Menopause is often framed as an estrogen story. When women start experiencing hot flashes, poor sleep, mood swings, or low libido, the conversation almost always turns to estrogen therapy, namely estradiol or estriol. But a growing body of research suggests another hormone may be playing a much bigger role than we realized: testosterone.

What’s This About?

Most menopause conversations revolve around declining estrogen and progesterone. But women also produce testosterone, a hormone often associated with men but essential for women’s health as well.

Testosterone receptors exist in almost every organ system in the body and influence things like energy levels, mood, cognition, muscle strength, and sexual desire. When levels drop or become imbalanced during menopause, women may experience symptoms such as fatigue, brain fog, low libido, sleep disturbances, and joint pain.

The study “The benefits of testosterone therapy for menopausal symptoms” explored whether replacing testosterone, specifically through small implanted pellets, could relieve these symptoms. As much as I am not a fan of pellets for women starting out on hormone therapy, this is an interesting study.

When & Who?

Researchers conducted a retrospective study spanning ten years, reviewing the medical records of women treated in a gynecology practice between 2014 and 2024.

The participants were 100 peri-menopausal and post-menopausal women aged 38 to 68, with a median age of 52. About 77% were already menopausal, while the remaining women were in perimenopause.

These women received testosterone pellet therapy, a treatment where tiny pellets containing testosterone are inserted under the skin every few months. The pellets slowly release hormones over time.

To track symptoms, the researchers used a validated tool called the Menopausal Rating Scale (MRS), which measures 11 common symptoms such as hot flashes, anxiety, sleep issues, vaginal dryness, and sexual problems.

Women filled out this questionnaire before starting therapy and again after several months of treatment.

What Did They Find?

The results were striking.

Among the 78 women who completed both surveys, 91% reported improvement in their symptoms after treatment. Their overall symptom scores dropped significantly, from a median score of 17 before treatment to 7 after therapy. 

Improvements were seen across all 11 menopause symptoms, including:

• Sexual problems
• Anxiety and irritability
• Vaginal dryness
• Hot flashes
• Sleep disturbances
• Physical and mental exhaustion

One interesting finding: the improvements didn’t depend on age or testosterone levels. Women across all age groups, under 50, in their 50s, and over 60, experienced symptom relief. 

The benefits were also sustained long-term, with many patients continuing therapy for five years or more.

Of course, like any treatment, there were side effects. The most common were facial hair and acne, which usually improved with dose adjustments. 

Why Does It Matter?

Menopause is often described as one of the most misunderstood and undertreated conditions in medicine.

For years, the conversation around hormone therapy was overshadowed by fear after the early 2000s Women’s Health Initiative study raised concerns about risks from certain hormone treatments. That led many doctors to stop prescribing hormone therapy altogether.

But in the years since, researchers have begun to reassess those conclusions. New evidence suggests hormone therapy, when used appropriately, can significantly improve quality of life.

This study adds another important layer to the conversation: testosterone may be a missing piece of the menopause puzzle.

While estrogen can help symptoms like hot flashes or vaginal dryness, testosterone may play a larger role in addressing low libido, fatigue, mood changes, and cognitive issues, symptoms many women struggle with but rarely discuss.

What Am I Doing About It?

I’ve been experimenting with testosterone therapy for several years now. I originally started with a compounded cream, hoping it might supercharge my libido, which for many women in midlife can quietly disappear. I tried different dosages, adjusted timing, and gave it plenty of time… but personally, I didn’t notice much of a change.

So recently I switched strategies.

Now I’m using a pharmaceutical testosterone gel designed for men, but at about one-tenth of the male dose, which is often what physicians recommend for women. My blood work shows that I’m absorbing it just fine and my levels look good on paper.

But in terms of how I feel? I still don’t notice a dramatic difference. No big shift in libido, motivation, or muscle. To be honest, these are all pretty good with high or low testosterone. 

Interestingly though, when I stop using it for a while, my testosterone levels drop right back down, so it clearly is doing something biologically.

For now, I’m continuing therapy because I suspect testosterone is doing far more in the body than we fully understand today, from bone and brain health to metabolic function. Libido tends to get all the attention, but it’s only one piece of the story.

At some point I may experiment with injectable testosterone, which some women respond to better. We’ll see.

What I can say from watching the women in our Biohacking Menopause community is that many do benefit from testosterone, sometimes dramatically, and through all kinds of delivery methods, creams, gels, pellets, and injections.

Which is why my approach is always the same: test, measure, and assess.

Hormones are not one-size-fits-all. They’re part of a much bigger midlife health picture that includes sleep, nutrition, movement, stress, and metabolic health.

Testosterone might be the missing piece for some women.

For others, it may be just one small piece of a much bigger puzzle.

Practical Tips

If you’re navigating perimenopause or menopause, here are a few practical steps to consider.

First, pay attention to your symptoms. Persistent fatigue, low libido, mood changes, or brain fog may be linked to hormonal shifts, not just stress or aging. Download the symptom tracker here, track your symptoms, then take the spreadsheet to your doctor.

Second, work with a menopause-literate healthcare provider. Hormone therapy, including testosterone, is still evolving, and not every doctor is familiar with the latest research.

Third, support your hormones. Strength training, adequate protein intake, stress management, and good sleep hygiene can all help stabilize hormone balance during midlife.

Finally, remember that menopause is not a disease – it’s a transition. But that doesn’t mean you have to suffer through it.

As research like this suggests, understanding the full hormonal picture could open new doors to feeling strong, energized, and vibrant in midlife.

Download the Menopause Symptom Tracker to help you figure it all out. 

Reference: Chan, J., Cunningham, J., Cunningham, C., Cunningham, J., & Cunningham, C. (2025). The Benefits of Testosterone Therapy for Menopausal Symptoms. European Journal of Obstetrics & Gynecology and Reproductive Biology: X. PMC.