Testosterone in Perimenopause: What It Does and What You Need to Know

The hormone nobody talks about

Most conversations about perimenopause focus on estrogen and progesterone. But testosterone plays a meaningful role in how you feel during this transition, and its decline often goes unaddressed.

Testosterone is produced in the ovaries and adrenal glands. During perimenopause, levels begin to decline gradually, often before estrogen does. The result can be fatigue that does not respond to sleep, a loss of motivation or drive, reduced libido, and difficulty maintaining muscle mass. These symptoms are real and they have a hormonal explanation.

What testosterone actually does in your body

Testosterone is often thought of as a male hormone, but it is essential for women too, just at lower levels. In women, it contributes to sex drive and sexual satisfaction, energy and motivation, muscle strength and bone density, and mood stability.

It also plays a role in cognitive clarity. Some women describe declining testosterone as a shift in their mental sharpness and overall sense of vitality. When both estrogen and testosterone are declining simultaneously, the cumulative effect on wellbeing can be significant.

Testosterone works alongside estrogen and progesterone. They do not operate in isolation. A decline in all three at once creates a more complex picture than any single hormone explains.

How perimenopause affects your testosterone levels

Testosterone levels in women peak in the mid-20s and decline gradually throughout adulthood. By perimenopause, many women have already lost a significant portion of their peak levels, even before other hormonal changes become noticeable.

Surgical menopause, meaning the removal of both ovaries, causes an immediate and steep drop in testosterone alongside estrogen and progesterone. For women who experience this, testosterone-related symptoms can appear suddenly and intensely.

Stress also suppresses testosterone. Chronically elevated cortisol, which is common during the demands of midlife, competes with the hormonal systems that produce testosterone. This is one reason that managing stress is not just good advice but a physiological necessity during this transition.

Signs that testosterone may be low for you

Low testosterone does not look the same for every woman. Common experiences include a noticeable drop in sexual desire or difficulty feeling aroused, reduced energy that is not explained by poor sleep, loss of motivation or a flattened emotional tone, more difficulty building or maintaining muscle despite regular exercise, and reduced strength or stamina.

These symptoms overlap significantly with other perimenopause experiences, including those driven by estrogen decline. This is why working with a knowledgeable healthcare provider matters. The goal is not to guess at which hormone is involved but to get a clear picture through proper assessment.

Testosterone therapy: what the evidence says

Testosterone therapy for women is an active area of research, and the evidence base is growing. The strongest evidence currently supports its use for hypoactive sexual desire disorder, a clinical term for significantly reduced or absent sexual desire causing distress.

Research has also explored its effects on energy, mood, muscle mass, and cognitive function, with generally positive findings, though the evidence is less definitive in these areas. Most studies have examined low-dose testosterone delivered via gel, cream, or pellet rather than oral tablets.

It is worth knowing that testosterone products approved specifically for women remain limited in many countries. Prescribing testosterone for women often involves off-label use of formulations designed for men at much lower doses. This is not uncommon in medicine, but it does mean finding a provider familiar with how to prescribe and monitor it in women is important.

What to ask your doctor

Practical steps to support testosterone naturally

Before or alongside any medical intervention, several lifestyle factors support healthy testosterone production. Resistance training is the most well-supported: compound movements like squats, deadlifts, and presses stimulate testosterone and support the muscle mass it helps maintain. Aim for two to three sessions per week.

Sleep quality directly affects testosterone production. Most hormonal repair, including testosterone synthesis, occurs during deep sleep. Prioritizing sleep is not a soft recommendation but a physiological one.

Reducing chronic stress lowers cortisol and takes the brakes off testosterone production. Even moderate stress management practices, like regular outdoor movement and limiting the demands you accept, have measurable hormonal effects. Adequate zinc and vitamin D from food and, when needed, supplements also support the hormonal pathways involved in testosterone production.

What to monitor over time

If you start testosterone therapy, monitoring is important. Your provider will likely check your levels periodically, watch for side effects like acne or excess hair growth, and adjust dosing accordingly. It can take several weeks before you notice changes, and effects build gradually.

Tracking your symptoms over time, before and during any treatment, gives you and your provider valuable information. Logging energy levels, libido, mood, and exercise capacity in a consistent way helps you see whether things are changing and in which direction. PeriPlan lets you log symptoms and track patterns over time, which can make those review conversations with your provider much more useful.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.