Testosterone Therapy Perimenopause Chronicles: A New Chapter in Women’s Hormonal Health

Introduction: The Evolving Landscape of Female Hormonal Health

Perimenopause is the time leading up to menopause when a woman’s body begins to go through natural changes in hormone levels. These changes often begin in the mid-to-late 40s but can start earlier for some women. During this stage, hormone levels do not drop all at once. Instead, they rise and fall unevenly, which can cause a variety of physical and emotional symptoms. Most people associate perimenopause with lower estrogen and progesterone, which are the main hormones involved in the menstrual cycle. However, testosterone, a hormone many think of as only important in men, also plays a role in women’s health and begins to change during this time as well.

For decades, doctors have mainly focused on estrogen and progesterone when treating perimenopausal symptoms. Hormone replacement therapy (HRT) has been used to help manage hot flashes, night sweats, and changes in mood that come with falling estrogen levels. Less attention has been given to testosterone in women, even though it also affects energy, mood, muscle strength, sex drive, and bone health. Research now shows that testosterone is an important part of the hormonal picture for women and may help improve certain symptoms that other hormones do not fully treat.

Testosterone is made in the ovaries and adrenal glands. Even though women make much less testosterone than men, it is still important for health and well-being. Starting in the late 30s and early 40s, testosterone levels slowly begin to decline. For some women, this drop becomes more noticeable during perimenopause and may continue after menopause. Lower testosterone levels have been linked to symptoms such as low sex drive, fatigue, difficulty concentrating, mood changes, and loss of muscle mass. These symptoms are common during perimenopause, but they are often blamed only on estrogen changes, so testosterone is sometimes overlooked.

In recent years, doctors and researchers have started to explore the use of testosterone therapy for women going through perimenopause. This has led to new discussions in the medical field about how to support women’s health during this life stage. Testosterone therapy for women is still a developing area, and there are no FDA-approved testosterone products made specifically for women in some countries, including the United States. However, doctors sometimes use lower doses of testosterone made for men or prescribe custom-made (compounded) products to help women who may benefit.

There is growing interest in the benefits and risks of using testosterone as part of a treatment plan for perimenopausal symptoms. Some studies suggest that it may help with low sex drive, improve energy and focus, and even help with bone strength. However, more research is needed to fully understand how safe and effective it is for long-term use. Many doctors believe that testosterone therapy may be helpful for certain women but should be used with care and under medical supervision.

The idea of including testosterone in women’s hormone care is not entirely new, but it has gained more attention as women seek better options for managing perimenopause. This period of life can bring many changes and challenges, and there is a need for more complete approaches to care that go beyond just estrogen and progesterone. With the right medical guidance, testosterone may become a useful part of managing symptoms and improving quality of life for some women.

As more is learned about how testosterone affects women during perimenopause, the way hormone therapy is viewed and used may continue to evolve. The goal is to provide safe and effective care that addresses the full range of hormonal changes. This includes looking at all the hormones that play a role in health, including the ones that have not always been part of the conversation. Testosterone therapy may represent a new chapter in hormonal health for women during midlife.

The Role of Testosterone in Female Physiology

Testosterone is often known as a male hormone, but it also plays an important role in the female body. Women naturally produce testosterone throughout their lives. This hormone helps with several body functions that support health and well-being. Even though it is made in much smaller amounts than in men, it is still very important for women, especially during midlife.

Where Testosterone Comes From in Women

In women, testosterone is mainly made in two places: the ovaries and the adrenal glands. The ovaries are the same organs that release eggs and make estrogen. The adrenal glands are small glands located on top of the kidneys. These glands help control stress and also make hormones like cortisol and DHEA. Both the ovaries and adrenal glands work together to produce testosterone.

After the age of 30, testosterone levels slowly begin to drop. This decline continues during perimenopause, which is the time leading up to menopause when hormone levels begin to change. Some women may notice changes in their health or how they feel during this time, and falling testosterone may be one of the reasons.

What Testosterone Does in the Female Body

Although it is known as an "androgen" or male-type hormone, testosterone supports many areas of health in women. It helps with the following:

1. Sexual Desire and Function

Testosterone plays a strong role in sex drive, also called libido. Low levels of testosterone can lead to a drop in sexual desire or interest. It may also affect arousal and satisfaction. Some women who experience low libido during perimenopause may be found to have low testosterone levels.

2. Energy and Stamina

Testosterone can help the body maintain energy levels. Some women with low testosterone feel tired more often or have trouble staying active. Restoring normal hormone levels may improve this type of fatigue, though other factors may also be involved.

3. Mood and Mental Clarity

The brain has receptors for testosterone, which means it responds to the hormone. It is believed that testosterone helps with mood balance and mental sharpness. Low levels may be linked with feeling low, irritable, or forgetful. While not the only cause of these feelings, hormone changes can make them worse during perimenopause.

4. Muscle Strength and Body Composition

Testosterone helps build and maintain muscle tissue. As women age and hormone levels drop, muscle strength can decrease. This may also lead to weight gain or changes in body shape. Adequate testosterone levels help support muscle tone and make it easier to stay strong and active.

