Testosterone for Menopause: What Every Woman Needs to Know

If you have been feeling exhausted, flat, or like your drive for life has quietly disappeared, testosterone might be part of the story nobody told you. Most women have never been taught that testosterone matters for them. But it does. Deeply.

Testosterone is not just a male hormone. Before menopause, women actually produce roughly three times more testosterone than estrogen. It is the hormone behind your energy, your motivation, your muscle tone, your sex drive, and a surprising amount of your emotional resilience.

When it starts to drop — which it does, gradually, from your 30s onward — things shift. You may not immediately connect the dots. But I want to help you do that today.

In this article, I am going to walk you through everything you need to know about testosterone and menopause: what happens to your levels, what it feels like when things are off, and what you can do about it — naturally and medically.

In this article, you will learn:

• What is testosterone — and why do women have it?

• How testosterone changes during menopause

• Signs your testosterone may be too low

• Signs your testosterone may be too high

• Testosterone therapy: what you need to know

• Vitamin D and hormone balance

• 5 natural ways to support healthy testosterone

• Dr. Anna's go-to support for hormone balance

• Frequently asked questions

What is testosterone — and why do women have it?

Testosterone is often labeled a male hormone, but that label is misleading. Women produce testosterone too, primarily in the ovaries and adrenal glands, and we rely on it for many of the same things men do.

In women, testosterone supports:

• Energy and stamina — the get-up-and-go feeling that carries you through a full day

• Muscle mass and strength — protecting you from age-related muscle loss (sarcopenia)

• Bone density — working alongside estrogen and progesterone to keep bones strong

• Libido — one of the most talked-about effects of declining testosterone

• Mood and motivation — testosterone influences dopamine pathways, affecting drive and emotional stability

• Cognitive sharpness — memory, focus, and mental clarity all have a testosterone connection

It is believed that before menopause, women produce as much as three times more testosterone than estrogen. (1) That puts testosterone in a different context entirely. It is not a footnote hormone. It is foundational.

How testosterone changes during menopause

In women without hormonal disorders, testosterone peaks in your 20s, then begins a slow, steady decline. By the time you reach postmenopause, your levels may be half of what they were in your younger years. (2)

Several factors accelerate this decline:

Natural aging and menopause

As ovarian function slows down, your ovaries produce fewer sex hormones across the board — estrogen, progesterone, and testosterone. The transition through perimenopause intensifies these fluctuations, and the drop in testosterone becomes more noticeable.

Surgical menopause

Women who undergo a hysterectomy that includes removal of the ovaries (oophorectomy) experience a sudden, dramatic drop in testosterone. This is not a gradual transition. It happens immediately, and the symptoms can be significant.

Other contributors

• Adrenal fatigue or dysfunction (the adrenals also produce small amounts of testosterone)
• Long-term use of hormonal birth control

• Chronic illness or high stress

• Certain medications including corticosteroids and some antidepressants

Signs your testosterone may be too low

Low testosterone is the more common scenario for women in and after menopause. The symptoms often overlap with other menopause changes, which is one reason they get missed. (3)

Here is what to look for:

• Persistent fatigue — tiredness that sleep does not fix

• Low or absent libido — one of the most common complaints I hear in practice

• Muscle weakness and loss — difficulty building or maintaining muscle despite exercise

• Weight gain — particularly around the abdomen, driven by slower metabolism and muscle loss

• Mood changes — depression, anxiety, irritability, or just feeling flat

• Brain fog — poor concentration, memory lapses, loss of mental sharpness

• Bone thinning — increasing osteoporosis risk

• Sleep disturbances — trouble falling or staying asleep, often linked to the hormone-fatigue cycle

The muscle connection

Adequate testosterone helps prevent sarcopenia — the age-related muscle wasting that accelerates after menopause. This matters beyond aesthetics. Muscle supports insulin sensitivity, protects your joints and bones, and determines how independently you function as you age. Protecting your muscle mass now is one of the most important things you can do.

