Testosterone and Menopause: A Guide to Symptoms, Solutions, and Science

Introduction

Yes, women produce testosterone. And, yes, you are in the right place. During menopause, the decline in testosterone leads to symptoms such as fatigue, low libido, mood swings, and cognitive changes. At Meno-Start, Dr. Shannon Cothran provides expert care, offering personalized, evidence-based solutions—including testosterone replacement therapy (TRT)—to help women regain balance, energy, and vitality. Learn more about the risks, benefits, and available treatment options.

The Role of Testosterone in Women's Health

Testosterone is a crucial hormone that plays a significant role in a woman's body despite being commonly associated with male physiology. Produced primarily in the ovaries and adrenal glands, testosterone belongs to a group of androgens—sex hormones that influence sexual development, reproductive health, and body composition in both males and females—and contributes to the regulation of various bodily functions. 

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While some testosterone in women is naturally converted into estrogen, testosterone’s direct effects include supporting cardiovascular health, maintaining muscle and bone strength, and influencing cognitive function. It may also protect against memory loss by improving blood flow to the brain, and may help regulate serotonin and dopamine levels, which play key roles in mood stability and overall emotional well-being. 

Testosterone is best known for its influence on sexual health and function. It drives libido, enhances sexual response, and contributes to overall sexual satisfaction. The hormone also plays a role in reproductive health by working alongside estrogen and progesterone to regulate menstrual cycles and ovulation. While testosterone levels in women are much lower than in men, its impact is profound—affecting energy levels, mood, and physical wellbeing.

Menopause's Role in Declining Testosterone Levels

Like estrogen, testosterone is a vital hormone that declines with age, particularly during perimenopause and menopause. According to the National Library of Medicine, normal testosterone levels in females range from 15 to 70 nanograms per deciliter (ng/dL) of blood, but these levels begin to drop in the mid-30s and accelerate during the menopausal transition. By the time women reach their 60s, testosterone levels have decreased by approximately 50% compared to their levels in their 40s, per a study from the Yale University School of Medicine.

The ovaries and adrenal glands are the primary sources of testosterone production, but as ovarian function diminishes, the body’s ability to produce androgens decreases. While the ovaries continue to produce some testosterone after menopause, the adrenal glands' contribution declines significantly, leading to an overall reduction in circulating testosterone levels. Certain medical conditions, treatments like chemotherapy, and lifestyle factors such as diet, stress, and sleep can accelerate testosterone decline in women, leading to more pronounced symptoms.

Signs of Decreased Testosterone in Women

The reduction in testosterone during menopause can contribute to a variety of physical and psychological symptoms. Lower levels are associated with decreased libido and reduced sexual satisfaction. Research also indicates that low testosterone may impair cognitive function, leading to difficulties with memory and concentration. Physically, the hormone plays a crucial role in maintaining muscle mass, bone density, and overall metabolic function. A decline in testosterone can result in muscle loss, increased body fat, bone density reduction, and symptoms such as joint pain, fatigue, and hot flashes.

Diagnosing Low Testosterone

Clinically diagnosing low testosterone can be challenging because its symptoms often overlap with other conditions such as depression, thyroid disorders, or anemia (low iron levels). If you’re experiencing symptoms, it’s important to consult your healthcare professional, like Meno-Start’s Dr. Cothran, for a physical examination and a discussion of your medical history. She may recommend blood tests to evaluate hormone levels and determine whether low testosterone could be contributing to your symptoms.

RELATED SERVICE: Meno-Start’s Medical and Labs Membership

What is Testosterone Replacement Therapy (TRT)?

Testosterone replacement therapy (TRT) is a synthetic replacement of testosterone, using lab-manufactured testosterone to help regulate hormone levels and may improve energy, mood, and sexual function in some women. However, TRT for women remains controversial. Due to limited research, no testosterone treatments are currently approved by the FDA for female patients in the U.S. 

“There aren’t approved, standardized guidelines for testosterone for women so we have to use male testosterone at lower doses. I monitor my clients closely to get feedback on how they are feeling. That communication is really important for effective therapy,” says Dr. Cothran.

How is TRT Applied?

Testosterone is available in various forms, each with specific usage instructions. Your doctor can help you select the method of delivery and dosage that works for your body and medical history:

The British Menopause Society (BMS) says it may take three to six months to fully evaluate the efficacy of TRT treatment. Based on the same criteria used for standard hormone therapy, Dr. Cothran recommends at least a quarterly re-evaluation of ongoing usage.