5. Bone Health

Bones need hormones to stay strong. Testosterone, along with estrogen, supports healthy bone growth and repair. When hormone levels fall, bones can become weaker over time, which increases the risk of fractures. Having enough testosterone can help protect bone density, especially in midlife and later years.

Why Testosterone Matters More During Perimenopause

During perimenopause, the body goes through many changes. Estrogen and progesterone levels start to rise and fall unevenly before dropping overall. At the same time, testosterone also declines. These combined changes can affect daily life, energy, sleep, focus, and even relationships.

While estrogen replacement has been commonly used to treat perimenopausal symptoms, the role of testosterone has received more attention in recent years. Medical experts are now looking at how it may help women feel better during this stage of life, especially when symptoms include low libido, lack of energy, and muscle weakness.

Understanding how testosterone works in the female body can help explain why some women may benefit from hormone therapy that includes testosterone. Even small amounts of this hormone can have a big impact on health and quality of life.

Eligibility for Testosterone Therapy in Perimenopausal Women

Testosterone therapy is often linked with men’s health, but it can also play a role in the care of women, especially during the midlife hormonal shift known as perimenopause. Not every woman going through perimenopause needs testosterone therapy. The decision to use this treatment depends on symptoms, lab results, and overall health history. Understanding who qualifies for testosterone therapy is important for making safe and effective choices in hormonal care.

Recognizing Signs of Low Testosterone

Testosterone levels naturally drop with age, even in women. Some women may experience symptoms that suggest low testosterone. These symptoms can include low sexual desire, tiredness, mood swings, poor concentration, and loss of muscle strength. While these signs are common in perimenopause, not all of them are caused by low testosterone. Other hormone changes, like drops in estrogen and progesterone, can also lead to similar symptoms. That’s why careful evaluation is needed.

Doctors may look for a group of signs that suggest a possible testosterone deficiency. This group of symptoms is sometimes referred to as female androgen deficiency syndrome (FADS). It is not officially recognized by all medical organizations, but it is often used to guide decisions in clinical care.

Testing Before Starting Therapy

Lab tests are often used to support a diagnosis before starting testosterone therapy. Doctors usually check blood levels of total testosterone and free testosterone. These levels can be hard to measure in women because normal testosterone levels are much lower in women than in men. Small changes in lab results can make a big difference. Free testosterone (the amount not bound to proteins in the blood) often gives more useful information than total testosterone.

Other tests might be used too. These may include:

• Sex hormone-binding globulin (SHBG) – to help calculate free testosterone

• DHEA-S – a related hormone made by the adrenal glands

• Estradiol – to check estrogen levels and understand the full hormonal picture

Test results alone do not decide if a woman is a good candidate for therapy. Symptoms must match lab findings. Doctors often look at both together before recommending treatment.

Who May Be a Good Candidate?

Testosterone therapy may be considered for women with ongoing symptoms such as:

• Low sexual desire that causes personal distress

• Persistent fatigue not explained by other conditions

• Difficulty building or maintaining muscle

• Reduced well-being or motivation

Women who are already on estrogen therapy and still have these symptoms may be more likely to benefit from adding testosterone. Research shows that testosterone can help improve sexual function in women who do not respond well to estrogen therapy alone.

Off-Label Use and Current Regulations

In many countries, including the United States, there are no testosterone products officially approved for use in women. This means that testosterone therapy in women is often prescribed “off-label.” Off-label use means a medicine is used in a way that is not listed on its official label. It is a legal and common practice when based on solid medical judgment.

Some doctors use very low doses of testosterone products made for men. Others work with compounding pharmacies to create low-dose creams or gels tailored for women. These custom-made formulas are not approved by the Food and Drug Administration (FDA), so they require careful monitoring.

Due to the off-label status, many medical societies offer guidance to help doctors use testosterone safely in women. The North American Menopause Society (NAMS) and the International Menopause Society (IMS) both support its use for women with low sexual desire, if used carefully and with regular follow-up.

Special Considerations

Women with certain health issues may not be eligible for testosterone therapy. These include those with active liver disease, untreated hormone-sensitive cancers (such as breast or uterine cancer), or those who already have high levels of testosterone. A complete health history and physical exam are needed to rule out risks and set realistic treatment goals.

It is also important to check for other possible causes of symptoms before starting therapy. Low thyroid function, depression, sleep disorders, and vitamin deficiencies can all cause similar problems. These must be ruled out or treated first.

Testosterone therapy may help some perimenopausal women who have low testosterone and symptoms that affect daily life. Before starting treatment, lab tests, symptom history, and overall health need to be reviewed. Because there are no products specifically approved for women in many countries, treatment should be done with care, using low doses and regular follow-up. This cautious and informed approach helps reduce risks and improve results.

Symptom Relief and Potential Benefits of Testosterone Therapy

During perimenopause, many women experience a variety of symptoms that affect daily life. These changes happen because hormone levels begin to shift as the body moves toward menopause. While estrogen and progesterone are the most well-known female hormones, testosterone also plays an important role in the female body. Lower levels of testosterone during perimenopause may contribute to several physical and emotional changes. In some cases, testosterone therapy may help improve these symptoms.

