Been told it’s your testosterone?
It’s all over social media and I’m almost certain the only reason you came upon my page is because something you’ve seen online has prompted you to do the research. I’ve seen it all, testosterone is the hero, it was that one thing that helped “her” get back to “her”. I know, I know, I wish it was as easy as it was for her. But what if it was never testosterone in the first place? Fun fact for you, testosterone isn’t just an active hormone; it’s also a precursor to oestrogen. So, you have to ask yourself, is she actually finding a magic cure in testosterone, or has she just managed to bump up her oestrogen more?
Testosterone isn’t a perimenopause-exclusive hormone
Perimenopause “crashed your testosterone” is a sick reel hook, not an actual finding. Testosterone in women has been observed to decline progressively across a woman’s life, around 25% between 18 and 45 according to Professor Susan Davis, the Monash endocrinologist who has spent decades on exactly this question. Natural perimenopause doesn't change it. It just inches along until your early 60s and then starts climbing again—hello, chin hair. (Surgical menopause is the exception, because removing the ovaries does drop it.)
Having your labs tested doesn't rescue the trending reel narrative either. Davis's research found no testosterone level that separates women with low desire from women without, and the 2019 Global Consensus Position Statement she co-led says the same: there's no diagnostic threshold. On a podcast I listened to of hers she said there aren't any associations between low testosterone and symptoms. Fatigue, mood, brain fog, nothing in the numbers points there. So "Your T is low, that's why" has nothing to support it.
To make matters worse, serum blood tests don't even capture the full biological picture. Women process a lot of their local tissue testosterone right at the cellular level from adrenal precursors like DHEA. Measuring it in a standard blood test tells us almost nothing about what’s actually happening inside your cells; not to mention other variables we need to consider, like SHBG, how wildly oestrogen is swinging, and the massive influence of insulin on hormone availability.
So what do we actually prescribe testosterone for?
One thing, that’s it. Low sexual desire that's causing a woman distress, in postmenopausal women, once other causes have been looked at. Even then, when you dig into that distress, it's often not coming from within the woman herself—it's coming from partner expectations or relationship pressure. The benefit over placebo is real but modest, but do you know what else drives low libido? Sleep, stress, pain, relationship dynamics, feeling like Cinderella, body confidence.
Interestingly enough, when it comes to fatigue, mood, cognition and body composition, the consensus statement found the evidence isn't there, and it advises against pellets, injectables and compounded preparations.
What you need to know is that most of that research was done in postmenopausal women, and perimenopause is who's being sold testosterone. We are extrapolating twice here: first, from one narrow indication (libido) to a massive symptom list, and second, from postmenopausal to perimenopausal women.
"But men get it, why not women?" Men aren't handed testosterone for being men. It's for a diagnosed deficiency, symptoms plus repeated low levels, so even the men's version starts with looking at the person. I would also argue that oestrogen is the better comparative here.
And let's be clear about what happens when you take an unproven therapy: you take on the risks without the evidence. Unmonitored off-label testosterone use can bring in real side effects: acne, irreversible voice deepening, hair thinning, and cholesterol changes for a benefit that the research simply doesn't back. Placebo effect in perimenopause symptom studies is notoriously high. If someone feels better on T, is it the testosterone, placebo, or just the fact that half of it converted straight into oestrogen anyway?
So why isn’t it my go-to referral in perimenopause?
Perimenopause isn't a hormone deficiency problem; it’s a hormone variability problem. Oestrogen swings, and then it falls, and the swings reach a lot of systems. Insulin sensitivity, neurotransmitters, body temperature control, sleep architecture, in fact, every system in your body.
Throwing testosterone at a system that is wildly fluctuating in oestrogen is really missing the point. If we want to target and support the biggest complaints of perimenopausal fatigue, brain fog, and mood shifts, we need to talk about buffering oestrogen cliffs and declining progesterone first (where actual evidence-based HRT shines). Naturopathically we check for other drivers like nutrient deficiencies, metabolic and thyroid dysfunction, nervous, adrenal, and digestive system challenges and addressing the life load.
T isn't the missing piece of your perimenopause puzzle; it’s just the latest thing trending on your feed.
Been told you need testosterone? What were you told it was for?
General information only, not medical advice. Talk to your GP or health practitioner about your own situation.
Melissa White, BHSc Naturopathy
Perimenopause clinical naturopath, Toowoomba | telehealth Australia-wide.
Book a free 15-minute call to find out whether this is the right fit for where you're at.
References
Global Consensus Statement & Primary Clinical Indications: Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J., Rymer, J., Simon, J. A., Vignozzi, L., & Wierman, M. E. (2019). Global Consensus Position Statement on the use of Testosterone Therapy for Women. Maturitas, 128, 89–93. https://doi.org/10.1016/j.maturitas.2019.07.001
Decline of Testosterone Across a Woman's Lifespan: Davis, S. R., & Wahlin-Jacobsen, S. (2015). Testosterone in women—the clinical significance. The Lancet Diabetes & Endocrinology, 3(12), 980–992. https://doi.org/10.1016/S2213-8587(15)00284-3
Intracrinology & Cellular Precursors: Labrie, F. (2015). All sex steroids are made in peripheral tissues in postmenopausal women: the critical role of intracrinology and DHEA. The Journal of Steroid Biochemistry and Molecular Biology, 145, 133–138. https://doi.org/10.1016/j.jsbmb.2014.06.001