Menopause is a natural phase in a woman’s life that comes with a host of uncomfortable symptoms, which can be classified broadly into four main categories: 1) Genitourinary Syndrome (GSM), 2) Vasomotor symptoms and related heart health issues, 3) musculoskeletal issues, and 4) Cognitive issues. Of these, GSM typically presents itself with low libido, dyspareunia (painful intercourse), vaginal atrophy, frequent urination and sometimes incontinence. This can lead to poor quality of life and social stress for your relationships.

​There has been much discourse about testosterone being a worthwhile supplement for managing GSM (the genitourinary symptoms of menopause), and there’s a growing number of women who are demanding it from their OB/GYN physicians as a part of their Menopausal Hormone Therapy (MHT). However, testosterone supplementation isn’t a solution that’s safe or suitable for all women.

Testosterone And Menopause

Testosterone is commonly believed to be a male hormone. However, women also make this hormone, but in lower amounts than men.

The ovaries and the adrenal glands (located on top of the kidneys) produce testosterone, which plays a vital role in libido, bone strength, sexual response, cognitive performance, energy levels, and more.

Though women produce three to four times as much testosterone as estrogen before menopause [1], their testosterone levels gradually decrease as they age. During menopause, the testosterone levels in most women fall to about one-quarter of what they were at their peak during their 20s. [2] A sudden decrease in testosterone levels also happens when both the ovaries are removed. [3]

When the hormone levels fall, women start experiencing depression, lower energy, and lower sex drive (libido).

How Does Testosterone Help Treat The GSM Symptoms?

Testosterone is best known for improving libido. However, testosterone receptors are present all over the body, so its effects are far-reaching.

​The hormone plays a vital role in strengthening nerves and arteries in the brain, thereby contributing to mental sharpness and clarity and protecting against memory loss. It also stimulates the release of serotonin and dopamine, improving overall mood and feelings of pleasure. It further boosts overall energy levels by improving muscle mass and bone strength. [4]

Perhaps this is why a lot of women take testosterone as part of their hormone replacement therapy (HRT), reporting: [5]

• Increased libido

• Improved energy

• Enhanced muscle strength

• Improved focus and mental clarity

• Improved sleep

​

Who Should Use Testosterone, And Who Shouldn’t?

​Due to the lack of long-term safety data for cardiovascular and breast outcomes, testosterone isn’t licensed for use in women, except in Australia, where Androfeme (1% of testosterone cream) is approved. [6]

​However, specialist doctors do prescribe testosterone supplementations to women whose sex drive doesn’t improve with MHT. This is because the NICE Menopause Guideline (NG23) [7] and the British Menopause Society (BMS) [8] state that a trial of HRT should be given to women before considering testosterone supplementation.

​Testosterone can be taken as a tablet/capsule. However, it isn’t recommended due to its negative impact on blood cholesterol levels. Transdermal delivery, such as gel, cream, patches, or implants, is generally considered the safest in doses that reflect young women’s testosterone levels.

Side Effects

​Adverse effects of testosterone in women are uncommon, given the supplementations are provided within the physiological range. The most common side effects include:

• Hair growth

• Acne

• Weight gain

These effects are reversible and can be addressed either by discontinuing the use of testosterone or by lowering its dosage. More severe but rare side effects include:

• Alopecia

• Deepening of voice

• Clitoral enlargement

Typically, testosterone has to be prescribed for 3-6 months before its efficacy can be thoroughly evaluated. [9] Furthermore, an annual re-evaluation of ongoing usage is performed just like with the standard HRT to weigh the pros and cons of long-term usage.

​Women with an active liver or cardiovascular disease or with a history of hormone-sensitive breast or endometrial cancer should avoid testosterone usage. [10]