Low Sexual Desire and Sexual Function

One of the most commonly reported symptoms during perimenopause is a drop in sexual desire, also known as low libido. For many women, this change can affect their relationships and emotional well-being. Research has shown that testosterone plays a key role in supporting sexual interest and arousal. When testosterone levels drop, the desire for sexual activity may also decrease.

Several clinical studies have found that testosterone therapy can help improve sexual desire in women, especially those with a condition called hypoactive sexual desire disorder (HSDD). This condition involves a lack of interest in sex that causes distress. Testosterone therapy has been shown to increase sexual thoughts, improve satisfaction, and support arousal in women with low testosterone levels. For these women, restoring testosterone to a normal level—not to male levels—may improve sexual well-being.

Low Energy and Fatigue

Feeling tired all the time is another common concern during perimenopause. Some women describe this as fatigue that does not improve with rest or sleep. Hormonal changes during this time may affect energy levels. Testosterone helps support the body's natural energy systems. It plays a role in the balance between physical strength, endurance, and mood.

Early research suggests that testosterone therapy may reduce fatigue in some perimenopausal women. The exact reason is not fully understood, but it may be related to how testosterone affects brain chemicals and energy metabolism. Some women report feeling more alert and motivated when their testosterone levels are brought back to a healthy range.

Mood Changes and Mental Clarity

Hormonal shifts during perimenopause can also affect mood. Some women experience mood swings, irritability, or even symptoms similar to depression. Others may notice brain fog, difficulty concentrating, or forgetfulness. Testosterone has an impact on certain brain pathways that control mood, attention, and memory.

Studies have explored whether testosterone therapy can help with these cognitive and emotional symptoms. While results vary, some findings suggest that balanced testosterone levels may improve mental clarity and emotional stability in women experiencing perimenopausal hormone changes. Women with very low testosterone levels may especially benefit from therapy in terms of sharper thinking and improved focus.

Loss of Muscle Mass and Strength

As women age, muscle mass and strength naturally begin to decline. This process can start as early as perimenopause and may worsen after menopause. Testosterone is known to help build and maintain muscle tissue. In fact, one of its main roles in the body is to support muscle growth and strength.

When testosterone levels fall, the body may lose muscle tone and become weaker over time. Testosterone therapy has been shown to help maintain lean body mass in women. Some studies report that therapy may lead to slight increases in muscle strength. This benefit can be important for daily function, balance, and physical health—especially as the risk for falls and fractures increases with age.

Supporting Evidence from Research

Multiple scientific studies have examined the effects of testosterone therapy on these symptoms. A well-known 2019 study published in The Lancet Diabetes & Endocrinology reviewed data from several trials involving thousands of women. The results showed that testosterone therapy significantly improved sexual function in women with low libido. The evidence was less clear for other symptoms, such as mood, energy, and muscle strength, but some studies still showed promising results.

It is important to note that not all women with perimenopausal symptoms are candidates for testosterone therapy. Treatment decisions should be based on hormone levels, symptom severity, and overall health. When prescribed and monitored properly, testosterone therapy may offer relief for specific symptoms that affect quality of life.

Methods of Testosterone Administration in Women

Testosterone therapy can be given to women in several different ways. Each method has its own benefits and risks. Choosing the right method depends on several factors, including the woman’s symptoms, hormone levels, personal preferences, and how her body responds to treatment. The goal is to use the lowest effective dose and to keep testosterone levels within a normal female range.

Topical Creams and Gels

One of the most common ways to deliver testosterone is through the skin. This is done with topical creams or gels. These products are usually applied to the upper arms, thighs, or lower abdomen once a day. The hormone is absorbed through the skin and into the bloodstream.

This method allows for steady hormone levels, and it is easy to adjust the dose. If side effects occur, the dose can be lowered or the therapy can be stopped. However, there are some things to consider. After applying the cream or gel, it is important to avoid skin-to-skin contact with others until the area is dry. This helps prevent the hormone from spreading to someone else, which could cause unwanted effects.

Also, some women may find the texture or smell of the product unpleasant. Skin irritation can also happen, although this is usually mild.

Injections

Another method of testosterone delivery is by injection. These are usually given every 1 to 4 weeks, depending on the type of testosterone used. Injections deliver the hormone directly into the muscle or under the skin.

This method allows the hormone to reach the bloodstream quickly. However, hormone levels may rise and fall between doses. This can lead to symptoms such as mood swings, especially if the injection schedule is not carefully managed.

Some women prefer injections because they do not have to think about daily applications. But injections require proper technique and may need to be given at a clinic unless the woman is trained to do it at home. Bruising or discomfort at the injection site may also happen.

Pellet Implants

Testosterone pellets are another option. These small pellets are inserted under the skin, usually in the hip or buttock area, during a short medical procedure. The pellets slowly release testosterone into the body over a period of 3 to 6 months.

This method gives a steady dose of hormone and does not require daily or weekly use. Some women like the convenience of long-lasting effects. However, once the pellet is in place, the dose cannot be changed. If side effects happen, the pellet cannot be easily removed. There is also a small risk of infection, bleeding, or the pellet coming out of the skin.

This method is less commonly used and may not be offered in all clinics.

Patches

Transdermal patches are another way to give testosterone through the skin. These are small, sticky patches worn on the body, usually on the lower abdomen or thigh. The patch releases the hormone slowly over time.