Bone density

While estrogen gets most of the attention for bone health, testosterone plays a supporting role in maintaining density. Low testosterone combined with declining estrogen is a real osteoporosis risk factor that is worth discussing with your doctor.

Mood and mental clarity

Testosterone influences neurotransmitters, including dopamine, which means it affects motivation, emotional stability, and drive. Women with low testosterone often describe feeling emotionally blunted — not depressed exactly, but without spark. This is real, and it is hormonal.

Sexual health and libido

Declining testosterone is a primary driver of low libido in menopausal women. But it is not just about desire — testosterone also supports vaginal tissue health and sexual sensitivity. Addressing testosterone is often the missing piece for women who are frustrated that nothing seems to help in the intimacy department.

For vaginal DHEA support — DHEA is a natural precursor that your body converts into testosterone and estrogen — I rely on Julva. It was created specifically for this.

Signs Your Testosterone May Be Too High

Less common, but worth knowing: some women experience elevated testosterone in menopause. This happens because as estrogen and progesterone drop, testosterone loses its hormonal counterbalance and can rise relative to the other hormones. (5)

Conditions that can also raise testosterone in women include polycystic ovary syndrome (PCOS), adrenal disorders, insulin resistance, and certain medications.

Signs of elevated testosterone include:

• Acne or oily skin
• Hair thinning at the crown or temples

• New hair growth on the face or chin

• Irregular cycles (in perimenopausal women)

• Mood shifts — irritability, aggression

• Weight gain

• Voice changes

If left unaddressed, high testosterone can contribute to insulin resistance, cardiovascular changes, and fertility challenges. If you suspect high testosterone, blood testing is the right starting point.

Testosterone Therapy: What You Need to Know

If lifestyle approaches are not enough, testosterone therapy is an option worth discussing with your doctor — with eyes open.

Forms of testosterone therapy

• Topical creams and gels: Applied to the skin daily. Easy to adjust dosage. Transfer risk to others through skin contact.

• Injections: Administered every one to two weeks. Consistent dosing but can cause hormone fluctuations between doses.

• Transdermal patches: Steady hormone delivery but may irritate the skin.

• Pellet implants: Small pellets inserted under the skin in the hip or thigh, releasing testosterone over 3 to 6 months. Growing in popularity, but not adjustable once implanted. Bruising, infection, or discomfort at the site is possible.

• Oral tablets: Rarely used due to potential liver strain and less predictable absorption.

Vitamin D is worth a separate conversation in the testosterone context because the research is genuinely interesting.

Vitamin D functions more like a hormone than a traditional vitamin. It interacts with hormone receptors throughout the body and influences sex hormone production, including testosterone. You have vitamin D receptors in your ovaries and adrenal glands — the same glands responsible for testosterone production. (7)

Here is what the research shows:

• Studies have found a positive correlation between vitamin D levels and testosterone in women. (8)

• Women with sexual dysfunction had low vitamin D, and supplementation appeared to improve testosterone levels, oxidative stress markers, and sexual function. (9)

• Women with PCOS — who often have both low vitamin D and elevated testosterone — showed decreased testosterone and improved insulin sensitivity when supplementing with vitamin D. (10)

Maintaining healthy vitamin D levels is a foundational step. I always recommend pairing D3 with K2 for optimal absorption and bone protection.

Learn more: Why I pair D3 with K2

• Sunlight: 10 to 30 minutes outdoors a few times per week

• Food: Fatty fish, egg yolks, fortified dairy, mushrooms

• Supplementation: D3/K2 combination, especially in winter or with limited sun exposure

• Testing: Ask your doctor to include 25-OH vitamin D in your next blood panel — most doctors do not order it automatically

5 natural ways to support healthy testosterone

Before going straight to hormone therapy, I always look for ways to support the body naturally. These approaches are not a replacement for medical care when levels are truly depleted, but they make a meaningful difference and support everything else you are doing.

Resistance training is one of the most effective natural strategies for supporting testosterone production. Aim for three to four sessions per week that include both strength work and some cardio. Beyond hormones, building muscle protects your metabolism and your independence as you age. This one is non-negotiable.

