The Role of Testosterone in Women During Perimenopause and Menopause

When we think of hormones that change during menopause, estrogen and progesterone usually take center stage. Yet, there’s another key hormone that deserves attention: testosterone. Though often labeled a “male hormone,” testosterone is vital for female health, metabolism, mood, and sexual wellbeing—and its decline during perimenopause and menopause can profoundly impact quality of life.

Testosterone: Not Just a Male Hormone

Women produce testosterone in their ovaries and adrenal glands, and it plays a role in nearly every body system. In fact, healthy premenopausal women produce two to three times more testosterone than estrogen daily. As we transition through perimenopause and menopause, ovarian and adrenal production both decline, leaving women with significant drops in circulating testosterone levels—often before estrogen levels fully plummet.

Why It’s Important to Test Testosterone

Testing testosterone (both total and free) is an essential part of a comprehensive hormone evaluation for women in midlife. Here’s why:

• Early decline detection: Testosterone levels often drop years before menopause, contributing to fatigue, irritability, low libido, and difficulty maintaining muscle tone.

• Symptom differentiation: Fatigue, low mood, and poor focus may be misattributed to stress or aging, when low testosterone is the true culprit.

• Individualized treatment: Knowing your baseline allows your clinician to tailor bioidentical hormone therapy safely and effectively.

• Monitoring safety and balance: Too much testosterone can convert to estrogen or DHT, potentially worsening hair loss, acne, or fluid retention—making follow-up labs essential for optimal dosing.

The Benefits of Testosterone Therapy for Peri- and Post-Menopausal Women

Clinical research and decades of clinical observation show that properly dosed testosterone replacement can have profound benefits for women experiencing hormonal decline.

1. Improved Energy and Motivation

Low testosterone is linked with reduced vitality, apathy, and difficulty completing tasks. Restoring optimal levels often brings back drive, stamina, and overall zest for life.

2. Enhanced Sexual Health

Testosterone plays a key role in sexual desire, arousal, and orgasm intensity. It also helps restore genital tissue health and increases sensitivity—benefits that estrogen alone may not provide.

3. Better Muscle Tone and Body Composition

Testosterone supports lean muscle mass and helps reduce visceral fat. Women on balanced testosterone therapy often notice improved strength, metabolism, and easier weight maintenance, even without major changes in exercise routines.

4. Sharper Cognition and Mental Clarity

Androgen receptors are abundant in the brain. Adequate testosterone supports neurotransmitter balance, contributing to better focus, memory, and mental resilience—particularly when combined with estrogen support.

5. Improved Mood and Well-Being

Studies show that testosterone can help stabilize mood, reduce anxiety, and improve overall sense of confidence and calm, especially in women who feel “flat” or emotionally blunted after menopause.

6. Stronger Bones and Heart

Like estrogen, testosterone contributes to bone mineral density and supports vascular elasticity. It’s one of the unsung heroes of cardiovascular protection in women.

Safe and Personalized Treatment Options

Women benefit most from bioidentical testosterone therapy, typically prescribed as a low-dose transdermal cream or gel. Dosing is far lower than what’s used for men and should always be based on symptoms, lab results, and ongoing monitoring.

At Your Functional Health, testosterone replacement is never given in isolation—it’s part of a comprehensive hormonal and metabolic assessment that includes thyroid, estrogen, progesterone, cortisol, and nutrient status. The goal isn’t just symptom relief—it’s to restore physiological balance for longevity, brain health, and vitality.

Key Takeaway

Testosterone is not optional—it’s essential. For women in perimenopause and menopause, testing and optimizing testosterone can mean the difference between “just getting through the day” and feeling strong, motivated, and fully alive. When thoughtfully prescribed and monitored, testosterone therapy is both safe and transformative.

If you’re in Texas and wondering whether testosterone therapy might be right for you…

You can schedule a virtual consultation with Xenia at Your Functional Health to review your hormone levels, symptoms, and options for personalized bioidentical hormone replacement therapy. Xenia is trained in hormone therapy by the Institute for Functional Medicine, and by Dr. Rachel Rubin, renowned urologist and sexual medicine expert.

👉 Book Your Consultation Here