Testosterone patches are more often made for men. Because the dose is higher than what is needed for women, patches may need to be cut or adjusted. This can be difficult and may affect how well the hormone is delivered. For this reason, patches are not widely used for women, unless a patch made specifically for women becomes available.

Skin irritation is also a possible side effect, especially if the patch is worn in the same place every time.

Compounded Formulations

In many places, there are no testosterone products approved for use in women. In these cases, healthcare providers may prescribe compounded formulations. These are made by special pharmacies and prepared to meet individual needs.

Compounded products can be made as creams, gels, lozenges, or capsules. They allow for very small doses, which may be helpful for women. However, there are concerns about safety and consistency. Compounded hormones are not always tested in the same way as approved medications. This can lead to differences in how the body absorbs the hormone and how strong the dose is.

Women using compounded testosterone should be closely monitored by a healthcare provider. Blood tests and symptom tracking are important to make sure the dose is safe and effective.

Choosing the Right Method

The best method of testosterone therapy depends on several things, such as how the woman feels, how her body absorbs the hormone, and how easy the method is to use. It also depends on safety and access. Some forms may be more expensive or harder to get than others. It is important to use a method that allows for safe dosing, steady hormone levels, and regular follow-up.

Each method has benefits and possible risks. A healthcare provider can help decide which method is best based on the woman’s symptoms, health history, and treatment goals.

Safety Profile and Adverse Effects

Testosterone therapy is sometimes used during perimenopause to help with symptoms like low energy, low sex drive, and mood changes. While it may provide relief, it can also cause side effects. Understanding the risks is important when deciding if this treatment is right for a patient.

Common Side Effects

Some women may notice changes after starting testosterone therapy. These changes are usually mild and go away if the dose is adjusted or the treatment is stopped.

Acne is one of the most common side effects. It happens because testosterone can increase oil production in the skin. The face, back, and chest may break out with pimples, similar to what happens during puberty. This can often be controlled with gentle skincare and adjusting the hormone dose.

Hirsutism means extra hair growth on the face, chin, chest, or abdomen. This happens because testosterone is an androgen, a hormone that encourages body hair growth. The amount of hair that grows depends on the dose and how sensitive the hair follicles are. If this becomes a problem, the dose can often be lowered.

Scalp hair thinning may also happen in some cases. Testosterone can affect hair growth on the scalp and may cause hair to fall out over time. This condition is sometimes called androgenic alopecia, or female pattern hair loss. It is not common at low doses, but it should be watched closely.

Voice deepening has been reported in a small number of cases. This side effect is rare and usually occurs only with very high doses. In some cases, the change in voice may not go away even after stopping the therapy. That is why regular check-ups and correct dosing are so important.

Long-Term Safety Concerns

There are still questions about the long-term effects of testosterone therapy in women. More studies are needed to fully understand the risks. However, some important areas are already being watched closely.

One area of concern is heart health. Testosterone can affect cholesterol levels. In some cases, it may lower HDL (the "good" cholesterol) and increase LDL (the "bad" cholesterol). These changes can raise the risk of heart disease over time. For this reason, doctors often check blood cholesterol levels before and during treatment.

Liver health is also monitored. Oral forms of testosterone used in the past sometimes caused liver damage. Today, doctors usually avoid pills and use gels, creams, patches, or injections instead. These methods are safer and less likely to harm the liver.

Another question is whether testosterone raises the risk of breast or uterine cancer. Right now, there is no strong proof that it does. Some studies have looked at this, but the results are mixed. Testosterone can be changed into estrogen in the body, and high estrogen levels have been linked to certain cancers. For this reason, women who have had breast cancer or who are at high risk may be advised to avoid testosterone therapy unless closely monitored.

The Importance of Proper Dosing

Many of the side effects of testosterone therapy are linked to taking too much. Women need much smaller doses than men. The right dose depends on age, symptoms, and hormone levels. Blood tests are used to help find the best dose. Symptoms and side effects should also be tracked closely.

Testosterone therapy should always be monitored by a trained healthcare provider. Lab tests help to check hormone levels and make sure the treatment is working. Regular follow-ups can also help spot problems early and adjust the treatment if needed.

When to Stop or Adjust Treatment

If side effects become hard to manage or lab results show a problem, the treatment may need to be changed. This could mean lowering the dose or stopping testosterone altogether. In many cases, side effects go away after stopping the therapy.

Women who are pregnant or planning to become pregnant should avoid testosterone therapy. It can affect the development of a baby and is not considered safe during pregnancy.

Testosterone therapy may help ease certain symptoms of perimenopause, but it is not without risks. Common side effects like acne and hair changes are usually manageable with the right dose. Long-term safety is still being studied, especially in relation to heart and cancer risks. Close monitoring by a healthcare provider is key to making the treatment safe and effective.

Differences Between Testosterone Therapy in Women and Men

Testosterone therapy is often linked to men’s health. It is commonly used to treat low testosterone levels in men, especially as they age. However, testosterone also plays an important role in women’s health. Even though both men and women produce testosterone, the amounts, treatment goals, and health effects differ greatly between the two sexes. Understanding these differences is important for safe and effective treatment.

