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title: "Testosterone and Menopause: The Hormone Nobody Talks About" description: "Testosterone is not just a male hormone. It's essential for women's libido, energy, strength, and mood — and it declines significantly during menopause." publishedAt: "2026-03-26" author: "MenoCue" category: "treatment" tags: ["testosterone menopause", "low libido menopause", "testosterone women", "HSDD menopause", "menopause energy"] featured: false excerpt: "Women produce testosterone throughout their lives, and declining levels in menopause cause real symptoms. Here's what you need to know about testosterone therapy for women."

Testosterone and Menopause: The Hormone Nobody Talks About

When people think about menopause hormones, they think estrogen and progesterone. But there is a third hormone that declines significantly during the menopause transition that very few women — or even doctors — discuss: testosterone.

Women produce testosterone throughout their reproductive lives. It plays a critical role in libido, energy, mood, muscle mass, bone density, and cognitive function. When testosterone declines, the symptoms are real, impactful, and often attributed to "just getting older."

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Women Need Testosterone Too

Testosterone is produced in women by the ovaries and adrenal glands. Women produce substantially less than men — but that doesn't mean it's less important. The female body is highly sensitive to testosterone, and even small changes in levels have noticeable effects.

Throughout the reproductive years, testosterone contributes to:

• Sexual desire and arousal
• Energy levels and stamina
• Mood and sense of wellbeing
• Muscle strength and maintenance
• Bone density
• Motivation and drive
• Cognitive sharpness

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How Testosterone Declines During Menopause

Testosterone levels in women actually begin declining gradually from the late 20s and 30s — well before estrogen and progesterone fall. By perimenopause, many women are already working with lower testosterone than they had in their 20s.

The ovaries produce roughly half of a woman's testosterone. When the ovaries stop functioning at menopause, there is a significant additional drop. Women who have had both ovaries removed (bilateral oophorectomy) experience a sudden and dramatic fall.

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Symptoms of Low Testosterone in Women

Low testosterone is clinically underrecognised in women. Its symptoms overlap with other menopause symptoms, making it easy to miss:

• Low or absent libido: the most well-documented symptom; loss of sexual desire, reduced arousal, fewer spontaneous sexual thoughts
• Fatigue and low energy: a persistent tiredness not explained by sleep
• Reduced sense of wellbeing and motivation: flatness, reduced drive, loss of initiative
• Muscle weakness: difficulty maintaining or building muscle even with exercise
• Mood changes: low mood, reduced resilience, difficulty finding enjoyment
• Cognitive difficulties: reduced focus, motivation, and sharpness

The overlap with estrogen deficiency symptoms makes diagnosis complex. Some women find that estrogen replacement addresses most symptoms but that libido, energy, and wellbeing remain poor — which can indicate that testosterone is also low.

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Low Libido in Menopause: Understanding HSDD

Hypoactive sexual desire disorder (HSDD) — persistent, distressing loss of sexual desire — affects an estimated 30-40% of postmenopausal women. It has multiple contributing factors:

• Testosterone deficiency (decreased desire and arousal)
• Estrogen deficiency (vaginal dryness, painful sex, reduced genital sensitivity)
• Relationship factors
• Psychological factors (body image, anxiety, depression)
• Medications (SSRIs in particular suppress libido)
• Sleep deprivation

Both estrogen and testosterone typically need to be addressed to fully restore sexual wellbeing. Vaginal estrogen addresses the physical aspects; testosterone addresses desire.

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Testosterone Therapy for Women

Testosterone therapy for women is available but remains significantly underused due to:

• Lack of licensed products specifically for women (in most countries)
• Insufficient training in prescribing testosterone for women
• Residual myths about testosterone being a "male hormone"

The evidence: A 2019 systematic review in The Lancet Diabetes & Endocrinology found testosterone therapy to be the most effective treatment for low sexual desire in women, with benefits across desire, arousal, orgasm, and satisfaction.

Forms Available

Testosterone gel (most commonly prescribed): Designed for men but used at approximately one-tenth the male dose for women. Applied to the inner thigh or lower abdomen. Examples: Testogel, Testim, Tostran.

Testosterone cream: Available in some countries, can be compounded to lower doses.

Implants: Subcutaneous pellets; less commonly used.

What to Expect

• Effects develop gradually over 3-6 months
• Libido and energy are typically the first improvements noted
• Mood and wellbeing often improve
• Muscle maintenance becomes easier

Monitoring

Blood testosterone levels should be monitored 3-6 months after starting to ensure levels remain within the normal female range. Side effects at appropriate doses are rare but can include acne, increased body hair, and voice changes — these are typically dose-related and reversible.

Who Can Prescribe It

GPs and gynaecologists can prescribe testosterone for women, though many are unfamiliar with it. Menopause specialists are typically most comfortable with prescribing and monitoring.

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Testosterone vs Estrogen: Do You Need Both?

Many women on HRT who have persistent fatigue, low libido, or reduced wellbeing despite adequate estrogen may benefit from adding testosterone. The two hormones are not interchangeable:

• Estrogen addresses: hot flashes, sleep, vaginal health, bone protection, heart health
• Testosterone addresses: libido, energy, motivation, muscle, and contributes to bone and mood

If you are on HRT and still experiencing these specific symptoms, it is worth asking your doctor about testosterone specifically.

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Talking to Your Doctor

Bring up testosterone if you are experiencing:

• Significantly reduced libido
• Persistent fatigue despite adequate sleep
• Loss of motivation and drive
• Muscle weakness
• Poor sense of wellbeing despite estrogen being well-managed

Useful framing: "I've read that testosterone can help with libido and energy in menopause. Can we discuss whether it might be appropriate for me and how to assess my levels?"

Be aware that many GPs will not proactively raise testosterone. You may need to ask. A referral to a menopause specialist may be warranted.

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Tracking Testosterone-Related Symptoms

Because testosterone-related symptoms (libido, energy, mood, motivation) overlap with estrogen-related symptoms, tracking them specifically helps establish whether they improve with estrogen alone or require additional treatment.

In MenoCue, you can log energy levels, libido, and mood daily. If these remain low after estrogen is well-established, that pattern in your symptom log becomes useful evidence for a conversation with your doctor about testosterone.

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This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting any hormone treatment.