Testosterone Therapy in Perimenopause: Weighing the Benefits and Risks

The Hormone You Might Not Know You're Losing

Most conversations about perimenopause focus on estrogen and progesterone. But testosterone is also produced in the female body, and its levels decline gradually from your 30s onward, becoming more noticeable during the perimenopausal years for some women.

Testosterone plays a role in energy, mood, bone density, muscle mass, brain function, and libido. When levels fall, some women experience a cluster of symptoms that estrogen-based HRT does not fully address. Testosterone therapy has become an increasingly discussed option, but it also comes with genuine complexity. Understanding both sides helps you have a better-informed conversation with your clinician.

What Declining Testosterone Can Feel Like

Low testosterone in women is not as clearly defined as it is in men, partly because reference ranges for female testosterone have not been as well established. But the symptoms that some women attribute to declining testosterone include reduced libido that feels qualitatively different from low desire related to relationship factors, persistent fatigue that is not explained by sleep or thyroid issues, loss of motivation, reduced physical strength, and flattened mood.

These symptoms overlap significantly with low estrogen and progesterone symptoms, which is one reason testosterone therapy is often considered alongside estrogen-based HRT rather than instead of it.

What the Research Suggests About Benefits

The strongest evidence for testosterone therapy in women concerns hypoactive sexual desire disorder (HSDD), the clinical term for persistently low libido that causes personal distress. Multiple studies have examined testosterone supplementation for HSDD in postmenopausal and perimenopausal women and found improvements in desire, arousal, and satisfaction.

Some research has also examined effects on mood, energy, cognitive function, and bone density, with more mixed findings. The evidence base is growing, but it is less robust for these areas than it is for sexual function. This is partly because testosterone research in women has historically been underfunded compared to research in men.

The Global Consensus Position Statement on the Use of Testosterone Therapy for Women, published by several major menopause societies, concluded that testosterone therapy for HSDD in postmenopausal women is supported by the evidence, though data in perimenopausal women is more limited.

What Are the Risks and Uncertainties?

Testosterone therapy carries real risks that need to be part of the conversation. The most commonly reported side effects at physiological doses include acne, oily skin, and increased facial or body hair growth. These effects are dose-dependent and typically reversible if treatment is stopped or the dose reduced.

At supraphysiological doses (doses that push testosterone above normal female range), virilizing effects such as voice deepening and clitoral enlargement may occur and may not be fully reversible. This is why monitoring testosterone levels during treatment is important. The goal is to restore levels to the normal female physiological range, not to push them higher.

Data on long-term cardiovascular safety and breast cancer risk with testosterone therapy in women is still limited. Current evidence does not clearly show increased risk at physiological doses, but longer-term studies are needed. Women with hormone-sensitive conditions should discuss this carefully with their specialist before considering testosterone therapy.

How Does Testosterone Therapy Compare to Doing Nothing?

For women whose symptoms genuinely stem from low testosterone, particularly HSDD, no treatment means continuing to live with those symptoms. For some women, that is an acceptable choice, especially if symptoms are mild. For others, reduced libido, flat energy, and low motivation significantly affect their quality of life and their relationships.

Non-hormonal approaches to libido and energy include addressing sleep, reducing stress, reviewing other medications that can dampen desire, and working with a sex therapist or psychologist. These are valuable options and should be considered alongside or before hormonal treatment in many situations. But for some women, these measures do not fully address what is happening hormonally.

What to Do If You're Considering Testosterone

Testosterone therapy for women is a specialist area in many healthcare systems. Access through standard GP or primary care can be limited, and testosterone products are not always licensed for use in women, even though prescribing them is common practice in menopause specialist settings. This means a referral to a menopause specialist or endocrinologist may be the most practical route.

Before starting, your clinician should measure your baseline testosterone level. During treatment, regular monitoring of levels ensures you stay within the physiological female range. Be cautious of any provider who offers high doses without monitoring, or who promises dramatic results without discussing risks.

Track How Your Symptoms Change

If you do decide to pursue testosterone therapy, tracking your symptoms before and after starting is genuinely valuable. Libido, energy, mood, and motivation can all be hard to remember accurately over weeks, but a consistent daily log builds a picture of what is actually changing.

PeriPlan lets you log symptoms and track patterns over time. Noting your energy levels, mood, and wellbeing daily makes it easier to assess whether a treatment change is helping, and to spot any side effects early.

When to Seek Medical Attention

Contact your prescribing clinician if you notice acne, increased facial or body hair, or any other unexpected changes after starting testosterone therapy. These may indicate the dose needs adjusting. Seek care promptly if you notice voice changes, which would suggest levels outside the intended range.

If you are thinking about testosterone therapy and have a history of a hormone-sensitive cancer or other hormone-related condition, this needs to be a careful specialist conversation rather than a self-managed decision.

You Deserve a Thoughtful Conversation About This

Testosterone therapy is neither a universal solution nor something to dismiss out of hand. The evidence supports its use for specific symptoms in appropriate candidates, with proper monitoring. The decision about whether it is right for you depends on your symptoms, your health history, your priorities, and your access to specialist care.

You are entitled to ask your doctor about testosterone, to receive a straight answer about what it might and might not help, and to make a decision based on real information rather than guesswork or dismissal.

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