Testosterone and Menopause - Beginners Guide | Stella
9 mins

Guide to testosterone for menopause

byDr. Nick Morse

There has recently been a lot of buzz around testosterone for women going through menopause. But can it really increase your sex drive? And is it safe? We answer your questions.

What is testosterone?

Testosterone is a hormone involved in many different body functions. Although it’s often thought of as a male hormone, women also produce it. Testosterone has a number of important functions, including effects on muscle development, behavior, mood, and sex drive.

Testosterone levels in women start falling from age 30. By the start of menopause they are about half of premenopausal levels. After menopause, there is very little further change.

How does testosterone help with menopause?

Testosterone is currently prescribed to help with low libido – your sex drive – during menopause. When a lack of sexual desire affects your life for a long time and causes distress, it is known as hypoactive sexual desire disorder (HSDD). Testosterone is usually given alongside estrogen, as this helps it work best.

There are some first-hand reports but no evidence yet to show that testosterone helps with mood, energy levels, brain fog, or aches and pains. Research is ongoing.

Of course, conventional HT – estrogen with or without progesterone – has been proven to help with menopause symptoms, including hot flashes, night sweats, and mood swings, along with low libido.

Does testosterone increase your sex drive?

Clinical studies have found that if you have low libido that is bothering you, adding testosterone treatment to estrogen with/without progesterone HT can improve your sex drive and enjoyment of sexual activity. However, for women with satisfactory sex drive, adding testosterone to ‘supercharge’ sexual desire is not recommended due to the possibility undesirable side effects.

A 2017 review found that women with low libido who took testosterone had:

  • Greater satisfaction with sex
  • More sex
  • More orgasms
  • Higher sex drive

On the other hand, the research also found that those who took testosterone were more likely to experience a few potentially annoying side effects, such as acne and excess hair growth. More on these later.

Is testosterone FDA-approved for menopause?

Testosterone for women is not currently FDA-approved, but providers can still prescribe it if they think it will help you.

When prescribed for low libido, testosterone is off-label. This means that the medication has not been specifically approved for this use by the FDA. In the US, this is relatively common practice – medications are often used in different ways to those originally tested by the manufacturer.

This means that the person prescribing the medication needs to have sufficient experience to safely prescribe off-label. In the case of testosterone, this often means seeing a menopause or sexual medicine specialist.

When should you ask your healthcare provider about testosterone?

It is reasonable to ask your healthcare provider about testosterone if you are struggling with low libido or other problems with sex, especially if other treatments like HT have not helped. 

Most will recommend a trial of conventional HT before adding in testosterone for at least three months.

A prescription will only be given after a full assessment including a discussion about relationship issues, mental health, and sexual health. Many different things can contribute to low libido, so it is important to ensure you are being treated for the right thing.

It is common for your healthcare provider to check your testosterone level before starting treatment so that they can monitor your progress. Once on treatment, you will need regular tests to ensure that your testosterone level stays within the normal female range. Don’t try to interpret your testosterone blood test result by yourself. Always speak to your healthcare provider.

Just like regular HT, testosterone is not suitable for everyone. Your healthcare provider will be able to advise the best options for you.

Do you need to take testosterone if you have low levels?

Having a low testosterone level doesn’t necessarily mean that you need to start testosterone or increase your dose. Many women have low testosterone levels, but are not troubled by low libido. This is thought to happen because the amount of testosterone in the bloodstream does not accurately reflect the way testosterone might be working in the brain or other parts of the body.

How do you take testosterone for menopause?

Testosterone is taken as a gel or cream, which is applied to your skin, absorbed into your bloodstream, and distributed through your body.

Common brands include:

  • Testim
  • Tostran
  • Testogel
  • Androfeme

Tostran, Testim, and Testogel are actually designed to be used by men with low testosterone, so your doctor will prescribe a much lower dose – about 1/10th – than that listed in the patient information leaflet. 

Androfeme is licensed for use in women, but it has so far only been approved by Australian authorities.

Can you take testosterone with other types of HT?

You can take testosterone alongside other forms of HT. It is important to note that oral HT tablets can affect the way testosterone works. For this reason, your healthcare provider might recommend switching to transdermal HT, taken as patches, gels, or sprays.

Learn more with our guide to different types of HT for menopause.

What are the side effects of taking testosterone for women?

If you are taking testosterone for menopause, more common side effects are:

  • Excess hair growth
  • Acne
  • Weight gain

Rare side effects include:

  • Thinning hair
  • Deepening voice
  • Enlargement of the clitoris

It is important for your healthcare provider to monitor your testosterone levels and adjust your dose of testosterone to keep them in the normal female range. Side effects usually improve once you stop taking testosterone.

We still do not have much definite data on the long-term risks of testosterone use and research is ongoing. But recent studies looking at risks over five years of use seem to be reassuring.

Final word

Testosterone can be a useful addition to your HT treatment plan if you are struggling with low libido, but so far it hasn’t been proven to help with other symptoms of menopause.

Find out more about menopause on our blog or in our symptoms library