For women in perimenopause and menopause experiencing menopause symptoms, testosterone often comes up as a potential solution. The reality is more nuanced than either "testosterone fixes everything" or "testosterone only helps with sex."
This article will help you understand what science supports, what's still uncertain, and how to get comprehensive evaluation and treatment for symptoms that are affecting your quality of life.
Q: What are the real signs of low testosterone during perimenopause and after menopause?
A: We'll explore the full range of symptoms women experience and what the evidence says about each one.
Q: How do I know if my testosterone is actually low?
A: We'll explain why there's no universal "low" number and what testing can (and can't) tell you about your hormone levels.
Q: Could low testosterone be causing my fatigue, brain fog, or weight gain?
A: We'll look at what research shows about these symptoms and what else could be causing them.
Q: When might testosterone therapy be worth considering?
A: We'll walk through the evidence-based uses and the more uncertain territory where some women report benefits.
Q: What should I investigate before trying testosterone?
A: We'll cover the other conditions that often cause the same symptoms and treatment alternatives for these symptoms.
Women produce testosterone in the ovaries and adrenal glands. Levels decline gradually with age, drop more noticeably during perimenopause, and fall further after menopause. For women who experience surgical menopause, the reduction in testosterone levels is much steeper.
Testosterone plays several important roles in women's bodies:
The question isn't whether testosterone matters; it’s when testosterone levels drop during menopause, which symptoms are actually caused by low testosterone, and which are caused by other factors?
This distinction matters because it determines whether testosterone therapy will actually help you feel better.
Reduced or absent sexual desire. Loss of arousal or responsiveness. Difficulty reaching orgasm. Distress about these changes.
This is the symptom cluster where evidence for testosterone therapy is strong. Multiple clinical trials have shown that low-dose testosterone can meaningfully improve sexual desire, arousal, satisfaction, and distress in postmenopausal women with hypoactive sexual desire disorde.
If low libido that causes you distress is your primary concern, testosterone therapy is an evidence-based option, which should be used in conjunction with addressing other causes, such as:
Exhaustion that doesn't improve with rest. Feeling like you're dragging through the day. Loss of stamina for exercise or activities you used to enjoy.
Clinical trials have not consistently shown that testosterone therapy improves energy or reduces fatigue in menopausal women. Some individual women report improvement, but controlled studies haven't proven this benefit reliably.
Fatigue in perimenopausal and menopausal women is incredibly common but it has many causes:
The good news? Many of these causes of constant fatigue are treatable. The challenge is that they can look exactly like "low testosterone."
Difficulty concentrating. Forgetting words or names. Feeling mentally sluggish. Trouble multitasking or processing information as quickly as before.
There is insufficient evidence that testosterone therapy improves cognitive function or "brain fog" in menopausal women. The little research focused on testosterone replacement therapy usage by women in midlife simply hasn't proven this benefit.
Brain fog during menopause is real and frustrating. But the primary hormone affecting cognition in menopause appears to be estrogen, not testosterone. Estrogen receptors are abundant in brain regions involved in memory and executive function.
Other common causes include:
Difficulty building or maintaining muscle despite exercise. Feeling physically weaker. Loss of muscle tone and definition. Workouts that used to feel manageable now don’t.
While testosterone is important for muscle mass and strength, studies have not proven that testosterone therapy prevents muscle loss or improves strength in menopausal women at typical doses.
Muscle loss during menopause is primarily driven by:
Resistance training 2–4 times per week and getting an adequate protein intake (about 25–35 grams per meal) still makes the biggest difference for building muscle and managing weight. However, testosterone also plays an important supporting role. Testosterone helps promote muscle growth in women, and because muscle burns more energy than fat, this increase in lean muscle can support weight loss and metabolic health over time. While lifestyle habits remain the foundation, testosterone therapy can act as a meaningful ‘booster’ for some women, enhancing the muscle-building response when combined with proper training and nutrition.
Weight gain (especially around the abdomen) often becomes more noticeable in late perimenopause. Many women find that the diet and exercise habits that once worked no longer lead to weight loss, which can feel frustrating and confusing.
