Testosterone Replacement in Menopause
 

Testosterone Replacement in Menopause

Dr. Sarah Ball, MD and Menopause Specialist, Health in Menopause

(www.healthinmenopause.co.uk, Instagram: @drsarahmollyball)

Testosterone Levels in Women Explained

In the menopause community today, testosterone is a real buzzword. It’s sparking plenty of discussion as awareness about its importance grows across medical, media, and wellness spaces.

Despite having a medical degree and more than two decades as a GP specializing in women’s health, I used to think of estrogen and progesterone as women’s primary reproductive hormones. While I knew that women (including trans men and some non-binary people) have small amounts of testosterone, I hadn’t paid it much attention — except to note that those with polycystic ovary syndrome (PCOS) naturally have higher levels of it.

Looking back now, I realize that some women who had their ovaries removed (often during a hysterectomy, triggering surgical menopause) were sometimes prescribed both estrogen and testosterone afterward — a practice that now makes perfect sense.

The truth is, women naturally produce healthy levels of testosterone, especially in their 20s. While total levels are only about 10% of what men produce, testosterone receptors are found throughout nearly every tissue in the body. From the early 30s onward, levels begin to decline by roughly 1% per year. So, low testosterone at menopause isn’t just about menopause itself (except for surgical menopause, where levels drop abruptly) — it’s also part of the aging process. However, symptoms often become more noticeable during menopause due to the additional hormonal fluctuations that occur.

Treating Menopause Symptoms: Estrogen, Progesterone, and Testosterone

Once I began focusing on menopause care, clear patterns started to emerge among the hundreds of women I saw. Many women in perimenopause or menopause feel significantly better once they start hormone replacement therapy (HRT), often noticing improvements in symptoms like:

  • Mood changes

  • Hot flashes

  • Fatigue and poor sleep

  • Brain fog

  • Aches and pains

  • Skin changes

  • Vaginal dryness

  • Low libido

  • Urinary symptoms

  • Migraines

For women with a uterus, HRT typically combines estrogen with progesterone.

Still, results vary widely, some women feel dramatically better, others partially, and some not much at all.

Even after optimizing estrogen and progesterone doses, many continue to experience persistent symptoms such as low libido, fatigue, brain fog, loss of physical strength or stamina, and mood changes. In these cases, adding transdermal testosterone can often make a real difference.

Accessing Testosterone in the U.S.

In the United States, testosterone therapy for women is still underrecognized, but access is gradually improving. While testosterone has not yet been formally approved by the FDA for use in women, many menopause and hormone specialists prescribe it off-label when clinically appropriate.

The current medical consensus supports testosterone therapy primarily for women with hypoactive sexual desire disorder (HSDD), or persistently low libido that doesn’t improve with estrogen therapy alone. However, an increasing number of clinicians also recognize its broader potential benefits for energy, cognition, and mood — even if large-scale studies are still underway to confirm these effects.

In the U.S., testosterone is typically prescribed in topical forms, such as gels or creams, using low doses tailored for female physiology. Some compounded formulations are also available through reputable compounding pharmacies, though these should be prescribed and monitored carefully by a qualified healthcare provider.

Women using testosterone are typically monitored through follow-up blood tests after several months to ensure levels remain within the optimal female range. When prescribed appropriately, side effects like acne, oily skin, or hair growth are rare.

The Role of Vaginal Health

It’s also important to remember that low libido during menopause isn’t always caused by testosterone deficiency alone. Vaginal dryness, irritation, and discomfort during sex can play a major role — and these symptoms often respond best to localized treatments such as:

💧 AH! YES® VM — a long-lasting vaginal moisturizer that provides hydration for up to three days

🌿 AH! YES® WB — a pH-balanced, water-based lubricant for comfort and connection

Using these alongside hormone therapy — or on their own if you prefer to avoid hormones — can help improve comfort, confidence, and intimacy.

In summary: Testosterone therapy isn’t just for men. When used carefully and under medical supervision, it can help many women regain energy, focus, strength, and sexual wellbeing during and after menopause. And for those managing vaginal dryness or discomfort, natural, hormone-free support can make all the difference.

Because women deserve to feel strong, confident, and comfortable, at every stage of menopause. 💜

NICE: Menopause Diagnosis and Management: http://www.nice.org.uk/guidance/ng23

Davis SR, Baber R, Panay N et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019; 104(10):4660-4666

Glaser R and Dimitrakakis C. Testosterone Implant Therapy in Women With and Without Breast Cancer: Rationale, Experience, Evidence. Androgens: Clinical Research and Therapeutics. 2021; vol 2.1:94-110

Glaser R and Dimitrakakis C. Testosterone therapy in women: Myths and misconceptions. Maturitas 2013; 74:230-234

Panay N. British Menopause Society Consensus Statement: Testosterone replacement in menopause. December 2022

HRT Easy Prescribing Guide. Newson Health Menopause Society. 2022 https://balance-menopause.com/uploads/2021/10/Easy-HRT-prescribing-guide-NHMS.pdf

Women’s Health Concern Fact Sheet: Testosterone for Women. 2022 https://www.womens-health-concern.org/wp-content/uploads/2022/12/22-WHC-FACTSHEET-Testosterone-for-women-NOV2022-B.pdf