Beyond Estrogen: Why Testosterone May Be the Missing Piece in Perimenopause Relief

5 min readAug 12, 2024

Testosterone is frequently associated with men, but it plays a crucial role in women’s health as well. In fact, women produce three to four times more testosterone than estrogen before menopause. This hormone is produced in the ovaries, adrenal glands, and peripheral tissues, contributing to several physiological processes, including:

Sexual function
Cognitive performance
Mood regulation
Bone density
Muscle strength

During perimenopause, the gradual decline in testosterone levels can lead to symptoms such as reduced libido, fatigue, cognitive changes, and mood disturbances.

Symptoms Treated by Testosterone

1. Sexual Dysfunction

One of the most well-documented benefits of testosterone therapy in women is the improvement in sexual function. A systematic review and meta-analysis found that testosterone significantly increased sexual desire, arousal, orgasm, and overall sexual satisfaction in postmenopausal women. This is particularly important as reduced libido is a common complaint among perimenopausal women.

2. Cognitive Function and Mood

Testosterone has a significant impact on cognitive function and mood. It helps regulate neurotransmitters like serotonin and dopamine, which are crucial for mood stabilization and cognitive clarity. Studies have shown that testosterone supplementation can improve mood, reduce anxiety, and alleviate symptoms of depression in perimenopausal women.

3. Energy and Stamina

Fatigue and reduced energy levels are common during perimenopause. Testosterone helps improve overall energy and stamina, both physically and mentally. Women undergoing testosterone therapy often report increased vitality and a better ability to engage in daily activities.

4. Bone and Muscle Health

Testosterone plays a vital role in maintaining bone density and muscle mass. A decline in testosterone levels can lead to osteoporosis and decreased muscle strength, making women more susceptible to fractures and physical weakness. Testosterone therapy has been shown to improve bone density and muscle strength, thereby enhancing overall musculoskeletal health.

Safety and Efficacy

The safety and efficacy of testosterone therapy in women have been subjects of extensive research. A systematic review highlighted that non-oral testosterone administration (e.g., transdermal patches or creams) is preferred due to its neutral lipid profile and fewer side effects. Common side effects include mild acne and hair growth, but serious adverse events are rare. Long-term studies have also indicated a potential reduction in the incidence of invasive breast cancer among women on testosterone therapy.

A Patient Success Story

Samantha was struggling with severe fatigue, low libido, and mood swings. Despite being on estrogen and progesterone therapy, her symptoms persisted. After a thorough evaluation, we decided to incorporate testosterone into her treatment plan.

Within a few weeks, she reported a significant improvement in her energy levels and mood. Her libido returned, and she felt more connected to her partner. Over time, her muscle strength and bone density also improved, allowing her to engage in physical activities she had previously avoided. This success story is just one of many that highlight the critical role of testosterone in comprehensive hormone therapy for women.

Why Use Testosterone?

The current recommended reason for testosterone therapy is for persistent low sex drive (Hypoactive Sexual Desire Disorder, HSDD) in women after all other possible factors, including taking adequate estrogen, have been addressed. Even with this indication, it does not help everyone. There is not enough evidence at the moment to recommend its use for low energy, low mood, fatigue, or brain fog.

How is Testosterone Treatment Given?

Testosterone is usually given as a gel, which you rub into your skin. It comes as a gel in a small tube, or sachet and you only need to rub a pea-sized amount of this gel into your skin. One 50mg sachet or tube should last around 10 days. The gel should be rubbed onto your lower abdomen, thighs, or the inner aspect of your forearm.

Testosterone is not currently licensed for use by women, so it is said to be prescribed ‘off license.’ Your prescriber will explain this to you. Usually, you will also be recommended HRT alongside testosterone as well as vaginal estrogen if needed to treat vaginal dryness. It can sometimes take a few months for the full effects of testosterone to work; a 3–6 month trial is often recommended.

Are There Side Effects?

If you use the recommended dose, i.e., a small amount over a week or more, side effects are very few. Rotate the area of skin you apply it to and do not use more than suggested. Higher doses may lead to unwanted effects such as acne and occasional hair growth. There is a lack of long-term data for women using testosterone, but data up to five years shows no adverse effect in healthy women after menopause.

Do I Need a Blood Test?

Blood tests are not able to diagnose whether or not you need testosterone but are used as a safety check to ensure you are not getting too much on top of your own natural levels. Blood tests before starting might be suggested with repeat testing after 3–6 months on treatment.

Conclusion

Testosterone plays a crucial role in alleviating various symptoms associated with perimenopause, including sexual dysfunction, cognitive decline, mood disturbances, fatigue, and musculoskeletal issues. Despite the controversy surrounding hormone replacement therapy, recent studies provide robust evidence supporting the safety and efficacy of testosterone supplementation in women. As awareness grows, more women may benefit from this therapy, leading to improved quality of life during perimenopause and beyond.