What happens to testosterone levels during menopause? And how can it affect us?

Testosterone tends to be primarily spoken of as a ‘male’ hormone but, along with oestrogen and progesterone, it is also an important one for women. Getting enough of it is important for energy levels, a healthy sex drive, maintaining muscle mass and bone health during menopause[1] and some studies suggest it can help with psychological and other physical symptoms.[2] Levels of it, however, decline gradually with age and tend to plateau around the time many women enter perimenopause and this can lead to a loss of sex drive, energy, low mood and harm concentration and confidence levels.[3] It also has a part to play in bone, muscle and skin health.

Recent data analysed by The Pharmaceutical Journal reveals NHS prescriptions for it have risen 10 fold in the last seven years but given that many women may be getting it privately means those figures may be higher [figure t/c from NHS FOI request as to what percentage of women have been prescribed it on the NHS].[4] The fact that it is also referred to as the ‘mojo hormone’ and some menopause experts are currently describing it as ‘the missing piece of the menopause jigsaw’ when taken alongside standard HRT – it is perhaps unsurprising that it is fast becoming a focus of menopause treatment and many women are evangelical about its benefits. Many have been posting on social media that after using it they have more energy, stamina, sleep better, think more clearly and their mood improves. Various newspaper coverage reflects many women’s positive experiences of how their brain fog has lifted, they have renewed enthusiasm for life and their ‘sexual spark has been reignited’.[5]

But whilst it could be a game changer for many menopausal symptoms its role remains slightly controversial and it is not suitable for everyone.

Benefits of testosterone for women

Oestrogens are the dominant sex hormones for women but androgens like testosterone (partially produced by the ovaries and also the adrenal glands in women) also play an important role. Although women produce around one tenth of the amount that men do, it is equally important for both and contributes to sexual desire, arousal and orgasm. It is also linked to improved bone health and the maintenance of muscle mass plus increased energy, stamina and concentration.[6] Testosterone is also linked to the neurotransmitter dopamine (this relationship is a bi-directional one so testosterone affects dopamine and dopamine affects testosterone). Dopamine is said to play a role in pleasure, concentration and decision-making.[7]

What happens to levels during menopause? 

Whilst levels of the hormones oestrogen and progesterone decrease significantly around the time of menopause, testosterone levels do not. These show a very gradual decline with age, where they tend to plateau at around 40 for women. For many, these declining levels are barely perceptible but others will be more sensitive to their effects and find their libido is almost non-existent and their energy and ability to concentrate are equally flagging.

Whilst dwindling testosterone is a natural part of ageing (for both women and men) one major cause of testosterone deficiency in women is surgical menopause (when a woman has her ovaries removed as part of a hysterectomy or other procedure) – when levels of it can drop quite dramatically, very quickly.

A Global Consensus Position Statement on the Use of Testosterone Therapy for Women in 2019[8] recommended testosterone only for postmenopausal women who have hypoactive sexual desire disorder (HSDD) – that is persistent lack of desire after other factors have been taken into consideration and ruled out (like depression, relationship problems, ill health, medication.) The National Institute for Health & Care Excellence (NICE) and The British Menopause Society (BMS) recommends testosterone as a medication for low libido for some women.[9] The BMS say that if a woman has low testosterone levels but is not complaining about low libido or other life-affecting symptoms, there is no need for her to be routinely prescribed testosterone.[10]

Signs and symptoms of low testosterone in women

• Decrease in sex drive (including sexual thoughts or fantasies)
• Difficulty becoming aroused or reaching orgasm
• Extreme tiredness and fatigue
• Lack of concentration
• Muscle weakness
• Thinning hair
• Weight gain
• Mood swings
• Headaches

How do you know if you need testosterone during menopause?

A diagnosis of low testosterone is usually made based on your symptoms and medical history alone – there is generally no need for a blood test but it can occasionally be useful in some cases to confirm if your levels are low.

Testosterone is usually only prescribed by a GP or menopause specialist if a woman’s sex drive does not improve after using standard HRT. Testosterone must always be used in addition to standard HRT as it works more effectively when used alongside oestrogen. Dosage is important – too much can cause nasty side effects (see below) and too little will be ineffective. It is also important not to think of it as a quick fix – it can take between three and six months to notice an improvement and if there isn’t one after this time I would recommend you stop using it.

Taking testosterone during menopause

Testosterone is usually prescribed as a gel or cream and is rubbed into the skin. Products that are commonly prescribed include:

• Tostran® – a gel that comes in a pump dispenser which you use three times a week
• Testogel® – a gel that comes in a sachet that you use over a week.

Testosterone is not, however, officially licensed in the UK to treat low sex drive in menopausal women and, as such, is known as an ‘off-label’ medicine in that the manufacturer of it has not specified that it can be used for women for this purpose. There does, however, seem to be irrefutable evidence that it can boost low libido and so doctors and menopause experts can prescribe it for this reason – but only for this reason. Rigorous research carried out by Professor Susan Davis involving 36 trials and 8,480 women concluded it does increase desire, pleasure and arousal but that no benefits were found to suggest it improved mood, brain health, bone density or muscle strength.[11]

Researchers are currently in the process of developing the world’s first testosterone patch for post-menopausal women. Clinical trials begin in the UK in the Autumn of 2023.[12]

Side effects of testosterone during menopause

There aren’t usually any side effects from testosterone – the amount you are prescribed is intended to help levels return to pre menopause levels not push them abnormally high. However, if you have used too much over time you could see some of the side effects listed below. It is also not uncommon to find you notice more hair growth in the areas where you apply the gel but this is generally avoided by applying it to areas with few hair follicles like the inner thigh or buttocks.