Hormone Levels and Dosage

Men naturally have much higher levels of testosterone than women. The average adult male produces about 6 to 8 milligrams of testosterone daily. In contrast, the average adult female produces only about 0.25 to 0.3 milligrams per day. Because of this, the amount of testosterone used in therapy must be much lower for women than for men.

Men who receive testosterone therapy usually get higher doses to bring their levels back into the normal male range. These treatments are often aimed at increasing muscle mass, energy, libido, and red blood cell count. For women, the goal is not to reach male levels. Instead, therapy aims to restore testosterone to levels that are typical for healthy premenopausal women. These levels are much lower, so the doses must be carefully adjusted. Too much testosterone can cause side effects such as acne, unwanted hair growth, and deepening of the voice in women.

Reasons for Treatment

The reasons for using testosterone therapy are also different between men and women. In men, it is often prescribed for conditions such as hypogonadism, where the body does not make enough testosterone. This may lead to low sex drive, tiredness, depression, and reduced muscle strength.

In women, testosterone therapy is most commonly used to treat sexual dysfunction, especially low desire or arousal. It may also be considered when women experience low energy, mood changes, or loss of muscle tone during perimenopause or after menopause. These symptoms are sometimes related to a natural drop in testosterone levels. Unlike in men, there is currently no official diagnosis of “low testosterone” in women that is widely accepted by medical authorities. Instead, doctors may look at a combination of symptoms and hormone levels to decide if therapy is right.

Treatment Forms and Products

Another difference lies in the types of testosterone products available. For men, there are many approved options, including gels, patches, injections, and implants. These are made in doses meant for the male body. However, very few testosterone products are approved specifically for use in women. Because of this, doctors often prescribe “off-label” treatments or use compounded testosterone formulas made by specialty pharmacies. These are created in lower strengths suitable for women. The lack of female-specific products makes it important to follow medical guidance closely during treatment.

Safety and Monitoring

Monitoring is important for both men and women during testosterone therapy, but what is measured and how often may vary. In men, doctors check testosterone levels to make sure they reach and stay within the normal male range. They also watch for risks such as high red blood cell counts, liver problems, or prostate issues.

In women, testosterone levels are monitored to avoid going above the normal female range. Women are also checked for signs of too much testosterone, such as hair growth in unwanted areas, acne, or voice changes. Regular follow-ups help doctors adjust the dose and reduce side effects. Blood tests may include total and free testosterone, sex hormone-binding globulin (SHBG), and other related hormones.

Health Effects and Outcomes

The health effects of testosterone can differ in men and women. In men, therapy may improve bone density, strength, mood, and sexual function. In women, research shows that low-dose testosterone therapy may help with sexual desire, arousal, and satisfaction. Some studies suggest possible benefits for mood and energy, but the evidence is still growing.

Testosterone therapy in women is not meant to replace estrogen or progesterone, which also drop during perimenopause. Instead, it can be used together with other hormone treatments when needed. The response to therapy can vary between individuals, and treatment plans must be customized.

Current Evidence and Research Findings

Testosterone therapy is becoming a topic of interest for doctors and scientists who study women’s health, especially during the perimenopausal years. Perimenopause is the time before menopause when hormone levels begin to change. While estrogen and progesterone are often discussed during this time, testosterone is another hormone that may also play an important role. Many studies in recent years have looked at how testosterone therapy might help with certain symptoms that some women experience.

Research on Sexual Health and Desire

One of the most studied areas is how testosterone affects sexual desire. Several clinical trials have found that low-dose testosterone therapy can help improve sexual interest and satisfaction in women who have low libido. A well-known review published in The Lancet Diabetes & Endocrinology in 2019 looked at more than 40 studies involving over 8,000 women. This review showed that testosterone therapy improved sexual desire, pleasure, and orgasm in women, especially those who had gone through menopause. The effect was strongest in women who had been diagnosed with a condition called hypoactive sexual desire disorder (HSDD), which means a low interest in sex that causes distress.

The improvements in sexual function were not only noticed by doctors but also reported by the women in the studies. These findings have led many experts to agree that testosterone may be a helpful treatment for sexual problems linked to hormone changes, although it is not approved by regulatory agencies in some countries for this purpose.

Effects on Mood, Energy, and Cognitive Function

In addition to improving sexual desire, some studies have explored how testosterone might affect mood, energy, and brain function. A few trials have suggested that women taking testosterone reported feeling less tired and more emotionally balanced. Some women also felt more focused and noticed a reduction in brain fog, which is a common complaint during perimenopause.

However, the evidence in this area is not as strong or clear as it is for sexual function. Some studies showed only small improvements, and others showed no clear benefit at all. Scientists believe more high-quality research is needed to fully understand how testosterone affects mood and mental sharpness in women.

Muscle, Bone, and Body Composition

Testosterone also plays a role in muscle and bone health. In men, testosterone is known to help with muscle growth and bone strength. In women, research suggests that testosterone may help preserve lean muscle mass and possibly improve bone density. This is important because muscle loss and weaker bones can become problems as women age, especially during and after menopause.

A few clinical studies have shown that women on testosterone therapy gained more lean body mass and had less fat mass compared to those who were not on the therapy. Some small trials have also suggested that bone density might improve slightly, although this has not been studied enough to make strong conclusions. Larger studies are needed to confirm these findings.

