Is testosterone the ‘missing hormone’ in midlife?

If you watched the Davina McCall menopause documentaries back in 2021-2022, you may have been part of the large increase in women requesting to have their levels checked and/or testosterone prescribed. You may have also been swept up in other influencers on social media recently claiming it to be the ‘missing hormone’ in HRT.

However, while testosterone continues to be an important hormone throughout a female’s life, this doesn’t mean all women should be having their testosterone levels checked – or that they need testosterone therapy.

Let’s dig in to why this is!

What is testosterone and what does it do?

Testosterone is an important hormone in women’s bodies, affecting the blood vessels, skin, muscle and bone, breast tissue and the brain. In both women and men, testosterone can act on its own or be converted into oestrogen.

Before menopause, testosterone is made in the ovaries, where it helps developing eggs grow and aids in oestrogen production. Some of the testosterone measured in blood is also produced outside the ovaries, such as in fat, where it is made from “pre-hormones” secreted by the adrenal glands.

Do testosterone levels decline due to menopause?

No.

Studies show that blood testosterone levels fall by about 25% between the ages of 18 - 40 years in healthy women (coinciding with the decline in eggs in the ovaries). From around 40, the rate of decline slows and blood testosterone levels don’t change when menopause occurs naturally. Studies have not shown testosterone levels change meaningfully during the menopause transition.

Problems in relying on blood tests for determining testosterone levels

Despite what influencers may have convinced you of, there is no “normal” blood level below which a woman can be diagnosed as having “testosterone deficiency”. Also, testing blood levels of testosterone in women is further complicated by:

1. Women having very low testosterone concentrations compared with men - most commercial methods used to measure testosterone cannot separate ‘normal’ from low levels in women with any certainty.

2. Testosterone levels may appear ‘low’ if blood is taken early in the menstrual cycle when testosterone levels tend to be lower.

3. In post-menopausal women, much of the action of testosterone occurs in the tissues where it is made, after which testosterone is either converted to oestrogen or broken down before it moves back into the circulation. So blood testosterone concentrations are not a true reflection of tissue concentrations.

4. There is enormous individual variability in the physiological effects of testosterone. At a given blood level of testosterone, some women might have oily skin, acne, increased body hair growth or balding, while others will have no such effects.

When might testosterone therapy be considered?

There is evidence from a number of clinical trials to support the use of testosterone therapy to improve sexual desire in post-menopausal women who have developed low sexual desire that bothers them. A systematic review of these trials found that treatment with testosterone therapy of at least 12 weeks, improved desire, arousal, orgasm and sexual satisfaction in post-menopausal women with low desire that caused them distress.

There is currently not enough evidence to confidently state that testosterone is beneficial for other menopausal symptoms, cognitive function or specific medical conditions. However, there is ongoing research investigating other potential uses for testosterone therapy including whether it may be utilised to protect against bone density loss and reductions in lean body mass seen following menopause.

In summary

Testosterone is a critical hormone for women’s overall health, influencing physical, emotional, and sexual well-being. Women experiencing persistent low sexual desire should seek professional advice to determine if testosterone therapy is appropriate for them.

References:

• Davis, S. R., et al. (2019). Global consensus position statement on the use of testosterone therapy for women. Climateric. https://doi.org/10.1080/13697137.2019.1637079

• Islam, R.M et al. (2019) Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes & Endocrinology, Volume 7, Issue 10, 754 - 766.

• Parish SJ, Simon JA, Davis SR, Giraldi A, Goldstein I, Goldstein SW, Kim NN, Kingsberg SA, Morgentaler A, Nappi RE, Park K, Stuenkel CA, Traish AM, Vignozzi L. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Womens Health (Larchmt). 2021 Apr;30(4):474-491. doi: 10.1089/jwh.2021.29037. Epub 2021 Apr 1. PMID: 33797277; PMCID: PMC8064950.

• Uloko M, Rahman F, Puri LI, Rubin RS. (2022) The clinical management of testosterone replacement therapy in postmenopausal women with hypoactive sexual desire disorder: a review. Int J Impot Res. 34(7):635-641.

Please note: This blog is intended for educational purposes and should not replace personalised medical advice. Consult a qualified healthcare provider for individual concerns.