Long-term research shows that the menopause transition changes body composition, not just body weight. During this time, fat mass increases while lean muscle mass declines, even if the number on the scale doesn’t rise much. This loss of muscle helps explain why weight feels harder to manage and why the body may look different despite similar habits.
Testosterone is not a weight-loss medication on its own, but it does support lean muscle. Because muscle helps regulate metabolism and insulin sensitivity, maintaining muscle during menopause can support healthier body composition over time.
Menopausal weight changes are driven by real biological shifts, not a lack of effort:
The reassuring takeaway: these changes are expected, and they are addressable. A muscle-first approach that combines strength training, proper nutrition, and individualized hormone support can help counter the body composition changes that occur during the menopause transition.
Low mood. Irritability. Loss of motivation. Feeling flat or numb. Difficulty experiencing joy or pleasure in activities.
The evidence for testosterone improving mood or treating depression in menopausal women is inconsistent and insufficient.
Depression and mood changes during menopause have multiple drivers:
Clinical depression requires proper evaluation and treatment, therapy, antidepressants, or both, regardless of hormone levels.
If you ask your provider to check your testosterone, you might get one of several responses:
All three might be problematic, and here's why.
Unlike with men, there's no agreed-upon testosterone level that defines "low" in women. Women's testosterone levels vary widely from person to person. What's normal for you might be low for someone else, and vice versa.
Your testosterone also declines naturally with age. A 50-year-old woman will typically have lower levels than she did at 30. This is normal biology, not necessarily a disorder.
Testosterone testing in women can be challenging because levels are much lower than in men, roughly one-tenth as high. Some standard laboratory tests were originally designed around male reference ranges, which can make interpretation in women less straightforward. As a result, testosterone results in women should be viewed in a clinical context and interpreted alongside symptoms, rather than relied on as a single deciding factor.
If testing is part of your care, providers typically focus on a small, targeted set of labs that help put testosterone levels into context. These may include:
Free testosterone: This reflects the portion of testosterone that is available for your tissues to use, rather than bound to proteins in the blood.
Blood count (CBC): This helps ensure testosterone therapy is being used safely, since testosterone can affect red blood cell levels.
Total testosterone: This measures the overall amount of testosterone in your bloodstream. While it does not reflect how much is biologically active, it provides a baseline reference and helps identify clearly low or unusually high levels.
Sex hormone–binding globulin (SHBG): SHBG is a protein that binds testosterone and affects how much is available for your tissues to use. Changes in SHBG can significantly alter how much testosterone your body can actually access, even if total levels appear “normal.”
These results are interpreted alongside your symptoms and overall health, rather than in isolation. Not every possible hormone-related test is necessary for every woman, and thoughtful, focused testing helps guide care without overcomplicating the process.
Let's say your testosterone comes back "low." What does that tell you?
Honestly, not as much as you'd hope. It tells you that on that particular day, your level was below the reference range. It doesn't tell you:
Low testosterone can be present with symptoms and may contribute to how you feel, but it is rarely the only cause. This is why comprehensive evaluation matters more than any single number.
Testosterone therapy has a clear, evidence-based role for postmenopausal women with hypoactive sexual desire disorder (HSDD), a persistent lack of sexual desire that causes personal distress. For women in this group, studies consistently show meaningful benefits, including improvements in:
For many women, this can feel like getting an important part of themselves back.
Many women also wonder about testosterone’s role in energy, mental clarity, mood, muscle strength, or weight changes. While research in these areas is still emerging, clinical experience shows that some women do notice benefits.
What’s important to know is that responses vary. Hormones don’t work in isolation, and testosterone tends to work best when other foundations are already being addressed. When used thoughtfully, testosterone can be one piece of a larger strategy to help you feel stronger, more engaged, and more like yourself.
When you and your provider decide to explore testosterone therapy, best practices focus on safety, balance, and realistic expectations:
This approach keeps the focus on your experience, not just numbers.
Short-term studies show that low-dose testosterone, used appropriately, is generally well tolerated. Some women may notice mild side effects such as acne or increased facial or body hair, which are usually dose-related and reversible.
