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

Mood swings, brain fog, sharp drop in libido. menopause symptoms can be debilitating. Many women turn to hormone replacement therapy for relief. These treatments are almost exclusively aimed at reversing the dramatic drop in estrogen and progesterone levels that women experience during midlife. However, research now shows that another hormone may also have benefits: testosterone. While most studies have examined its effects on libido and sexual health, preliminary evidence suggests that testosterone may help with a wide range of menopause symptoms, from mood changes to muscle loss.

We often think of testosterone as the male hormone, but it also occurs in women, usually at a tenth the level found in most men, says Sarah Glynn at the Portland Hospital in London, who worked as a consultant on menopause treatment guidelines for the British Society of Sexual Medicine. Because of this misconception, research into how it affects women's health has been limited, she said. But the situation is starting to change. Increasing evidence suggests this hormone plays a crucial role in female sex drive, and some early research suggests it's even important for brain, muscle, bone and bladder health.

Approximately half of the testosterone in women comes from the ovaries. The rest is produced in the adrenal glands, located above the kidneys. Levels tend to peak in your 20s and then gradually decline starting in your 30s. By middle age, ovarian testosterone production is about half what it used to be, scientists say. Sharon Parish at Cornell University in New York. While this usually occurs during menopause, it is probably not a direct result of it, she said.

Little is known about how this decrease affects health, but what is clear is that it can lead to decreased libido. “[Testosterone] has very important benefits for sexual function,” says Joanne Pinkerton at UVA Health in Virginia. He plays a role in sexual arousal, desire and vaginal lubrication. So it makes sense that almost half of menopausal and postmenopausal women in the report, the US struggles with libido and pain during sexual intercourse, mainly as a result of hypoactive sexual desire disorder (HSDD), a condition in which the absence of sexual fantasies or desire for at least six months causes distress. Meanwhile, the survey is more than 1800 postmenopausal women In Europe, more than a third reported a decrease in sex drive, and more than half were less interested in sex.

The idea that decreased testosterone levels leads to decreased 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, 2005 study Of 533 women with HSDD due to surgical removal of the uterus and ovaries, those who received a testosterone patch twice a week along with estrogen therapy reported more satisfying sexual experiences than those who took estrogen alone. A 2010 study found similar results among 272 menopausal women.

In 2019 meta-analysis of more than 80 studies Including 8,480 women, testosterone treatment in postmenopausal women was found to significantly increase sexual desire, frequency of sexual satisfaction, pleasure, arousal, orgasm, and self-esteem. As a result, about a dozen professional health organizations, including the International Menopause Society, the Royal College of Obstetricians and Gynecologists and the North American Menopause Society, approved the use of testosterone for the treatment of HSDD.

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

“Most healthcare providers caring for menopausal women would like FDA-approved, safe and effective transdermal medications. [testosterone] “Therapy is for women,” Pinkerton says. “We really think there is a need for it, especially in the libido area.”

The right mixture

Some doctors suggest therapy can have benefits outside the bedroom, too. A 2023 analysis Of seven studies of testosterone in postmenopausal women, it was found that it can increase muscle mass, reduce body fat, and improve insulin sensitivity and cholesterol levels. IN 2024Glynn and her colleagues assessed hormone use in 510 perimenopausal and postmenopausal women also using estrogen. After four months of treatment, about half of the participants reported fewer panic attacks and crying spells. About 40 percent also reported improvements in depression, concentration and fatigue, and more than a third reported improved memory and decreased irritability. “The most common thing I hear from women is that they feel more like themselves. They feel stronger. They feel more robust,” Glynn says.

But others are skeptical. Pinkerton notes that these studies do not include a control group and are based on self-reported improvements, raising doubts about whether testosterone or a placebo effect is responsible for these improvements. “Essentially, there is some research in the areas of cognitive function, mood, muscle strength, cardiovascular health and bones. [health]”,” says Parish. “Although they show promising results, we do not have efficacy or safety data from any substantial randomized controlled trials to warrant recommendations for these indications.”

Most studies use testosterone therapy in combination with estrogen, but some have found that testosterone alone still significantly improves sexual function. However, there is a higher incidence of side effects such as acne and excessive hair growth, so it is recommended usually not recommended. Glynn says he typically treats his patients with estrogen first and then adds testosterone if symptoms still persist.

Researchers agree that clinical trials examining the effects of testosterone beyond libido are urgently needed. Additionally, questions still remain about the effects of time, dose and duration, Pinkerton says.

It is clear that current menopause treatments are insufficient for many people, especially those with a history of hormone-sensitive breast cancer who are unable or unwilling to risk estrogen therapy as it may stimulate growth or relapse these cancer cells. “At this point, it's a big black hole that we need a lot more data on,” Glynn says.