Menopause is a significant phase in a woman's life, marking the end of her reproductive years. While it brings about a range of changes, both physical and emotional, one aspect that has garnered attention in recent years is the role of testosterone therapy for women during menopause. Estrogens are the principal sex hormones we associate with women, however, the androgens - testosterone (a sex steroid) and dehydroepiandrosterone (DHEA) play important roles in your reproductive tissues, mood, cognition, breast, bone, muscle, and other systems.
Testosterone is not just an ovarian hormone. Women produce testosterone in 3 areas of the body: the adrenal glands (25%), the ovary (25%), and the conversion from other hormones in your body’s tissues (50%). Unlike the sex hormones estrogen and progesterone, the production of testosterone does not come to a screeching halt in menopause. Instead, testosterone slowly begins its decline in one’s 30s. Once a woman enters menopause, the ovary still produces testosterone.
Many practitioners recommend hormone testing to determine if your estrogen, progesterone, and testosterone are low. We know your estradiol and progesterone will be low in menopause - that is the definition! Testing testosterone is also not useful to determine if you are deficient. There is no absolute testosterone level that determines if a woman is deficient. That’s right - no blood, saliva, or urine test can accurately determine if you have “low” testosterone, otherwise known as an androgen deficiency. Despite multiple clinical studies, the medical community just doesn’t know what an accurate “low” or “normal” level is for a woman at every age. Furthermore, a decline in testosterone has not been shown to correlate with clinical symptoms of low mood, decreased muscle mass, or weight gain. In fact, despite what you may see advertised on social media and the internet, The Endocrine Society, The American College of Obstetricians and Gynecologists, and The Menopause Society do not recommend prescribing testosterone to improve mood, hot flashes, night sweats, bone health, muscle mass or for weight management. The only evidence-based reason for women to supplement testosterone is to treat a low sex drive in menopause after you have optimized your estrogen and progesterone with hormone therapy.
So what does one do to combat feeling fatigued, flabby, and not in the mood in perimenopause and menopause? First, treat your symptoms with estrogen and add progesterone if you have a uterus. You can use hormone therapy safely even if you are still getting a period every month.
Once your energy improves with hormone therapy, add resistance training to boost your muscle mass, improve your metabolism, and reshape your body, bringing your internal and external sexy back. When most women find improvement in their menopause symptoms and have happy vaginas and overall health, they feel better about themselves and their desire naturally improves. If you feel good, are happy with yourself and your relationship with your significant other, are not suffering from menopausal symptoms, and still lack desire, you may be suffering from hypoactive sexual desire, and giving testosterone a try is absolutely indicated.
Testosterone has a vital role in menopause care, but the scientific evidence points to it being helpful for some, not everyone. If you believe you would benefit from testosterone, give estrogen a try first. Estrogen always comes before testosterone in evidence-based menopause care.
The content is meant for educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Please seek the advice of your physician with any questions you may have regarding a medical condition.