Testosterone and Menopause: Separating Fact from Fiction

Social media often portrays testosterone as a crucial component of menopausal hormone therapy (MHT), promising relief from symptoms like low mood and brain fog. Yet, recent research challenges this narrative, revealing a more nuanced understanding of testosterone’s role during and after menopause. This article explores the latest findings on testosterone levels in women, clarifies common misconceptions, and outlines current guidelines for testosterone therapy.

The Misconception of Testosterone Deficiency in Menopause

For years, there’s been a belief that menopause leads to a significant decline in testosterone levels, creating a “testosterone deficiency syndrome” in women. However, robust studies now demonstrate that testosterone doesn’t dramatically change at menopause. Instead, testosterone levels decline with age, beginning around age 20, not specifically due to the fact that of menopause.

Early studies attempting to measure testosterone in women were limited by inaccurate testing methods, unable to reliably detect low levels. Newer, “gold-standard” methods have provided more accurate data. A 2019 study of 588 women found an average decline of approximately 25% in testosterone levels between the ages of 18 and 39 [1]. A more recent study, examining 1104 participants aged 40 to 69, confirmed this age-related decline, finding no measurable differences in testosterone levels between pre-menopausal, peri-menopausal, and post-menopausal women [1].

What the Research Reveals About Testosterone Decline

Research indicates that testosterone levels tend to decrease by about 50% from around age 20 to age 60. Interestingly, levels may then subtly increase, continuing into the eighth and ninth decades of life. The reasons behind these changes remain unclear.

The studies also showed that postmenopausal women who had both ovaries surgically removed had lower blood testosterone levels than those with at least one ovary remaining, suggesting the ovaries continue to contribute to testosterone production even after menopause [1].

Testosterone Therapy: Current Guidelines and Evidence

Whereas testosterone treatment can modestly improve sexual desire in postmenopausal women who are experiencing a bothersome change in their sexual desire [2], there is currently no robust evidence to support its use for other menopausal symptoms. International clinical guidelines state that testosterone should only be prescribed for low sexual desire in postmenopausal women [2].

The routine prescription of testosterone or dehydroepiandrosterone (DHEA) for low androgen levels due to conditions like surgical menopause is not recommended, as there is limited data supporting improvement in signs and symptoms [4].

Researchers are currently evaluating the effects of testosterone on women’s muscle function and bone density, with findings expected to be released later this year.

Testosterone and Age-Related Changes

While low testosterone isn’t directly linked to symptoms like lower sexual desire, poorer muscle mass, or lower mood, the subtle increase in testosterone levels later in life may contribute to age-related hair thinning and facial hair growth in some women.

The Role of Oestrogen in Menopause

It’s important to remember that the primary hormonal change during menopause is a substantial decline in oestrogen. Replacing this oestrogen with MHT effectively relieves symptoms such as hot flushes, night sweats, and vaginal dryness. Testosterone’s role is secondary, and its supplementation should be considered only in specific cases of low sexual desire.

The decline in testosterone levels appears to be age related at least partly due to loss of ovarian function, but can also occur more profoundly due to iatrogenic menopause which may be medical or surgical [1].