Updated: Aug 21
Testosterone is often thought of as 'the male hormone', but it is an important sex hormone for everyone, and it too declines with age (and with induced menopause).
Testosterone in larger quantities produces stereotypical male traits and reproductive characteristics. Those assigned female at birth also produce testosterone, along with the sex hormones estrogen and progesterone.
When it comes to discussion of menopausal hormone replacement, much attention has been given to estrogen, but testosterone has been largely ignored in this process. It is also a controversial topic amidst providers in its use for those who are not cis male.
This is unfortunate, since those assigned female at birth often begin to experience symptoms related to testosterone decline well before symptoms related to the fall in estrogen. In those assigned female at birth, production of testosterone peaks in the mid 20’s and begins to steadily decline to about 50% by age 40. This is when many patients will often present with complaints of increased abdominal fat, hair loss, fatigue, brain fog, loss of sex drive, reduced orgasm, anxiety, irritability, depression, headaches, and general lack of well-being.
We may attribute these symptoms to aging, but some believe testosterone replacement has the potential to improve mood, libido, orgasm, energy level, lean body mass, and general feeling of well-being. Proponents of testosterone therapy tout the potential health benefits of reduced cardiac risk, improved bone density, and reduced breast cancer risk. Some advocate that testosterone therapy can be beneficial for symptomatic individuals as early as a decade or more before onset of the menopausal transition.
Testosterone contributes to libido, sexual arousal and orgasm and is also involved in metabolic functions related to muscle and bone strength, mood and cognitive ability.
In those assigned female at birth, testosterone is produced in the ovaries, adrenal glands and fat cells at about a tenth of the amount of testosterone that the cis- male body produces. While estrogen and progesterone decrease significantly at menopause, testosterone levels gradually decrease with age.
Some folx will not notice any symptoms as levels fall. Others though may be more sensitive to the changes and experience lack of sexual desire, low mood, low energy and impaired focus and concentration.
In addition to aging, a major cause of testosterone deficiency is surgical removal of the ovaries. This can cause an abrupt drop in testosterone and the onset of symptoms.
Testosterone combined with estrogen can improve sexual function and bone density in cis women, but is not FDA approved for this purpose.
Testosterone, an essential precursor of estrogen in cis women, is made in the ovaries and adrenal glands. There is a steady decline in testosterone levels from the 20's through menopause. With surgical menopause, the level of testosterone drops precipitously. No clear lower limit of testosterone has been established; however 15 ng per dL (0.5 nmol per L) commonly is used. One study found that women with 0 to 10 ng per dL (0 to 0.3 nmol per L) had markedly decreased sexual desire in all situations and absent or markedly decreased orgasms.
Many patients started on testosterone usually (not everyone however!) notice an improvement in libido and energy within days or weeks.
Testosterone is important for cis women since it is a major precursor of estradiol production. In premenopausal cis women, circulating testosterone levels are approximately 10-fold greater than estradiol levels. The normal range for testosterone in women is 15 to 70 ng/dL, and by the time women reach their 40s, their testosterone levels are approximately one-half less than in their 20s.
Those who could become pregnant should avoid testosterone therapy, because its use during pregnancy introduces the risk of the development of male traits in a female fetus. Testosterone therapy should also be avoided in women who have or have had breast or uterine cancer, have high cholesterol or heart disease, or have liver disease.
A study using combined estrogen and testosterone preparations for treatment showed uncommon side effects of alopecia, acne, and hirsutism, although these side effects are dependent on dosage and duration.15 Low incidence rates of deep voice, oily skin, acne, and male-pattern hair loss were found in a few controlled studies. Virilization can occur with higher-than-normal dosing of testosterone, but it is uncommon and reversible.18 Women using the lowest effective dosage of testosterone have not been shown to experience side effects or adverse events. Increased dosages inevitably result in the aforementioned adverse effects, as well as increased hair growth.
At Hearthside Medicine Family Care, we may offer testosterone in addition to other hormones used in the treatment of perimenopausal or menopausal symptoms. We can prescribe testosterone as a cream, troche (dissolves in mouth), or gel. We don't prefer to offer it via the oral or injection route for safety reasons. We also offer testosterone for cis men and for transgender men.
To learn more about perimenopause, menopause, hormones in general, options for hormones, safety, side effects, and more, check out our following blogs on hormones & health:
An In-Depth Look at Your Options: https://www.hearthsidemedicine.com/post/an-in-depth-look-at-your-hormone-options
Weight gain, low sex drive, moods--It might be perimenopause: https://www.hearthsidemedicine.com/post/low-sex-drive-moods-weight-insomnia-it-might-be-perimenopause-sooner-than-you-think
Navigating Menopause Naturally: An Integrative Medicine Approach
Havilah Brodhead, FNP is a family nurse practitioner and owner of Hearthside Medicine in Bend Oregon. Havilah and her NP partner Marie are progressive and compassionate providers who are passionate about hormones and health.
Both are taking new patients and accept most insurances. Marie and Havilah are able to provide telehealth to anyone residing in Oregon, in person clinic care to those willing to travel to Bend, OR, and Marie can also offer telehealth care to those residing in California.