Research Gaps and Limitations

While there is growing evidence about the benefits of testosterone for women, many questions remain. One of the biggest problems is the lack of long-term safety data. Most studies have only followed women for a few months to a few years. This makes it hard to know what might happen after many years of use.

There is also a lack of testosterone products made specifically for women. In many places, doctors use compounded or adjusted doses from male testosterone products. Because of this, the results of studies may not always match real-life use, especially when different types and doses are used.

Another challenge is that not all studies include women who are in perimenopause. Some studies focus only on postmenopausal women or women who had their ovaries removed. More research is needed to understand how testosterone works in women who are still going through hormonal changes during perimenopause.

Clinical Guidelines and Expert Opinions

Several medical organizations have reviewed the current evidence and have given guidance on testosterone therapy for women. Groups like the Endocrine Society and the International Menopause Society say that testosterone can be considered for women who have HSDD, but only after other causes have been ruled out. They also recommend using the lowest possible dose and monitoring hormone levels and symptoms regularly.

These guidelines also stress that therapy should be individualized. What works for one woman may not work for another. This is why doctors often start with low doses and adjust treatment based on results and side effects.

Testosterone therapy for women during perimenopause is supported by strong evidence in some areas, such as sexual health. Other possible benefits, like better mood, energy, and muscle mass, are still being studied. While many women may benefit, more research is needed to confirm long-term safety and create better treatment options made for women. Medical experts agree that care should be personalized, cautious, and well-monitored.

Monitoring and Evaluation During Therapy

Testosterone therapy during perimenopause requires careful monitoring. This is important to make sure the treatment is safe and working well. Hormone levels can change over time, and symptoms can improve, worsen, or stay the same. Regular testing and follow-up help doctors adjust the dose and delivery method to match each patient’s needs.

Baseline Testing Before Starting Therapy

Before starting testosterone therapy, doctors usually order blood tests. These tests check hormone levels and provide a starting point to measure future changes. The most common hormone tests include:

• Total testosterone: This measures all the testosterone in the blood, including both free and bound forms.

• Free testosterone: This measures the active testosterone that is not attached to proteins and can be used by the body.

• Sex hormone-binding globulin (SHBG): This protein binds to testosterone. High SHBG levels can lower the amount of free testosterone available.

• DHEA-S (Dehydroepiandrosterone sulfate): This is another hormone made by the adrenal glands that may play a role in overall androgen balance.

• Estradiol: This form of estrogen is also checked because estrogen and testosterone levels often affect each other.

These tests help doctors understand the body’s hormone balance and make sure testosterone therapy is needed. Testing is usually done in the morning, when hormone levels are most stable.

Ongoing Monitoring After Starting Therapy

Once therapy begins, hormone levels are checked regularly. Blood tests are often repeated 6 to 12 weeks after treatment starts. After that, testing may happen every 3 to 6 months, depending on the person’s response.

The goal is to keep testosterone levels within the normal female range. High levels may lead to side effects such as acne or unwanted hair growth. Low levels may mean the dose is too small or the treatment is not being absorbed well.

Doctors also check other signs of how well the treatment is working, such as:

• Changes in energy and fatigue

• Sexual desire and function

• Mood and mental clarity

• Muscle strength and physical endurance

If symptoms improve and hormone levels are in the safe range, the current treatment plan may continue. If there are side effects or no changes in symptoms, the doctor may adjust the dose or switch the delivery method.

How Symptoms Are Tracked

Lab tests are only part of the monitoring process. Doctors also ask about daily symptoms and how they have changed. This is called symptom tracking and can include:

• Questionnaires or rating scales for sexual health

• Mood surveys or energy level checklists

• Notes about changes in sleep, focus, or muscle tone

Some people may keep a journal to track changes over time. These notes help the doctor understand if the therapy is helping and whether any problems are developing.

Sometimes, symptoms improve before blood levels change. In other cases, blood levels may improve but symptoms stay the same. Both lab results and symptom reports are needed to guide treatment.

Adjusting the Treatment Plan

Testosterone therapy is not the same for every woman. Body weight, age, other health conditions, and lifestyle all affect how the body responds to hormones. Because of this, doctors may change the dose, delivery method, or schedule over time. For example:

• If testosterone levels are too high, the dose may be reduced.

• If symptoms do not improve, a different method (like switching from gel to injection) might be tried.

• If estrogen levels are low, combination hormone therapy may be considered.

Regular monitoring helps avoid unwanted effects and improves the chance of getting good results. It also helps find problems early, such as hormone imbalances or signs of liver stress, which can sometimes happen with certain delivery methods.

The Importance of Follow-Up

Follow-up visits with the healthcare provider are essential. These visits include lab tests, a review of symptoms, and a discussion of treatment goals. Skipping follow-ups can lead to hormone levels becoming too high or too low without being noticed.

Monitoring testosterone therapy carefully supports both safety and success. It allows treatment to be personalized, giving the best chance for improved well-being during the perimenopausal years.

