Welcome back to Menopause Mondays! Today, I wanted to bust some myths and shed light on an often overlooked but crucial hormone in women’s health during menopause: testosterone. So, I reached out to menopause specialist Dr. Jennifer Davis, Founder of San Diego Menopause.

Testosterone: Not Just for Men

Contrary to popular belief, testosterone is produced in the female body, and it plays a vital role in women’s health and well-being. Our ovaries, adrenal glands, and other tissues and cells produce testosterone. Often, as women approach menopause, testosterone levels drop.

It is helpful to note that if you have had an oophorectomy (had your ovaries removed), you will most likely have low testosterone levels because your ovaries are responsible for about half of all testosterone production. A blood test is the only way to know your testosterone level.

I found it interesting that other health issues can cause low T.  Here are just a few: ovarian insufficiency, malnutrition, chemotherapy, tumors on your pituitary gland, and premature menopause (menopause before the age of 40).

I was surprised to learn that oral estrogen, such as in the pill, can affect libido in some women.  Estrogen taken by mouth causes the liver to increase a protein called SHBG (sex hormone binding globulin).  SHBG can bind to testosterone, lowering the amount of active testosterone in your body.

Easing Menopausal Symptoms

Menopausal symptoms stem from a drop in estrogen, progesterone, and testosterone. Adding low-dose testosterone when combined with estrogen as part of hormone therapy (HT) may improve:

• Mood
• sexual desire, pleasure, arousal, and orgasm
• muscle aches and joint pain
• bone density
• lean muscle mass, metabolic rate, and weight maintenance
• concentration, clarity, and overall cognition
• blood flow to the genitals
• sluggishness
• overactive bladder
• cardiovascular risk (Lancet 2022)

Forms of Testosterone for Women

I asked Dr. Davis about the various options for women who find that they need testosterone. She shared with me that currently, all forms of testosterone for women are used off-label in this country. You heard me correctly. Yes, only men can get a prescription that is FDA-approved and covered by insurance for testosterone.

Dr. Davis recommends transdermal (administered through the skin) cream or gel. I asked her about her thoughts on pellets, which are injected by a doctor under the skin. However, once injected, you cannot modify the dosage if you find that you were given too much, which is often the case with pellet therapy. Too much testosterone can cause acne, hair loss, unwanted hair growth, and increased belly fat. No one wants that…………so,  for this reason, Dr. Davis confirms that the more conservative approach is a transdermal cream or gel.   The FDA-approved men’s testosterone gels can be prescribed using 1/10^th of the dose recommended for men.

Think  Goldilocks and the Three Bears – you gotta find the amount and levels of testosterone that are just right for you. That is why you want an experienced menopause specialist!

If you do start testosterone therapy, she recommends that your levels be monitored by your menopause specialist 6-8 weeks after initiating treatment.

The Menopause Care Gap

Every day, 6,000 women in the U.S. enter menopause, and many try reaching out to their OB/GYN doctors for help.  Despite menopause affecting all aspects of our health, only 31% of OB/GYN residency programs include menopause training.  Additionally, menopause training is NOT required for any physician to maintain board certification.  I know, it’s shocking and infuriating!!!!! This is why we must educate ourselves on perimenopause, menopause, and post-menopause so that when symptoms hit, we are prepared to advocate for the care we need and deserve.

Thank you, Dr. Davis, for educating us about testosterone in women.

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