There is some evidence to suggest high testosterone levels are related to increased cancer risk[13] and women who have hormone-sensitive breast cancer or liver disease should not be prescribed it.[14]

Signs and symptoms of high testosterone in women

• Increased body hair, including facial hair
• Greasy skin and acne
• Balding
• Decrease in breast size
• Increased muscle mass
• Deepening of the voice
• Enlarged clitoris

How to increase testosterone naturally in women

• Some studies (on men) have shown that having a diet high in ultra-processed foods appears to reduce levels of testosterone but eating healthy natural foods, particularly those which are good sources of the mineral zinc and also vitamin D,[15] appear to help maintain normal testosterone levels. Key testosterone-maintaining foods include oysters and shellfish, avocadoes, salmon and mushrooms. Vegan options include tofu, pulses, oats, walnuts, cashew nuts, chia seeds, hemp seeds, pumpkin seeds and spinach. Chickpeas, lentils and beans are also a good source and research suggests sprouting, [16]soaking or fermenting them can improve zinc levels further. Nutritional Therapist Helen Roach discusses this more in Foods that boost testosterone in menopause
• Sleep. This is when your body produces hormones including testosterone and if you are not getting enough (and this is generally taken to mean between seven and nine hours nightly) it could be affecting your production of testosterone.[17] Given that in recent Health & Her research women report sleep disruptions and tiredness as one of their most common perimenopause and menopause symptoms, this could potentially be influencing your testosterone levels. If you are struggling to get enough, Nutritional Therapist Rosie Letts suggests a range of natural ways to improve your menopause sleep.
• Reducing caffeine. Caffeine has been shown to increase testosterone in men but lower it in women. It is also a recognised trigger known to make perimenopause and menopause symptoms worse for many women. In Health & Her research, caffeine is the fourth most common trigger for exacerbating perimenopausal symptoms so it should help to cut down or switch to decaf varieties of tea, coffee, cola or chocolate. This should also help improve the quality of your sleep.
• Exercise. Physical activity increases testosterone because it increases muscle mass. Weight training and High Intensity Interval Training (HIIT) have been shown to increase testosterone levels in men. Regular exercise will also help to keep your weight down and being overweight or obese is linked to lower testosterone.

Frequently asked questions

References and sources

^{[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098532/#:~:text=Testosterone can be important in,, sexual function, and energy.&text=Adequate levels of testosterone are,possibly vascular and brain function.}

^{[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999217/}

^{[3] https://www.panmerseyapc.nhs.uk/media/2599/testosterone_women.pdf}

^{[4] https://pharmaceutical-journal.com/article/feature/testosterone-for-menopause-why-women-face-difficulties-accessing-treatment#:~:text=On 17 February 2023, data,about the menopause in 2021}

^{[5] https://www.dailymail.co.uk/health/article-9409805/How-testosterone-provided-cure-businesswomans-low-libido-menopausal-brain-fog.html}

^{[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098532/#:~:text=Testosterone can be important in,, sexual function, and energy.&text=Adequate levels of testosterone are,possibly vascular and brain function. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098532/#:~:text=Testosterone can be important in,, sexual function, and energy.&text=Adequate levels of testosterone are,possibly vascular and brain function.}

^{[7] https://www.webmd.com/mental-health/what-is-dopamine}

^{[8] https://academic.oup.com/jcem/article/104/10/4660/5556103}

^{[9] https://thebms.org.uk/2023/03/bms-statement-on-testosterone/#:~:text=healthcare professionals alike.-,British Menopause Society guidance follows NICE NG23 which recommends that,plateaued out and are stable.}

^{[10] https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf}

^{[11] https://www.monash.edu/medicine/news/latest/2019-articles/large-study-shows-beneficial-role-of-testosterone-for-postmenopausal-women}

^{[12] https://warwick.ac.uk/newsandevents/pressreleases/?newsItem=8a17841a8727a18c018746616f9e0131}

^{[13] https://pubmed.ncbi.nlm.nih.gov/15531122/#:~:text=However, in postmenopausal women, who,with greater breast cancer risk.}

^{[14] https://www.bupa.co.uk/newsroom/ourviews/menopause-testosterone#:~:text=Some people can’t take,-label’ medicine for menopause.}

^{[15] https://blog.insidetracker.com/can-vitamin-d-restore-low-testosterone-levels#:~:text=Vitamin D and testosterone: Not,concentrations and total testosterone levels.}

^{[16] Health & Her research conducted Oct 2020 – Sept 2022}

^{[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445839/#:~:text=The majority of the daily testosterone release in men occurs during sleep.&text=Sleep fragmentation and obstructive sleep apnea are associated with reduced testosterone levels.}