Combination Hormone Therapy: Testosterone with Estrogen or Progesterone

Hormone therapy is often used to help manage symptoms during perimenopause. Most treatments focus on estrogen and progesterone because these hormones drop the most during this time. However, doctors are now learning that testosterone can also play an important role. Some treatment plans combine testosterone with estrogen or progesterone to improve how women feel during perimenopause.

Why Combine Hormones?

Each hormone in the body has a different job. Estrogen helps control body temperature, bone health, and the menstrual cycle. Progesterone helps balance estrogen and supports sleep and mood. Testosterone is often known as a male hormone, but it is also made in women’s bodies. It supports energy, sexual desire, muscle strength, and mood.

When hormone levels drop during perimenopause, many symptoms can appear. These may include hot flashes, low sex drive, tiredness, trouble sleeping, and mood swings. Using just one hormone may not always be enough to treat all these symptoms. That is why some doctors consider combining testosterone with estrogen or progesterone. The goal is to treat more symptoms at the same time and help improve quality of life.

Benefits of Adding Testosterone

Several studies have shown that testosterone can help improve certain symptoms when added to estrogen therapy. One of the most common reasons for using testosterone is to treat low sexual desire. A condition called hypoactive sexual desire disorder (HSDD) is common during perimenopause. It means a woman has little to no interest in sex, and this causes distress. Testosterone has been shown to help with this problem more than estrogen alone.

Testosterone may also help with energy and motivation. Some women report feeling stronger, more active, and more focused when testosterone is added to their hormone therapy. This is still being studied, but early research shows promise.

Another possible benefit is improved muscle mass. As hormone levels fall, it becomes easier to lose muscle and gain fat. Testosterone helps the body keep lean muscle tissue. In combination with regular exercise and healthy eating, it may help improve strength and body composition.

Safety and Hormone Balance

When more than one hormone is used, balance becomes very important. Estrogen and progesterone must be carefully managed to protect the uterus. If estrogen is used without progesterone, there is a risk of thickening in the lining of the uterus, which can lead to cancer. Progesterone is added to protect against this.

Testosterone levels also need to be monitored. If too much is given, it can cause side effects such as acne, unwanted hair growth, or changes in mood. Doctors usually start with a low dose and adjust it slowly. Blood tests are used to check hormone levels and make sure they stay within a safe range.

Not every woman is a good candidate for combination therapy. A full medical history and lab work are needed before starting. Women with hormone-sensitive cancers or liver problems may not be able to use this kind of treatment. Each case must be looked at closely to see what is best.

Personalized Hormone Plans

There is no one-size-fits-all approach when it comes to hormone therapy. Every woman has a different hormone pattern, family history, and set of symptoms. A doctor will create a plan based on these factors. The right mix of estrogen, progesterone, and testosterone depends on a woman’s needs and health goals.

Some women may only need estrogen and progesterone. Others may benefit from adding testosterone to improve certain symptoms. The goal is always to find the safest and most effective treatment for each person.

Hormone therapy, when managed carefully, can improve quality of life during perimenopause. Using testosterone along with estrogen or progesterone is a newer option, but one that is gaining more attention from doctors and researchers. As knowledge grows, more women may have access to this broader approach to hormone health.

Contraindications and Patient Selection Criteria

Not every woman going through perimenopause is a good candidate for testosterone therapy. Before starting any hormone treatment, it is important for doctors to carefully assess health history, current symptoms, and possible risks. Certain conditions and medical histories may make testosterone therapy unsafe or less appropriate. These are called contraindications.

Absolute Contraindications

Some health conditions make testosterone therapy completely unsafe. These are known as absolute contraindications. In these cases, testosterone should not be used under any circumstances.

1. History of Hormone-Sensitive Cancers
   Women who have or have had hormone-sensitive cancers, such as certain types of breast cancer or uterine cancer, should not take testosterone therapy. These cancers often grow in response to hormones. Although testosterone is an androgen, not an estrogen, it may still affect cancer cell growth in some cases. Research on the link between testosterone and cancer risk in women is still ongoing. Until more is known, testosterone therapy is usually avoided in anyone with a history of hormone-driven cancers.
2. Active Liver Disease
   The liver plays a major role in processing hormones. If the liver is not working well because of disease, it may not be able to handle added hormones safely. Testosterone can put extra strain on the liver, especially if taken in high doses or in certain forms. Women with active liver problems should not receive testosterone therapy. Liver function tests are often done before starting hormone treatment to check for issues.
3. Severe Acne or Androgenic Symptoms
   Some women are more sensitive to testosterone than others. High sensitivity can cause unwanted side effects, even at low doses. These may include oily skin, acne, or excess hair growth on the face and body (hirsutism). If these symptoms are already severe before treatment, adding testosterone could make them worse. Women with polycystic ovary syndrome (PCOS), which is linked to higher natural testosterone levels, may also be at higher risk for side effects. In these cases, careful evaluation is needed before starting therapy.
4. Pregnancy or Breastfeeding
   Testosterone therapy is not recommended during pregnancy or while breastfeeding. Testosterone can cross the placenta or enter breast milk, which may be harmful to a developing baby or infant. Women who are pregnant, planning to become pregnant, or nursing should not use testosterone.

Relative Contraindications and Cautionary Factors

Some conditions do not completely rule out testosterone therapy, but they do require caution. These are called relative contraindications. In these cases, hormone therapy may be considered only after weighing the benefits and risks.

