Should You Take Testosterone During Menopause?

When you think about menopause and hormones, you likely think about estrogen and progesterone—not testosterone. But in a 2010 study, post-menopausal women treated with testosterone showed “significantly more improvement in satisfying sexual episodes, sexual desire, arousal, orgasms, sexual pleasure, self-image, personal distress and sexual concerns.”

Using testosterone to treat low sex drive in women might seem counterintuitive, but it’s not. Here’s a bit of background: Testosterone is the most common type of androgen, a.k.a. the hormones responsible for libido. Prior to menopause, 25 percent of androgen production occurs in the ovaries. This production starts declining in our 40s, so by the time we reach menopause, there is significant loss. For this reason, symptoms of hypoactive sexual desire disorder (HSDD)—which is defined by a mental and physical lack of desire to engage in sex for a prolonged period, leading to distress—are more pronounced in women who are post-menopausal, have gone through chemotherapy or have had their ovaries removed, as there is a marked decrease in testosterone production.

Testosterone is only appropriate for a certain subset of women. “There are many things that can contribute to sexual dysfunction in women, such as medical conditions, mood disorders and relationship issues,” says Dr. Stephanie Faubion, the Florida-based director of the Mayo Clinic Center for Women’s Health and medical director of the North American Menopause Society. Only once the cause of a diminished libido can be attributed to HSDD will testosterone treatment—usually in the form of a gel, like Androgel—be considered. (Other forms of testosterone, such as oral tablets, pellets or compounds, are not recommended, as dosing is problematic.)

According to Dr. Alison Shea, associate professor of obstetrics and gynecology in the faculty of health sciences at McMaster University in Hamilton, Ont., testosterone therapy for menopausal women has been around for decades, but it’s “an off-label treatment.” The only known side effects are mild hair growth and acne, which are reversible.

It often takes three to six months to evaluate whether the treatment is working—but don’t pin all your hopes on it. “The longest safety data available is from four-year studies sponsored by pharmaceutical companies,” says Shea. “More research is needed.” Faubion stresses that testosterone is not a cure-all: “Most of the low sexual desire that comes into my office is not a testosterone problem.”

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