Testosterone Supplementation and Menopause

Testosterone is increasingly recognized as an essential hormone in women’s health—one that plays a meaningful role across the lifespan and becomes especially relevant during the menopausal transition. Although commonly described as a “male hormone,” testosterone is produced naturally in women and contributes to sexual function, motivation, musculoskeletal integrity, cognitive vitality, and overall wellbeing.

As estrogen levels decline during perimenopause and menopause, many women experience changes that are not fully explained—or fully relieved—by estrogen therapy alone. For some, this includes diminished sexual desire, reduced sexual responsiveness, changes in body composition, decreased vitality, and a sense of lost connection to their physical selves. In this context, testosterone supplementation has emerged as a valuable and often underutilized therapeutic option when used thoughtfully, at physiologic doses, and with appropriate monitoring.

a woman standing in a field of flowers

This article explores the role of testosterone in the female body, how menopause alters androgen balance, and what current research and clinical consensus tell us about testosterone supplementation. By grounding the conversation in physiology and evidence—while also centering women’s lived experiences—we can better understand how testosterone therapy fits into modern, individualized menopause care.

Testosterone in the Female Body: More Than a “Male Hormone”

Testosterone is a key androgen hormone present in all women. It is produced by the ovaries, adrenal glands, and through peripheral conversion of androgen precursors such as DHEA and androstenedione. In women, testosterone acts both directly—via androgen receptors in multiple tissues—and indirectly, as a precursor that can be converted into estradiol or dihydrotestosterone (DHT).

Androgen receptors are widely distributed throughout the body, including in the brain, bone, muscle, skin, and genitourinary tissues. Through these receptors, testosterone influences:

• Sexual desire and arousal

• Motivation and reward pathways in the brain

• Maintenance of lean muscle mass

• Bone remodeling

• Energy regulation and physical confidence

Importantly, only a small fraction of circulating testosterone is “free” and biologically active. Levels are influenced by sex hormone–binding globulin (SHBG), which can rise with aging, oral estrogen use, thyroid status, and other metabolic factors. As a result, symptoms of androgen insufficiency can occur even when total testosterone levels appear “normal” on standard lab testing.

Menopause and Androgen Decline: A Subtle but Meaningful Shift

While menopause is primarily defined by declining estrogen production, androgen physiology also changes with age. Testosterone levels tend to decrease gradually across adulthood, with contributions from both ovarian and adrenal aging. Surgical menopause, chemotherapy, or premature ovarian insufficiency can accelerate this decline.

For many women, this reduction becomes clinically relevant during midlife, particularly when estrogen loss unmasks or amplifies androgen-related symptoms. These may include:

• Reduced sexual desire and responsiveness

• Increased sexual distress

• Loss of spontaneous sexual thoughts

• Decreased physical confidence or vitality

Notably, these symptoms are not always resolved with estrogen therapy alone, highlighting the complementary role that testosterone can play in comprehensive menopause care.

The Role of Testosterone in Sexual Health

The strongest and most consistent evidence for testosterone supplementation in women is in the treatment of hypoactive sexual desire disorder (HSDD) in postmenopausal women. HSDD is characterized by persistently low sexual desire that causes personal distress and is not better explained by relationship factors, untreated pain, mood disorders, or medication effects.

Clinical trials and meta-analyses demonstrate that physiologic testosterone supplementation can:

• Improve sexual desire

• Increase sexual responsiveness and arousal

• Reduce sexual distress

• Increase the frequency of satisfying sexual experiences

While the magnitude of change varies between individuals, many women report meaningful improvements in quality of life, body autonomy, and intimate connection. These benefits are particularly significant given how profoundly sexual wellbeing can influence overall mental and emotional health.

Beyond Desire: Broader Quality-of-Life Effects

Although sexual function remains the primary evidence-based indication, many women and clinicians observe broader benefits when testosterone is used appropriately. These may include:

• Improved sense of vitality or motivation

• Enhanced physical confidence

• Support for lean muscle maintenance

• Greater engagement in physical activity and self-care

While research in these areas is still evolving, these effects are biologically plausible given testosterone’s role in neuromuscular and central nervous system signaling. Importantly, these potential benefits underscore the value of individualized therapy rather than one-size-fits-all hormone protocols.