Importantly, studies have not shown increased risks of heart disease, breast cancer, or blood clots at appropriate doses. While long-term data beyond a few years is still limited, this simply reflects the need for more research. Ongoing monitoring and individualized dosing are key.
Testosterone works best when the basics are already in place. Many symptoms blamed on “low testosterone” are actually driven by other common and treatable factors during menopause.
For many women, estrogen plays the largest role in overall wellbeing during perimenopause and menopause. Adequate estrogen support can improve:
For women who are candidates, estrogen therapy (with progesterone when needed) often addresses multiple symptoms more broadly than testosterone alone.
Quality sleep is foundational. When sleep improves, energy, focus, mood, and metabolism often follow. Addressing night sweats, insomnia, or sleep apnea can make a noticeable difference in how you feel day to day.
Thyroid imbalance, iron deficiency, and low levels of vitamin D, B12, or magnesium are common in midlife and can strongly affect energy, mood, and muscle strength. Identifying and correcting these can be transformative.
Mood changes, anxiety, and depression are common during the menopause transition and deserve real attention. Support may include therapy, medication, lifestyle changes, or hormonal care and often works best when these options are combined.
Muscle health becomes more important after menopause. The most effective foundation includes:
These habits support metabolism, bone strength, insulin sensitivity, and long-term independence. Hormone therapy can support this work, but it doesn’t replace it.
Testosterone therapy isn’t a one-size-fits-all solution, but for the right woman, at the right dose, and in the right context, it can be a valuable part of care. When combined with comprehensive hormone support, strength-focused movement, and personalized medical guidance, it becomes less about “fixing” something and more about supporting your body through a natural transition.
If you're experiencing symptoms you think might be related to low testosterone:
"I'm experiencing [specific symptoms: fatigue, brain fog, muscle loss, low libido] that are significantly affecting my quality of life. I'd like a comprehensive evaluation to understand what's causing these symptoms and explore all treatment options, including whether hormone therapy might be appropriate."
Here's a framework for addressing symptoms during perimenopause and menopause:
Get thorough testing and evaluation for all potential causes of your symptoms, not just testosterone.
Optimize sleep, nutrition, exercise, stress management, and treat any identified deficiencies or conditions (thyroid, iron, vitamin D, etc.).
For many women in perimenopause and menopause, estrogen therapy addresses more symptoms more effectively than testosterone. Discuss this with your provider.
Address vaginal health, mental health, pain, medication side effects, or other specific contributors.
After 3-6 months of addressing foundational factors, reassess your symptoms. Many women find significant improvement without ever needing testosterone.
If you still have persistent symptoms (especially low libido with distress, or possibly other symptoms after everything else has been optimized) discuss a trial of testosterone therapy with your provider, understanding the evidence is strongest for sexual symptoms.
If you're struggling with fatigue, brain fog, muscle loss, weight gain, low mood, or low libido during perimenopause or menopause, you deserve comprehensive care and effective treatment.
Testosterone might be part of the solution, particularly if poor sexual health is your primary concern. But it's rarely the whole solution, and often not the most important solution.
The goal is to identify and address all the factors contributing to how you feel, not to chase a single hormone that may or may not be the culprit.
Many women find that addressing sleep, thyroid function, iron status, estrogen deficiency, blood sugar, and lifestyle factors makes a profound difference. Some women also benefit from testosterone therapy, especially for sexual symptoms.
The key is comprehensive, evidence-based care that addresses your whole health.
What are the real signs of low testosterone in women?
Answer:
The clearest, evidence-based sign is low sexual desire that causes distress. Other symptoms like fatigue, brain fog, or weight gain are common in menopause but are usually caused by factors other than testosterone.
How do I know if my testosterone is actually low?
Answer:
There’s no universal “low” number for women. Blood tests provide context, but symptoms and overall health matter more than a single lab value.
Will testosterone fix my fatigue, brain fog, or weight gain?
Answer:
Research hasn’t consistently shown that testosterone improves these symptoms. Sleep, estrogen levels, thyroid health, and muscle loss are more common causes.