Testosterone Therapy in Menopause

When we talk about menopause hormone therapy, estrogen and progesterone usually get most of the attention, but testosterone is becoming part of the conversation too.

Read on to learn about testosterone’s role in women’s health and why more women are looking for testosterone in menopause care.

Women produce testosterone too

Testosterone is often described as a male hormone, but women naturally produce it too, just in much smaller amounts. It is part of the hormone picture throughout your life, including after menopause. [1]

What testosterone does in the body

Testosterone has a role in sexual desire and arousal. It also acts on tissues throughout the body, including muscles and bones, and is converted into estrogen in some tissues. [5]

Naturally produced testosterone also acts in the brain, interacting with neurotransmitter systems — the chemical messengers that help regulate mood, motivation and other brain functions. These interactions are part of the complex hormone signalling involved in emotional wellbeing and our sense of drive and energy. [10]

This helps explain the interest in testosterone as part of menopause care.

Testosterone changes as you get older

Testosterone levels generally begin to decline during your 20s, well before menopause. The pattern varies between women and across later life. Unlike estrogen, testosterone does not usually drop suddenly when you reach natural menopause. Although, having both ovaries removed can cause a more abrupt decrease. [7, 1]

So while testosterone is often discussed in the context of menopause, changes in this hormone start much earlier on.

When testosterone is used in menopause care

In Canada, the main evidence-supported reason to prescribe testosterone for menopause is persistent low sexual desire that causes distress, often called hypoactive sexual desire disorder, or HSDD. [2, 6]

In everyday terms, you might notice that your interest in sex has fallen and that the change bothers you. HSDD involves more than having sex less often or having a different sex drive from your partner. The way you feel about the change matters. If lower desire does not bother you, it does not automatically need treatment. [2]

For postmenopausal women with HSDD, research shows testosterone can improve desire, arousal, orgasm and sexual satisfaction, while reducing distress about sex. The average benefit is moderate, and some women respond more than others. [3]

Could it help with more than libido

What about feeling tired, struggling to concentrate, losing muscle or simply feeling less like yourself?

These are common reasons women become curious about testosterone. Some report improvements in energy, mood or mental clarity while taking it. So far, though, research has not established that testosterone reliably improves these symptoms, builds muscle or protects bone health in women after menopause. [1, 3]

That does not mean the questions have been settled. More trials are underway. The ESTEEM trial is studying whether adding testosterone to hormone therapy improves menopause-related quality of life, looking beyond sexual desire alone. Researchers at Monash University are also investigating its effects on muscle strength after menopause. [8, 9]

For now, there is not enough evidence to recommend testosterone routinely for fatigue, brain fog, weight management or muscle loss. Those concerns still deserve attention and a care plan.

Low desire can have more than one cause

Testosterone is one part of the picture. Poor sleep, stress, vaginal dryness, painful sex, mood changes, relationship concerns and certain medications can all affect your interest in sex. [1]

A useful conversation with your provider looks at what has changed for you. For example, treating dryness or pain may make intimacy more comfortable. NICE recommends considering testosterone for menopause-related low desire when hormone replacement therapy alone has not helped enough. [4]

What treatment involves

Canada currently has no testosterone product specifically formulated and dosed for women. Providers may prescribe a much smaller dose of a product approved for men. This is called off-label prescribing, meaning the use falls outside the product’s approved indication. [6]

Treatment is usually applied to the skin. You will need clear instructions on how much to use and how to prevent the medication transferring to someone else through skin contact. Guidelines advise against testosterone pellets, injections and compounded products. [5]

Blood tests help your provider check that levels are not getting too high. There is no single test result that can explain your sex drive or tell you whether testosterone will help. Your symptoms and experience matter too. [2, 5]

What to know about side effects

Possible side effects include acne, extra facial or body hair, and scalp hair thinning. Too much testosterone can also cause voice changes or clitoral enlargement, which may not fully reverse. The aim is to keep levels within the usual female range. [5]

Long-term safety, including effects on breast and heart health, is still being studied. Your provider should discuss your health history and individual risks before prescribing. [1]

Give it time and keep checking in

Testosterone is not an instant fix. Some women notice a change within four to eight weeks, with fuller benefits around three months. If it has not meaningfully helped by six months, the usual recommendation is to stop and reconsider the approach with your provider. [5]

The goal is an improvement that matters to you, with a treatment you feel comfortable continuing.

Talk about what has changed for you

You do not need to know which hormone is responsible before asking for support. Whether you are noticing lower desire, uncomfortable sex or other changes around menopause, you can start by describing what feels different.

At HorminaCare, we can help you explore your symptoms and discuss options suited to your health, preferences and goals. Testosterone may be part of that conversation, alongside other ways to help you feel better.

This article provides general education and does not replace individualized medical advice.

Sources

1. British Menopause Society. Testosterone replacement in menopause. Reviewed May 2026. https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf

2. Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6821450/

3. Islam RM et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7:754–766. https://pubmed.ncbi.nlm.nih.gov/31353194/

4. NICE. Menopause identification and management. NG23. https://www.nice.org.uk/guidance/ng23/chapter/Recommendations

5. Parish SJ et al. ISSWSH Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Sex Med. 2021;18:849–867. https://www.isswsh.org/images/PDF/jsm_18_5_849.pdf

6. Menopause Foundation of Canada. Change — menopause policy agenda. https://menopausefoundationcanada.ca/change/

7. Monash University. Testosterone levels decline with age, not menopause, despite what you have heard. 2026. https://lens.monash.edu/testosterone-levels-decline-with-age-not-menopause-despite-what-youve-heard/

8. Monash University. Prevention of Muscle Loss After Menopause Using Testosterone — The PAMELA study. https://supervisorconnect.med.monash.edu/projects/prevention-muscle-loss-after-menopause-using-testosterone-pamela-study

9. ISRCTN. ESTEEM trial registration. https://www.isrctn.com/ISRCTN21554333

10. Jovanovic H et al. Effects of estrogen and testosterone treatment on serotonin transporter binding in the brain of surgically postmenopausal women — a PET study. NeuroImage. 2015. https://pubmed.ncbi.nlm.nih.gov/25462800/