Forms of Testosterone Supplementation: Clinical Considerations

Because there is currently no FDA-approved testosterone product specifically indicated for women in the United States, therapy is typically prescribed off-label using lower doses of existing formulations or compounded preparations.

1) Transdermal Therapy (Creams, Gels, Patches)

Transdermal testosterone is the most studied and widely recommended delivery method for women.

Advantages

• Mimics physiologic daily hormone exposure

• Allows flexible dose titration

• Lower risk of supraphysiologic peaks

  
  

2) Injections and Pellets

Injectable and pellet-based therapies can be effective for some patients, particularly when adherence or absorption is a concern.

Considerations

• Require careful dosing and monitoring

• Less flexible once administered

• Best suited for experienced clinicians and well-informed patients

  
  

3) Compounded Formulations

Compounded testosterone allows dosing tailored to female physiology and can be useful when commercial options are limited. Quality and consistency depend on the compounding pharmacy and clinician oversight.

Safety and Monitoring: Supporting Long-Term Success

When testosterone is prescribed at physiologic doses and monitored appropriately, it is generally well tolerated. The most common side effects—such as acne or increased hair growth—are dose-related and typically reversible with adjustment.

Best practices include:

• Using the lowest effective dose

• Monitoring clinical response and symptoms

• Periodic laboratory assessment to avoid supraphysiologic levels

• Ongoing reassessment of benefit versus risk

Current data suggest that short- to medium-term use in appropriately selected patients is safe, though continued research will further clarify long-term outcomes.

Testosterone as Part of Comprehensive Menopause Care

Testosterone therapy is not a replacement for estrogen, nor is it a universal solution for all menopausal symptoms. Instead, it is best understood as one component of a personalized, whole-person approach to midlife hormone care.

For women experiencing distressing loss of sexual desire or related quality-of-life changes, testosterone supplementation can be a powerful and affirming option—one that validates sexual health as a legitimate and important aspect of overall wellbeing.

Conclusion

Testosterone is a vital hormone in women’s health, deserving of thoughtful consideration rather than dismissal or hype. When used intentionally, guided by evidence, and tailored to the individual, testosterone supplementation can meaningfully improve sexual wellbeing and quality of life for many postmenopausal women.

As menopause care continues to evolve, integrating testosterone into nuanced, patient-centered hormone therapy represents an important step toward more complete, compassionate, and effective support for women in midlife and beyond.

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Key References

1. Davis SR, et al. (2019).Global Consensus Position Statement on the Use of Testosterone Therapy for Women.Journal of Clinical Endocrinology & Metabolism, 104(10), 4660–4666.https://academic.oup.com/jcem/article/104/10/4660/5556103

2. Parish SJ, et al. (2021).ISSWSH Clinical Practice Guideline on the Use of Testosterone for Hypoactive Sexual Desire Disorder in Women.Journal of Sexual Medicine, 18(5), 849–867.https://www.isswsh.org/images/PDF/jsm_18_5_849.pdf

3. Islam RM, et al. (2019).Safety and Efficacy of Testosterone for Women: A Systematic Review and Meta-analysis.Lancet Diabetes & Endocrinology, 7(10), 754–766.https://pubmed.ncbi.nlm.nih.gov/31474548/

4. Wierman ME, et al. (2014).Androgen Therapy in Women: An Endocrine Society Clinical Practice Guideline.Journal of Clinical Endocrinology & Metabolism, 99(10), 3489–3510.https://academic.oup.com/jcem/article/99/10/3489/2836272

5. Santoro N, et al. (2015).Menopause: Biology and Pathophysiology.Endocrine Reviews, 36(1), 1–25.https://pubmed.ncbi.nlm.nih.gov/25540440/

6. The Menopause Society (2022).Hormone Therapy Position Statement.Menopause, 29(7), 767–794.https://pubmed.ncbi.nlm.nih.gov/35797481/