Testosterone Therapy in Perimenopause: What Women Need to Know

Understanding symptoms, testing, and when treatment may help

For many women, conversations about hormones during perimenopause focus almost exclusively on estrogen and progesterone. But there is another hormone that plays a meaningful role in women’s health: testosterone.

Although often thought of as a “male hormone,” testosterone is essential for women as well. It influences sexual desire, energy, mood, cognition, muscle strength, and overall well-being. During perimenopause, testosterone levels naturally decline, which may contribute to symptoms that many women experience but rarely discuss.

In this article, we’ll explore:

• What testosterone does in the female body

• How levels change during perimenopause

• Symptoms that may suggest low testosterone

• When testosterone therapy may be appropriate

• Safety considerations and monitoring

At Psychiatry for Women, we frequently evaluate hormonal contributors to mood, cognition, and sexual health during perimenopause. Our approach integrates psychiatric expertise with thoughtful hormone optimization, helping women understand how hormonal shifts may be affecting both mental health and overall well-being.

What Does Testosterone Do in Women?

Women produce testosterone primarily in the ovaries and adrenal glands. While levels are much lower than in men, the hormone still plays an important role in multiple body systems.

Testosterone in women contributes to:

• Sexual desire and arousal

• Energy and motivation

• Mood and emotional resilience

• Cognitive function and focus

• Muscle mass and strength

• Bone health

Researchers also believe testosterone supports brain function, mood regulation, and sexual health, making it an important hormone for overall quality of life.

Testosterone Levels in Women

Testosterone levels vary widely between individuals and across the lifespan.

Typical ranges for adult women are approximately:

• Premenopausal women: ~15–70 ng/dL

• Postmenopausal women: ~7–40 ng/dL

Unlike in men, there is no single blood level that defines testosterone deficiency in women. Instead, clinicians evaluate symptoms alongside laboratory results when considering treatment.

What Happens to Testosterone During Perimenopause?

Testosterone levels begin to decline gradually in a woman’s early 30s, decreasing by about 1–2% per year. By the time menopause occurs, levels may be roughly half of what they were at their peak.

Perimenopause can amplify these changes because ovarian hormone production becomes irregular. While estrogen fluctuations often get the most attention, declining testosterone may also contribute to symptoms.

Symptoms of Low Testosterone in Women

Symptoms are often subtle and overlap with other hormonal changes. Possible signs include:

Sexual symptoms

• Low libido

• Reduced sexual satisfaction

• Difficulty with arousal or orgasm

Emotional and cognitive symptoms

• Brain fog

• Low motivation

• Mood changes

• Irritability or anxiety

Physical symptoms

• Persistent fatigue

• Loss of muscle strength

• Increased body fat

• Thinning hair

Even small hormonal shifts can produce noticeable changes because women naturally operate within a much narrower testosterone range than men.

When Is Testosterone Therapy Used in Women?

Current clinical guidelines are cautious about testosterone therapy.

The strongest evidence supports its use for hypoactive sexual desire disorder (HSDD) in postmenopausal women when symptoms cause distress and other factors have been addressed.

Research shows that testosterone therapy may improve:

• Sexual desire

• Sexual arousal

• Orgasm frequency

• Sexual satisfaction

However, data for other symptoms such as mood, cognition, and energy are less definitive, and treatment decisions should be individualized.

In clinical practice, many clinicians evaluate testosterone as part of a broader hormone optimization strategy during perimenopause.

Forms of Testosterone Therapy

In the United States, there is no FDA-approved testosterone product specifically designed for women. As a result, treatment is typically prescribed off-label.

Common formulations include:

• Transdermal creams or gels

• Compounded topical preparations

• Occasionally low-dose patches

Clinical studies often use very small doses—about one-tenth of typical male doses to maintain physiological female levels.

The goal is symptom improvement while keeping blood levels within the normal female range.

Monitoring Testosterone Therapy

If testosterone therapy is initiated, careful monitoring is essential.

Typical monitoring includes:

• Baseline testosterone levels

• Repeat testing after 3–6 weeks

• Periodic monitoring every few months once stable

Clinicians also monitor for potential side effects such as:

• Acne

• Increased facial or body hair

• Voice changes

• Scalp hair thinning

Maintaining testosterone levels within the normal premenopausal range helps minimize risks.

Considering Hormone Therapy During Perimenopause?

If you’re experiencing symptoms such as low libido, brain fog, fatigue, mood changes, or loss of motivation, it may be helpful to explore whether hormonal changes are contributing.

At Psychiatry for Women (PFW), we specialize in the intersection of hormones and mental health. Our clinicians provide personalized evaluations for women navigating perimenopause, including:

• Comprehensive psychiatric assessment

• Hormone therapy consultation (including estrogen, progesterone, and testosterone when appropriate)

• Evidence-based treatment for mood, anxiety, and cognitive symptoms

• Collaboration with therapists and other specialists when helpful

Because hormonal changes often affect both body and mind, our goal is to provide a whole-person approach to care for women during midlife transitions.

If you’d like to learn more or schedule a consultation, you can explore our services or request an appointment through Psychiatry for Women.

Is Testosterone Therapy Right for You?

Testosterone therapy is not appropriate for every woman experiencing perimenopause.

Many symptoms attributed to testosterone deficiency may actually be caused by:

• Estrogen fluctuations

• Thyroid dysfunction

• Sleep disturbance

• Mood disorders

• Relationship or stress factors

A comprehensive evaluation is important to determine whether testosterone therapy may be helpful.

The Bottom Line

Testosterone is an important but often overlooked hormone in women’s health. During perimenopause, declining levels may contribute to symptoms such as low libido, fatigue, and changes in mood or motivation.

While testosterone therapy can be beneficial for some women—particularly those experiencing distressing low sexual desire—it should always be prescribed thoughtfully and monitored carefully.

If you’re experiencing hormonal symptoms during perimenopause, a personalized evaluation can help determine the best approach for your health, goals, and overall well-being.

If you are searching for a perimenopause psychiatrist, hormone therapy for women, or testosterone therapy for women, our team at Psychiatry for Women provides specialized care designed specifically for women’s mental and hormonal health.