease and fat can increase. The loss of muscle mass leads to a decrease in strength and metabolic rate. Women with more lean muscle mass burn more calories at rest than women with lower muscle mass, even at the same body weight.

Women with lower testosterone levels tend to gain weight more quickly because they have a lower metabolic rate. Another way to look at weight loss or weight gain is “calories in vs. calories out.” Calories out are dependent on your metabolic rate. All else being equal, women with a higher metabolic rate burn calories more quickly and have an easier time losing weight. Yes, calories matter, but especially in menopause and perimenopause, hormones matter more. Taking HRT can have powerful effects on preventing weight gain.

When testosterone replacement is given in doses that aim to replace current levels to normal levels, testosterone is very safe. There is a slight chance of some minor side effects like mild acne or hair growth. There is no need to worry about more concerning side effects such as voice deepening, clitoromegaly, and male pattern baldness. Those things are only seen when women are taking testosterone at very large doses; levels much higher than normally found in women. High doses of testosterone are typically used by female bodybuilders. Replacing testosterone to normal levels, in women with low testosterone, is very safe with mild or no side effects.

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Myths Associated With Testosterone in Women

  • Testosterone is the male hormone and not needed in women
    This is not true. Testosterone is essential for women’s health and wellbeing and has many important functions in women’s bodies. It is made in the ovaries and present in larger concentrations than estrogen.  

  • Testosterone replacement will make me look like a man.
    This is false. Replacing testosterone to normal levels has very few negative side effects. Some women may experience mild acne or hair growth but most have no detrimental side effects at all. It is only when testosterone is given in very high doses that there are risks of more serious side effects such as voice deepening, male pattern hair growth, and clitoromegaly.

  • Testosterone replacement will give me huge muscles, I don’t want to look like an athlete from East Germany in the 1970’s.
    Another falsehood. Women who take huge doses of testosterone and train to increase muscle mass can transform their bodies into the stereotypical 1970’s athletes. This will not occur with normal replacement doses used for women wanting to regain the advantages of normal testosterone levels.

  • Testosterone replacement will change my personality and make me aggressive.
    Also not true. Replacing testosterone to normal levels will not change a woman’s personality or make them aggressive. It can help improve mood by helping women feel better and improve their quality of life. But returning testosterone to normal levels will not make a woman aggressive or change a woman’s personality.

  • Testosterone replacement is dangerous for my liver.
    Again, another false myth. It is true that testosterone is metabolized by the liver. Women who have a pre-existing liver disease, such as hepatitis, should not take hormone replacement. It is also true that in massive doses, testosterone can stress the liver. The important fact is that in healthy women, replacing testosterone to normal levels will not hurt their liver.

Summary

As women approach and go through menopause, many undesirable physical and mental changes that can occur. Replacing falling hormones can reverse these changes and return women to the healthy vigor they enjoyed before the start of menopause. Estrogen and progesterone are the hormones most often discussed and replaced. Testosterone is an important hormone for women that also decreases during menopause.  Replacing testosterone during menopause is a relevant part of hormone replacement therapy (HRT).

Winona offers testosterone replacement for symptoms of low testosterone in women. We use DHEA, sometimes in combination with anastrozole, to gently and safely return testosterone to normal levels. DHEA is a testosterone precursor. The body naturally breaks down DHEA into both estrogen and testosterone.

Taking DHEA is a natural way to replace falling testosterone to normal levels without the risk of taking too much and ending up with high testosterone levels. Anastrozole is a medication that can block the conversion of DHEA to estrogen. By adding anastrozole, more of the DHEA ends up as testosterone. This can give a slightly higher testosterone boost for women that need a bit more testosterone, but still far below a level that would have negative side effects.

Testosterone replacement is an important part of hormone replacement therapy for many women in the years surrounding and including menopause. Talk to your Winona provider about testosterone replacement that can improve mood, wellbeing, energy levels, help with weight loss, improve cognition, and restore sexual health. 

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”

References:

  1. Glaser, Rebecca, and Dimitrakakis, Constantine, “Testosterone Therapy in Women: Myths and Misconceptions.” Maturitas, Vol 74, issue 3, 2013, 230-234

  2. https://www.biotemedical.com/research/testosterone-insufficiency-and-treatment-in-women-international-expert-consensus-resolutions/

  3. Davison, S.L., et. al, “Androgen Levels in Adult Females: Changes with Age, Menopause, and Oophorectomy.” The Journal of Clinical Endocrinology & Metabolism, Vol 90, Issue 7, 2005, 3847-3853

  4. https://www.monash.edu/medicine/sphpm/units/womenshealth/info-4-health-practitioners/therapeutic-use-of-testosterone-for-women