Estrogen and progesterone hormone therapy are standard for easing menopausal symptoms, but a very different type of hormone treatment may ease certain issues too: testosterone therapy.
Classified as an androgen,
testosterone famously triggers male physical sexual development, but it also plays a significant role in women’s bodies.
“Most of the testosterone in a woman’s body is used for our sexual function, but it also helps with our strength, cognition, and mood, says Tangela Anderson Tull, MD, a menopause specialist with Hoffman and Associates, an all-female obstetrics and gynecology practice affiliated with Mercy Medical Center in Baltimore.
Testosterone therapy is not currently approved by the U.S. Food and Drug Administration (FDA) for women, but some doctors do prescribe it off-label.
Here’s what to know about this method of menopause treatment, and if it will help you address your symptoms.
The Role of Testosterone in the Female Body
While often considered a male hormone, testosterone has important physiological effects in women throughout their lives. It plays a role in:
“Testosterone is a critical hormone in women,” says
Mary Rosser, MD, PhD, an obstetrician-gynecologist, menopause expert, and the director of Integrated Women's Health at Columbia University’s Irving Medical Center in New York City. It’s also a precursor for estradiol production, the most powerful type of estrogen in the female body.
As we age, testosterone levels start dropping in the body, but in a different way than estrogen does. “Testosterone levels do not decline significantly at menopause itself,” says Dr. Rosser. “They decline gradually with age starting in the early reproductive years. “This is an important distinction that challenges common assumptions about menopause and testosterone.”
When testosterone levels are lower, it may result in these symptoms, many of which directly overlap with the ones commonly associated with the menopausal transition:
- Low sex drive
- Fatigue
- Loss of strength and muscle tone
- Infertility or trouble conceiving
- Irregular menstrual cycles
- Vaginal dryness
- Depression or anxiety
- Thinning hair
- Dry, brittle skin
- Trouble sleeping
What Is Testosterone Therapy for Women?
Testosterone therapy is an off-label treatment, typically for postmenopausal women with low libido. But current research suggests that it may also have benefits for perimenopausal women experiencing sexual problems, anxiety, vaginal dryness, irritability, and physical and mental exhaustion.
This type of therapy has gained mainstream attention recently, despite being used for more than 80 years to treat
perimenopause and menopause symptoms. Testosterone therapy has been licensed for use in women in England and Australia for six decades.
“When I [first] trained there was no mention of testosterone therapy for women beyond sexual function,” says Dr. Anderson Tull. “It wasn’t until I did training years later and started to do my own research that I found that patients were reporting they felt significant improvements in brain fog, hot flashes, and other menopausal symptoms, too.”
How It’s Administered
Since it’s not FDA approved, there are no recommended dosages. You’ll work with your doctor to determine what amount may be effective for you. Testosterone comes in different formulations, including:
- Creams and Gels This is the safest and most common form. They’re typically applied daily to the lower abdomen or buttocks.
- Pellet Therapy Testosterone pellets are intended to deliver the hormone for three to four months, and sometimes up to six. A doctor will place it under the skin in a 15-minute in-office procedure.
- Injections These shots are administered into a muscle every week or two, although some formulations can be given every 10 weeks.
Dr. Rosser says the most extensively studied formulation is a transdermal patch, but it’s not currently available in the United States. She also urges caution with certain types of testosterone therapy, as it can be difficult to control the amount of testosterone that is absorbed by the body.
Testosterone is also available in OTC supplements and compounded products, but these are mostly unregulated in the United States, so it’s best to avoid using over-the-counter testosterone products.
What Testosterone Can and Can’t Do for Perimenopause Symptoms
Emerging science suggests testosterone may be an effective treatment for certain perimenopausal symptoms, although more research is needed.
Low Libido
Testosterone has shown the most promise in treating an unwanted decrease in sexual desire, a symptom that may impact as many as a third of women in perimenopause.
“Testosterone therapy has demonstrated moderate effectiveness in postmenopausal women with distressingly low sexual desire,” says Rosser.
She points to a comprehensive meta-analysis involving 8,480 participants that found testosterone significantly increased satisfactory sexual events, sexual desire, pleasure, arousal, orgasm, and responsiveness, while reducing sexual concerns and distress.
“[Low libido] is the only evidence-based indication for testosterone use in women,” says Rosser.
Hot Flashes
Conventional hormone therapy remains the go-to treatment for hot flashes. Testosterone plays a minor role in managing
vasomotor symptoms, but is not currently considered a first-line treatment.
But some research suggests testosterone shows promise in that area. An observational study of 78 perimenopausal and menopausal women treated with testosterone pellet therapy over the course of 10 years reported that their hot flashes were significantly reduced.
Mood and Brain Fog
Rosser says that the current evidence doesn’t support testosterone use for mood and brain fog.
“Available data show no effect of testosterone therapy on depressed mood, and there is insufficient evidence to support its use to enhance cognitive performance or delay cognitive decline in postmenopausal women,” she says.
She pointed to one small pilot study which suggested improvements in mood and cognition with testosterone therapy, but it was a retrospective study without a control group and requires confirmation in randomized trials.
Fatigue
Testosterone therapy is commonly used to address fatigue in men; however, there is less evidence to support its use in perimenopausal and menopausal women.
Results from the previously mentioned pellet therapy study found that fatigue improved considerably after treatment.
More studies are needed to confirm their findings.
Risks and Side Effects of Testosterone Therapy
When used at dosages that approximate pre-menopausal levels, testosterone therapy has only mild side effects, though long-term safety has not been established.
Common side effects, which are typically reversible when you stop taking testosterone, may include:
- Acne
- Excessive hair growth
- Weight gain
More serious side effects, such as
alopecia (hair loss), voice deepening, and clitoral enlargement are rare with testosterone replacement.
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