Testosterone helps libido in menopause – can it treat other symptoms?

Mood swings, brain fog, plummeting libido – menopausal symptoms can be debilitating. Many women turn to hormone therapy for relief. These treatments focus almost exclusively on restoring the declining estrogen and progesterone levels that women experience in midlife. Yet research now suggests another hormone may also have benefits: testosterone. While most of the research has looked at its effect on libido and sexual health, preliminary evidence suggests that testosterone can help with a wide range of menopausal symptoms, from mood swings to muscle loss.

We often think of testosterone as a male hormone, but it is also present in women, just usually at one-tenth the level of most men, says Sarah Glynne at the Portland Hospital in London, who has worked as an adviser on menopause treatment guidelines for the British Society of Sexual Medicine. Because of this misunderstanding, research into how it affects women’s health has been limited, she says. But that is starting to change. More evidence reveals the hormone’s crucial role in female sex drive, and some early studies show it’s even important for brain, muscle, bone and bladder health.

About half of testosterone in women comes from the ovaries. The rest is made in the adrenal gland, which sits on top of the kidneys. Levels tend to peak during a woman’s 20s and then gradually decline starting in their 30s. In middle age, ovarian production of testosterone is about half of what it used to be, says Sharon Parish of Cornell University in New York. While this tends to occur around menopause, it’s probably not a direct result of it, she says.

Little is known about how this decline affects health, but it is clear that it can lead to low libido. “[Testosterone] has a very important benefit for sexual function,” says JoAnn Pinkerton of UVA Health in Virginia. It plays a role in sexual arousal, desire, and vaginal lubrication. So it makes sense that nearly half of menopausal and postmenopausal women in the United States report struggling with libido and pain during intercourse, largely as a result of hypoactive sexual desire disorder (HSDD), a fantasy disorder or a fantasy disorder. at least six months causes distress. Meanwhile, a study of more than 1,800 postmenopausal women in Europe found that more than a third reported decreased sex drive and more than half were less interested in sex.

The idea that declines in testosterone levels drive lack of libido dates back to the 1940s. Since then, study after study has shown that testosterone replacement therapy improves sexual function in menopausal and postmenopausal women. For example, a 2005 study of 533 women with HSDD due to surgical removal of their uterus and ovaries found that those treated with a twice-weekly testosterone patch along with estrogen therapy reported more satisfying sexual experiences than those given estrogen alone. A 2010 study found similar results among 272 menopausal women.

In 2019, a meta-analysis of more than 80 studies, including 8,480 women, found that treatment of postmenopausal women with testosterone significantly increased sexual desire, frequency of satisfying sexual activities, pleasure, arousal, orgasm and self-image. As a result, about a dozen professional medical organizations, including the International Menopause Society, the Royal College of Obstetricians and Gynecologists, and the North American Menopause Society, endorsed the use of testosterone for HSDD.

One reason testosterone increases libido is that it interacts with brain receptors that activate nerve pathways that control desire, Parish says. So far, only four countries have approved a testosterone product designed for women: Australia, New Zealand, South Africa and, in July, the UK. The US Food and Drug Administration (FDA) has not followed suit due to concerns that there is not enough data tracking potential long-term side effects. But Parish believes this is misplaced, noting that some studies have followed participants for years and found no increased risk of heart, breast or uterine problems.

“Most providers who care for menopausal women would love to have an FDA-approved, safe and effective transdermal [testosterone] therapy for women,” Pinkerton says. “We really think there’s a need for it, especially in the libido area.”

The right mix

Some doctors suggest that the therapy may also have benefits beyond the bedroom. A 2023 analysis of seven studies of testosterone in postmenopausal women found that it can increase muscle mass, lower body fat, and improve insulin sensitivity and cholesterol. In 2024, Glynne and her colleagues evaluated the use of the hormone in 510 perimenopausal and postmenopausal women who were also using estrogen. After four months of treatment, about half of the participants reported fewer anxiety attacks and crying. About 40 percent also reported improvements in depression, concentration and fatigue, and more than a third experienced improved memory and decreased irritability. “What I hear most often is women saying they feel more like themselves. They feel stronger. They feel more resilient,” says Glynne.

But others are skeptical. Pinkerton notes that these studies do not include a control group and rely on self-reported improvements, raising questions about whether it is testosterone or the placebo effect that is driving them. “There is basic research into cognition, mood, muscle strength and cardiovascular and bone health [health]”, says Parish. “Although these show promising results, we do not have efficacy or safety data in any large randomized controlled trial to warrant recommendations for these indications.”

Most studies use testosterone therapy in conjunction with estrogen, but some have found that testosterone alone still meaningfully improves sexual function. However, there is a higher incidence of side effects such as acne and excessive hair growth, so it is not usually recommended. Glynne says she usually treats her patients with estrogen first and then puts testosterone on if symptoms persist.

Researchers agree that clinical trials examining testosterone’s effects beyond libido are desperately needed. Plus, there are still questions about the impact of timing, dose and duration, Pinkerton says.

What is clear is that current menopausal treatments are not sufficient for many people, especially those with a history of hormone-sensitive breast cancer, who cannot or do not want to risk estrogen therapy, as it may stimulate the growth or recurrence of these cancer cells. “It’s a big black hole at the moment that we need a lot more data on,” says Glynne.