Testosterone
Definition
Testosterone is an androgen hormone produced in smaller amounts by the ovaries and adrenal glands in women. It contributes to libido, energy, muscle mass, bone strength, and cognitive function, and declines gradually with age rather than sharply at menopause.
In Depth
Although typically described as a "male" hormone, testosterone is biologically essential in women. Levels peak in the mid-20s and decline gradually, so by the time of menopause a woman typically has roughly half the circulating testosterone she had at 25. Unlike estrogen, testosterone does not drop abruptly at the final menstrual period — surgical menopause is the main exception, where removal of the ovaries causes an immediate ~50% loss.
Clinically, testosterone is best studied in postmenopausal women for one indication: hypoactive sexual desire disorder (HSDD) causing personal distress. The 2019 Global Consensus Position Statement on the Use of Testosterone Therapy for Women, endorsed by NAMS, the Endocrine Society, and the International Menopause Society, supports physiologic-dose transdermal testosterone for this indication when other causes have been excluded.
Evidence for other proposed benefits — cognition, mood, bone density, cardiovascular protection, generalized "energy" — is currently insufficient to recommend testosterone for those purposes. Doses must remain in the physiologic female range; supraphysiologic dosing produces androgenic side effects (acne, hirsutism, voice changes) that may not be reversible. No testosterone product is currently FDA-approved for women in the United States, so prescribing relies on off-label use of male formulations at one-tenth strength or on compounded preparations.
Why It Matters
Low testosterone is a legitimate, treatable contributor to distressing low libido after menopause — but it is frequently either overlooked or, conversely, prescribed for vague symptoms without evidence. Understanding what the data does and does not support helps women have an informed conversation with their clinician.