The Benefits of TRT

NIH research shows that adding testosterone to hormone therapy can improve sexual function and overall well-being for menopausal women. A recent review strongly supports its use when medically appropriate, highlighting benefits such as increased desire, pleasure, arousal, orgasm, and self-image.

Testosterone may also enhance urogenital health, mood, energy, concentration, motivation, and cognitive function, especially when combined with estrogen in HRT. Additionally, it has been linked to increased bone density and relief from psychological and physical symptoms. Many women report feeling more balanced and revitalized with treatment.

The Risks of TRT 

As for the risks of TRT, the NIH reports, “Side effects can occasionally occur, including acne and increased hair growth at the site of application, but increase in facial hair, alopecia, or voice deepening does not occur if testosterone levels are kept within the female physiological range.” 

Another risk is the lack of medical research data, underscoring the gender inequality in studies to improve female sexual function and general well-being. For example, The FDA has not approved any testosterone treatments for female patients in the U.S., thus there are no standardized guidelines for dosing. Before choosing a treatment, discuss the risks and benefits with a healthcare provider. 

"There are specific checkboxes I use for my clients when it comes to TRT. I always advocate for a tailored treatment plan to account for differences in each woman's symptoms, medical history and lifestyle. It’s the safest way to mitigate the risks," says Dr. Cothran.

Organic Alternatives to TRT

If you’re not ready for TRT, you can manage testosterone loss naturally during menopause by focusing on lifestyle habits that support hormone balance. 

Regular exercise, particularly strength training, has been shown to support testosterone levels. Lifting weights, particularly with compound exercises like squats, deadlifts, and bench presses, creates small muscle damage during exercise. The body responds by producing testosterone to repair the tiny tears in muscle fibers and increase muscle mass. This increase not only enhances recovery and boosts strength but also helps sustain healthy testosterone levels, counteracting the natural decline that comes with aging.

Nutrient intake plays a crucial role in maintaining testosterone production. Zinc is essential for hormone regulation and can be found in foods like oysters, beef, chicken, and pumpkin seeds. A diet rich in healthy fats (avocados, olive oil, coconut oil, and nuts) and high-quality protein supports hormone synthesis. Certain foods, such as oysters (rich in D-aspartic acid), salmon (high in zinc and essential vitamins), and sun-exposed mushrooms (which boost vitamin D and B5 levels), can further aid in testosterone production. 

Meno-Start is proud to have not only a medical clinic onsite, but also a fitness studio, led by Coach Dulany Washington, certified in Wellness, Neuromuscular Stretching, and Nutrition Strategies for Women. “My job is to help our clients build muscle and manage metabolism. I start by identifying my clients’ personal needs and together we build an achievable plan. It’s a balanced approach that really helps women feel better inside and out,” says Coach Washington.

RELATED SERVICE: Meno-Start’s Fitness and Nutrition Membership

Who Can I Talk to About Testosterone Replacement Therapy?

When considering testosterone treatment, it’s crucial to consult a board-certified physician specializing in menopause care. Dr. Shannon Cothran, an OB-GYN and a Menopause Society Certified Practitioner (MSCP), offers personalized treatment plans, including testosterone replacement therapy. At Meno-Start, located in Tysons, VA, Dr. Cothran is dedicated to providing evidence-based care that supports women through menopause with a holistic, individualized approach.

RELATED BLOG: The Ultimate Credentials for Menopause Care: What to Look For

Conclusion

Balancing hormone levels during menopause can help ease unwanted symptoms, and testosterone may play a vital role in energy, mood, cognition, and sexual well-being. While TRT may offer benefits, it’s important to weigh the potential risks and explore both medical and natural alternatives. Since no FDA-approved testosterone treatments exist for women, seeking guidance from a menopause-certified physician is crucial. Dr. Shannon Cothran at Meno-Start provides personalized, evidence-based care to help women navigate menopause with confidence. Schedule a consultation to discuss the best approach for your individual needs.

Schedule a FREE 15 minute consultation with Dr. Cothran.

ABOUT THE AUTHOR

Renier is a communications consultant from Fairfax, Virginia. He is passionate about promoting the health and wellness space.