Testosterone is a natural female hormone, just like oestrogen and progesterone. Levels are usually highest between the ages of 18 and 24. Our levels decline steadily with age and may be up to 70% lower by the time of natural menopause.
Many women will not notice the reduction in testosterone levels over time and will have no need to replace this hormone. However for some it can be the missing piece and appears to be especially important in women with premature ovarian insufficiency (POI), early menopause and/or surgical menopause (removal of ovaries).
What is testosterone?
Testosterone is a natural androgen (sex) hormone. In males, it plays a key role in the development and maintenance of sex characteristics and functions including deepening of the voice, libido and the stimulation of sperm production.
Testosterone is an important hormone in women. It is produced in the body by your ovaries and adrenal glands, as well as other tissues and cells. It plays a role in sexual function, including libido and sexual response, and contributes to the maintenance of muscle and bone health.
Testosterone levels change throughout a woman's life, including during the menopausal transition. However, testosterone has a range of physiological effects in the body, and the evidence for using testosterone as a treatment for symptoms other than low sexual desire is limited.
Testosterone levels in menopause
Testosterone levels usually reach their peak in your early 20s. They begin to decline in your 30s and by the time you reach menopause, levels can have reduced significantly.
If you have your ovaries removed (oophorectomy) or an operation or treatment that impacts your ovarian function, you can experience a more sudden and drastic drop in hormones than would naturally occur as the ovaries are responsible for producing around half of a woman’s testosterone.
Aside from age and surgical menopause, there are other causes for reduced testosterone including:
- Turner syndrome (a genetic condition where the ovaries don’t develop)
- Pituitary gland tumour
- Radiation
- Chemotherapy
- Addison’s disease (where the body doesn’t produce enough of certain hormones)
- Ovarian insufficiency
- Malnutrition (due to anorexia, for example)
- Hyperprolactinemia (too much of the hormone prolactin)
- Hypothalamic amenorrhea (the loss of periods due to extreme weight loss, exercise or stress)
Certain medications can also lower testosterone. These include:
- Hormonal contraceptives
- Corticosteroids
- Antiandrogen medications
- Oral oestrogen
- Opioids
When might testosterone be considered?
For some women, testosterone may be considered when persistent low sexual desire continues despite optimised HRT, after other potential contributing factors have been considered.
Symptoms such as low energy, changes in mood, sleep difficulties and changes in muscle strength can have many possible causes during menopause. Some women report improvements in these symptoms when testosterone is prescribed, although evidence for benefits beyond sexual function remains limited. Your clinician will consider your individual symptoms and circumstances when assessing whether testosterone may be appropriate for you.
Should you take testosterone for menopause?
Not all women with lower testosterone levels experience symptoms, and a testosterone blood test alone does not determine whether testosterone treatment is appropriate. Treatment decisions are based on symptoms, medical history and individual circumstances.
Testosterone is not routinely used on its own to treat menopause symptoms. NICE recommends considering testosterone supplementation for women with low sexual desire associated with menopause when HRT alone has not been effective.
Some women report improvements in areas such as energy, mood, mental sharpness and physical wellbeing when testosterone is prescribed. However, evidence for benefits beyond sexual function remains limited, and current guidelines do not recommend testosterone specifically for these symptoms.
Your clinician will assess your individual circumstances and discuss whether testosterone may be appropriate for you, including the potential benefits, limitations and risks.
Side effects and risks of testosterone replacement
Many women who use testosterone experience no side effects as the dose prescribed replenishes the levels of the hormone in the body. However, like with any medication, there is a possibility of side effects including:
- Skin irritation at the application site
- Increased hair growth at the application site
- Acne
- Change in mood
- Deepening of the voice
- Enlarged clitoris
- Androgenic alopecia (hair loss)
There is limited research on how safe or effective testosterone replacement therapy is for long-term use, but studies are currently being conducted on its use to treat menopause symptoms.
Benefits of testosterone replacement in menopause
The primary use for testosterone replacement is to treat low libido/ sexual desire in women. It isn’t usually prescribed for other reasons and randomised clinical trials of testosterone to date have not demonstrated the beneficial effects of testosterone therapy for cognition, mood, energy or musculoskeletal health.
However, some women find that taking testosterone as part of their HRT regimen brings about additional benefits than when just using oestrogen.
Can a GP prescribe testosterone for menopause?
Currently, there is no testosterone product available on the NHS licensed for female use or to treat menopause symptoms. However, a specialist doctor may be able to prescribe it for you.
Types of testosterone replacement for menopause
Testosterone treatment for menopause
Testosterone is usually prescribed as a transdermal preparation, such as a gel or cream, applied to the skin. When used at appropriate doses and monitored carefully, testosterone is generally well tolerated. However, side effects can occur, particularly if testosterone levels become higher than the female physiological range.
Possible side effects include increased facial or body hair, acne, hair thinning or loss and changes at the application site. More significant androgenic effects can occur with excessive doses. Regular clinical review and blood-test monitoring can help ensure that testosterone levels remain within the appropriate range and minimise the risk of side effects.
When using testosterone gel or cream, care is needed to avoid transferring the medicine to another person through skin-to-skin contact. The application area should be allowed to dry and covered with clothing, and hands should be washed after application. The specific precautions depend on the product being used, so your clinician will explain how to apply and use your treatment safely.
If you are experiencing persistent low sexual desire despite optimised HRT, a menopause specialist can assess your symptoms, medical history and current treatment and discuss whether testosterone may be appropriate for you.
To get discuss your symptoms in more detail, book a consultation with one of our Menopause Care specialists.
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