Certain nutrients directly support hormone production. Focus on:

• Healthy fats: Avocado, olive oil, nuts, fatty fish — hormones are made from fat

• Quality protein: Eggs, meat, and clean plant-based options like my Keto-Green Shake

• Zinc and magnesium: Pumpkin seeds, shellfish, leafy greens, and nuts

Reduce excess sugar and refined carbohydrates, which drive insulin resistance and may further suppress testosterone.

Chronic stress triggers cortisol. Elevated cortisol over time suppresses testosterone production. Exercise, mindfulness, meditation, and deliberately scheduled downtime are not luxuries — they are hormone medicine. Do not skip your self-care.

Hormone production and regulation happen largely during sleep. Seven to nine hours of quality rest is the target. Keep the bedroom dark, cool, and quiet. Reduce screen exposure before bed to support natural melatonin production. Read more in my article on menopause fatigue and sleep.

Excess abdominal fat disrupts hormonal balance and is associated with lower testosterone. When working toward a healthier weight, focus on preserving muscle while reducing body fat — not just watching the scale.

Dr. Anna's go-to support for hormone balance

These are the products I reach for when women come to me with the symptoms we've been talking about — low energy, depleted libido, hormonal imbalance. They are designed to support the body's own systems, not override them. Always structure/function support, not a replacement for medical care

Frequently asked questions

Can testosterone levels drop during menopause?

Yes. Testosterone levels begin declining gradually from a woman's late 20s, and the drop accelerates through perimenopause and menopause as ovarian function decreases. By postmenopause, levels may be half of what they were in your 20s. This is normal, but the symptoms it causes are not something you have to simply accept.

What are the signs of low testosterone in women?

Persistent fatigue, low or absent libido, difficulty building muscle, mood changes including depression or flat affect, brain fog, abdominal weight gain, bone thinning, and disrupted sleep are the most common indicators. These overlap with general menopause symptoms, which is why testing matters.

Is testosterone therapy FDA-approved for women?

No. Testosterone therapy for women is currently prescribed off-label. That does not mean it is unsafe, but it does mean it requires careful oversight, regular blood testing, and a physician who specializes in hormonal health.

What is DHEA and how does it relate to testosterone?

DHEA is a precursor hormone your body converts into testosterone and estrogen. Topical DHEA — like what is in Julva — delivers this precursor directly to vaginal and vulvar tissue, supporting many of the same outcomes that testosterone therapy targets for intimate health, with a more localized approach.

Can lifestyle changes improve low testosterone in women?

Yes, meaningfully. Resistance training, a nutrient-rich diet, stress management, quality sleep, and healthy body composition all support testosterone production. These are a first step, not a last resort. They work best alongside medical care when levels are clinically low.

Does vitamin D affect testosterone in women?

Research shows a connection between vitamin D status and testosterone regulation in women. Vitamin D receptors are present in the ovaries and adrenal glands. Women with deficiencies have shown improvements in testosterone and sexual function with supplementation. It is worth testing your levels and supplementing if needed.

Final Thoughts

Testosterone plays a far more significant role in women's health than most people realize. When it drops — or gets out of balance — the effects ripple through your energy, your mood, your body composition, and your intimacy.

You have options. Natural strategies can make a meaningful difference. And if those are not enough, having an informed conversation with your doctor about testosterone therapy is worth it.

For my patients who want to start somewhere tangible, I often recommend building the foundation first: support your adaptogenic hormone balance with Mighty Maca Plus, address intimate tissue health with Julva, and if vitamin D is low, get that sorted. These are accessible, daily-use steps you can take while you get more information.

You deserve to feel like yourself again. That is not too much to ask for.

References

• PMC7098532 — Testosterone in women before menopause
• PubMed 12007895
• Boston University — Testosterone insufficiency in women
• PubMed 11937111
• PMC9004339
• PMC9331845 — FDA status testosterone women
• PMC6191853 — Vitamin D and hormone production
• PubMed 24742123
• ScienceDirect — Vitamin D sexual function women
• PMC10328709 — Vitamin D PCOS testosterone