Uncovering the power of testosterone - why this 'hidden' hormone matters for women’s health and vitality

Testosterone is a crucial hormone present in everyone, though often overlooked by women who may not realise its importance alongside oestrogen for maintaining health and vitality. It is produced in the body along with oestrogen and progesterone and is the most recognised androgen, a group of hormones including DHEA-S, DHEA, androstenedione, and dihydrotestosterone. These androgens not only contribute to oestrogen production but are also essential for cardiovascular, muscular, skeletal, and reproductive health.

Our hormones act as intricate chemical messengers, working together in a complex network. Testosterone, oestrogen, and progesterone circulate in the bloodstream, either carried by proteins or derived from cholesterol, and are produced by the ovaries and endocrine glands like the adrenal, pituitary, and hypothalamus. Together, they influence reproductive organ development, regulate menstrual cycles, affect mood, and, in the case of testosterone, drive libido.

Why does testosterone matter?

As we age, testosterone levels, like other hormones, decrease. Many middle-aged women experience low testosterone levels, raising the question of whether women with low libido and related symptoms should consider testosterone treatment.

During perimenopause and menopause, lower testosterone levels can impact intimate relationships. Around 40% of women report sexual issues, with 12% experiencing distress as a result. Severe sexual dysfunction is most common in midlife women (ages 45–64) and tends to decrease beyond 65. The most prevalent sexual issue is hypoactive sexual desire disorder (HSDD), characterised by low desire and related distress.

What can be done?

Though no testosterone products are currently approved in the EU for treating HSDD in women, testosterone is sometimes prescribed off-label, typically as a compounded topical cream or a reduced dose of a testosterone gel formulated for men. However, the safety and efficacy of compounded testosterone, particularly for female sexual health, lack clinical evaluation.

Evidence supports testosterone therapy for postmenopausal women with HSDD when no other causes of sexual dysfunction are present. A thorough assessment considering physical, psychological, lifestyle, and relationship factors is essential before starting any treatment.

It can also be helpful to explore non-hormonal approaches like relationship counselling, stress management, and sex therapy. These methods, combined with treatments for menopausal symptoms like hot flushes, can support intimacy needs holistically.

Key takeaway on testosterone

Ageing doesn’t mean we have to suffer in silence. Body changes are normal, but understanding them can help you make informed choices with your healthcare provider or partner. Don’t hesitate to seek support and consider the treatments that best meet your needs.

According to the International Society for the Study of Women’s Sexual Health, key insights on testosterone include:

• Testosterone is essential for the development and maintenance of female sexual health and influences sexual behaviour.
• It plays a wide role in women’s physiology through specific cell receptors, by non-receptor actions, and by conversion to other hormones.
• No specific testosterone level is required to diagnose HSDD or as a treatment target.
• Total testosterone concentration is the most practical test, and measurements should be taken before starting therapy.
• Dosing should aim to maintain total testosterone within the premenopausal range.
• IM injections, oral formulations, and pellets are generally not recommended, with adjustments needed if responses are atypical or testosterone/SHBG levels are high.

Understanding testosterone’s role in women’s health highlights the value of balanced hormones for physical, emotional, and intimate well-being. As we navigate perimenopause, menopause, and beyond, recognising testosterone’s impact on energy, libido, and overall vitality enables us to take control of our health. Though hormone levels naturally decline with age, options like targeted testosterone therapies and holistic approaches provide effective ways to manage symptoms and enhance quality of life.

Communicating openly with healthcare providers about concerns is key, whether considering hormone therapy, relationship support, or lifestyle adjustments. With knowledge and the right support, we can embrace this phase of life with strength and confidence.