During peri-menopause and menopause women’s hormones begin to decline. All of us know that estrogen is a female hormone. Testosterone is also a very important hormone for women. The decline begins as early as our thirties. Symptom can include low libido, fatigue, mood swings, brain fog, decreased bone density, and muscle weakness. Sometimes, low testosterone mimics depression and anxiety.
“Part of the confusion with testosterone and estrogen is that we genderize them and call them ‘sex hormones,’” says Dr. Crawford. “But in reality, both have important biological functions in both men and women.” A blood test is the only way to check for low testosterone. Testosterone replacement therapy requires routine blood work. Testosterone Therapy for Women: What To Know Cleveland Clinic
Testosterone is also cardiovascular protective. Studies have shown that women with low testosterone have a higher incidence of atherosclerosis. As your testosterone levels plummet (through your 30s and 40s) your immune system stops regulating inflammation, and this inflammation is can cause plaque build up in your coronary arteries. Studies have shown that TRT in women reduced inflammation, showed improvement in blood vessel lining, reduced pain, kept LDL in check, and improved HDL
In this study dated April 2023, CVD is specifically studied, and further studies are ongoing.
Despite all the controversies, hormone replacement therapy (HRT) with T has gained prominence in treating pre and postmenopausal women in the last decades. HRT with silastic and bioabsorbable testosterone hormone implants has gained prominence recently due to its practicality and effectiveness in treating menopausal symptoms and hypoactive sexual desire disorder.Renke G, Tostes F. Cardiovascular Safety and Benefits of Testosterone Implant Therapy in Postmenopausal Women: Where Are We? Pharmaceuticals (Basel). 2023 Apr 20;16(4):619. doi: 10.3390/ph16040619. PMID: 37111376; PMCID: PMC10146246.
Transdermal testosterone therapy for 4 months was associated with significant improvements in mood and cognition. Further research including randomised clinical trials are needed to establish the long-term efficacy and safety of testosterone for the treatment of menopausal cognitive and psychological symptoms. Glynne S, Kamal A, Kamel AM, Reisel D, Newson L. Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study. Arch Womens Ment Health. 2025 Jun;28(3):541-550. doi: 10.1007/s00737-024-01513-6. Epub 2024 Sep 16. PMID: 39283522; PMCID: PMC12092509.
Serum total T level was positively associated with lumbar BMD in middle-aged postmenopausal women up to a T level >30 ng/dL. Therefore, increasing T level in women with a low serum total T level may have beneficial outcomes on bone health. Yang J, Kong G, Yao X, Zhu Z. Association between Serum Total Testosterone Level and Bone Mineral Density in Middle-Aged Postmenopausal Women. Int J Endocrinol. 2022 Aug 17;2022:4228740. doi: 10.1155/2022/4228740. PMID: 36034179; PMCID: PMC9402345.
A sad fact is that testosterone replacement is understudied in women. Thankfully, is starting to change.
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