1. Heart Disease or High Risk of Cardiovascular Problems
   There is still debate about how testosterone affects heart health in women. Some studies suggest it may improve energy and metabolism, while others raise concerns about cholesterol and blood pressure. Women with a history of heart attack, stroke, or blood clots need careful monitoring. The therapy may still be used in low doses under close medical supervision.
2. Uncontrolled Diabetes or Obesity
   Both diabetes and obesity can change how the body processes hormones. These conditions may also increase the risk of side effects from testosterone. Blood sugar levels and body weight may need to be managed before starting therapy. Doctors may also use lower starting doses and adjust the treatment slowly over time.
3. Mood Disorders or History of Aggression
   Hormones can affect brain chemistry and emotions. In rare cases, testosterone may lead to irritability, mood swings, or even increased aggression. Women with a history of mood disorders, including depression or anxiety, should be monitored closely. The goal is to avoid any worsening of mental health symptoms.

The Importance of Proper Screening

Before starting testosterone therapy, a full medical evaluation is important. This often includes blood tests to check hormone levels, liver function, and general health. A physical exam and detailed medical history help identify possible risks. Doctors also ask about current symptoms and goals for treatment. Based on this information, a personalized decision can be made about whether testosterone therapy is appropriate.

If therapy is started, ongoing monitoring is essential. Hormone levels, side effects, and symptom changes should be reviewed regularly. If any concerns arise, the dose may be adjusted or the therapy may be stopped.

Testosterone therapy can be helpful for some women during perimenopause, but it is not right for everyone. Certain health conditions make treatment unsafe, while others require close attention and expert care. Careful screening and regular check-ups help reduce risks and improve outcomes. When chosen wisely and monitored properly, testosterone therapy can be a valuable part of hormone care for selected patients.

Conclusion: A Broader Understanding of Hormonal Therapy in Perimenopause

Testosterone is often thought of as a male hormone, but it also plays an important role in the health and well-being of women. During perimenopause—the time before menopause when hormone levels begin to shift—many women experience changes that can affect their quality of life. These changes may include low energy, poor sleep, mood swings, and a decrease in sexual desire. While estrogen and progesterone have long been the focus of hormone replacement therapy, new research has shown that testosterone can also help with some of these symptoms.

In the female body, testosterone is made in the ovaries and adrenal glands. It supports several key functions, such as maintaining muscle strength, supporting bone health, improving focus, and increasing sexual interest. As women age, natural testosterone levels begin to drop. This decline is often slow and may not be noticed right away. However, for some women, the loss of testosterone may lead to noticeable symptoms, especially during perimenopause. This has led more healthcare providers to explore testosterone therapy as a way to improve symptoms and overall quality of life in certain women.

Clinical research has shown that low-dose testosterone therapy may improve symptoms such as low libido, fatigue, mood changes, and muscle weakness. In particular, studies have found that testosterone may help women with a condition called hypoactive sexual desire disorder (HSDD), which is one of the most common sexual health concerns during midlife. For these women, testosterone has been shown to improve sexual interest, satisfaction, and frequency of desire without causing serious side effects when properly managed.

The way testosterone is given matters. There are several forms of therapy, including creams, gels, patches, injections, and small pellets placed under the skin. Each method has its own pros and cons. For example, topical gels allow for easy dose adjustments, while pellets last longer but require a small medical procedure. The dose given to women is much smaller than what is given to men. Careful monitoring is needed to avoid too much testosterone, which can lead to side effects like acne, extra hair growth, or changes in voice. When prescribed at the right dose and carefully followed by a healthcare provider, testosterone therapy is generally considered safe for short- to medium-term use in selected women.

While testosterone can offer benefits, it is not suitable for everyone. Women with a history of hormone-sensitive cancers, liver disease, or certain skin conditions may be advised against using it. That is why proper screening and lab testing are important before beginning treatment. Blood tests can measure hormone levels and help decide whether therapy is a good option. Ongoing checkups allow providers to adjust the dose if needed and watch for any side effects. This step-by-step approach helps reduce risks while improving symptoms.

Another factor to consider is whether testosterone should be used alone or with other hormones. In some cases, combining testosterone with estrogen may lead to better results, especially for women who are also experiencing hot flashes, vaginal dryness, or other symptoms that estrogen helps to control. The right mix depends on the individual’s health history, hormone levels, and specific symptoms.

Experts agree that more research is still needed. While short-term studies support the use of testosterone for sexual desire and other issues, long-term safety studies are limited. It is important for researchers to continue studying the effects of testosterone over time, especially in terms of heart health, breast cancer risk, and mental health.

As the understanding of women’s hormones grows, testosterone is becoming a more accepted part of care for perimenopausal and postmenopausal women. It offers a new option for those whose symptoms are not fully helped by estrogen alone. With proper evaluation, low-dose therapy, and regular follow-up, testosterone can be a useful part of personalized hormone treatment.

Overall, testosterone therapy opens the door to more complete care for women going through midlife changes. When used with care, it can improve physical, emotional, and sexual well-being in ways that other treatments may not. This marks a new chapter in how hormonal health is understood and managed during the transition to menopause.