Currently, there are more than 30 FDA-approved testosterone products for men, but none for women.
Testosterone “Replacement” Therapy in Postmenopausal Women for Libido
5/5 - (30 votes)
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Testosterone is linked with sexual desire in both men and women. Women normally produce testosterone throughout the life cycle. Although postmenopausal ovaries continue to produce testosterone, levels naturally decline with age. Testosterone blood levels decrease approximately 50 percent by age 50, which may play a role in the decline in libido (using masturbation frequency as a partner-independent proxy). A syndrome of “female androgen deficiency” symptoms has been popularized, but there is no evidence testosterone “replacement” helps with mood or well-being, hot flashes, or bone, cardiovascular, or metabolic health. The only evidence-based reason to try testosterone in postmenopausal women is for the treatment of low sexual desire that’s causing distress.
A systematic review and meta-analysis of three dozen randomized controlled trials involving more than 8,000 women found that testosterone treatment significantly increased postmenopausal sexual desire. The increase in frequency of “satisfactory sexual events” was statistically significant, but not clinically significant enough to warrant FDA approval, especially given the uncertainty about long-term side effects. The women on testosterone only logged a little under one additional satisfactory sexual event a month, compared to placebo.
Currently, there are more than thirty FDA-approved testosterone products for men, but none for women. Clinicians can trial a few months of a male transdermal testosterone preparation at one-tenth the dose or less, making sure to check levels to prevent overdosing, which can have virilizing side effects, such as clitoral enlargement and voice changes. Even at premenopausal physiological doses, testosterone can cause acne and excessive hair growth on the chin, cheeks, and upper lip. Unlike oral testosterone, formulations administered through the skin don’t appear to have the same negative effects on cholesterol levels, but long-term safety data for women regarding cardiovascular, cancer, and cognitive outcomes are lacking.
It has been estimated that more than a fifth of prescriptions for male testosterone products are actually written for women, and this is not including custom-compounded testosterone. A consensus position statement of international medical societies specializing in hormone issues recommends against compounded “bioidentical” testosterone due to the lack of evidence for efficacy and safety. Similarly, the dietary supplement DHEA, which can convert into testosterone within the body, cannot be recommended for low libido in women, since a meta-analysis of more than 20 randomized controlled trials found no significant effect on improving desire and sexual function.
Are there any natural ways for women to raise their testosterone levels? Listening to music for just 30 minutes can increase testosterone levels in young women by about 20 percent. Interestingly, the opposite effect is found in men. For more on the effects of music, check out my video Music as Medicine.
Heavy mint consumption may lower testosterone levels in both men and women. There are case reports of men drinking four cups (0.95 L) of day of spearmint or peppermint tea losing their sex drive. Given the apparent anti-androgenic effects, researchers decided to try it out on women concerned about excessive hairiness, and in a matter of just five days, were able to drop their free testosterone levels by about 30 percent with two cups (0.50 L) of mint tea a day. There’s a syndrome called PCOS, or polycystic ovarian syndrome, which can result in abnormally high testosterone levels in women, which can be successfully brought down with mint tea. But for women struggling with low libido, it might not be a good choice.
Please consider volunteering to help out on the site.
- Nappi RE. To be or not to be in sexual desire: the androgen dilemma. Climacteric. 2015;18(5):672-674.
- Davis SR, Wahlin-Jacobsen S. Testosterone in women--the clinical significance. Lancet Diabetes Endocrinol. 2015;3(12):980-992.
- Simon JA, Kapner MD. The saga of testosterone for menopausal women at the food and drug administration(Fda). J Sex Med. 2020;17(4):826-829.
- Randolph JF, Zheng H, Avis NE, Greendale GA, Harlow SD. Masturbation frequency and sexual function domains are associated with serum reproductive hormone levels across the menopausal transition. J Clin Endocrinol Metab. 2015;100(1):258-266.
- Smith T, Batur P. Prescribing testosterone and DHEA: The role of androgens in women. Cleve Clin J Med. 2021;88(1):35-43.
- Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. J Sex Med 2019;16:1331-1337
- Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766.
- Scavello I, Maseroli E, Di Stasi V, Vignozzi L. Sexual health in menopause. Medicina (Kaunas). 2019;55(9):559.
- Derman RJ. Effects of sex steroids on women’s health: implications for practitioners. Am J Med. 1995;98(1A):137S-143S.
- Pinkerton JV, Blackman I, Conner EA, Kaunitz AM. Risks of testosterone for postmenopausal women. Endocrinol Metab Clin North Am. 2021;50(1):139-150.
- Simon JA, Lukas VA. Distressing sexual function at midlife: unmet needs, practical diagnoses, and available treatments. Obstet Gynecol. 2017;130(4):889-905.
- Elraiyah T, Sonbol MB, Wang Z, et al. Clinical review: The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99(10):3536-3542.
- Fukui H, Yamashita M. The effects of music and visual stress on testosterone and cortisol in men and women. Neuro Endocrinol Lett. 2003;24(3-4):173-180.
- Akdoğan M, Tamer MN, Cüre E, Cüre MC, Köroğlu BK, Delibaş N. Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism. Phytother Res. 2007;21(5):444-447.
- Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res. 2010;24(2):186-188.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Testosterone is linked with sexual desire in both men and women. Women normally produce testosterone throughout the life cycle. Although postmenopausal ovaries continue to produce testosterone, levels naturally decline with age. Testosterone blood levels decrease approximately 50 percent by age 50, which may play a role in the decline in libido (using masturbation frequency as a partner-independent proxy). A syndrome of “female androgen deficiency” symptoms has been popularized, but there is no evidence testosterone “replacement” helps with mood or well-being, hot flashes, or bone, cardiovascular, or metabolic health. The only evidence-based reason to try testosterone in postmenopausal women is for the treatment of low sexual desire that’s causing distress.
A systematic review and meta-analysis of three dozen randomized controlled trials involving more than 8,000 women found that testosterone treatment significantly increased postmenopausal sexual desire. The increase in frequency of “satisfactory sexual events” was statistically significant, but not clinically significant enough to warrant FDA approval, especially given the uncertainty about long-term side effects. The women on testosterone only logged a little under one additional satisfactory sexual event a month, compared to placebo.
Currently, there are more than thirty FDA-approved testosterone products for men, but none for women. Clinicians can trial a few months of a male transdermal testosterone preparation at one-tenth the dose or less, making sure to check levels to prevent overdosing, which can have virilizing side effects, such as clitoral enlargement and voice changes. Even at premenopausal physiological doses, testosterone can cause acne and excessive hair growth on the chin, cheeks, and upper lip. Unlike oral testosterone, formulations administered through the skin don’t appear to have the same negative effects on cholesterol levels, but long-term safety data for women regarding cardiovascular, cancer, and cognitive outcomes are lacking.
It has been estimated that more than a fifth of prescriptions for male testosterone products are actually written for women, and this is not including custom-compounded testosterone. A consensus position statement of international medical societies specializing in hormone issues recommends against compounded “bioidentical” testosterone due to the lack of evidence for efficacy and safety. Similarly, the dietary supplement DHEA, which can convert into testosterone within the body, cannot be recommended for low libido in women, since a meta-analysis of more than 20 randomized controlled trials found no significant effect on improving desire and sexual function.
Are there any natural ways for women to raise their testosterone levels? Listening to music for just 30 minutes can increase testosterone levels in young women by about 20 percent. Interestingly, the opposite effect is found in men. For more on the effects of music, check out my video Music as Medicine.
Heavy mint consumption may lower testosterone levels in both men and women. There are case reports of men drinking four cups (0.95 L) of day of spearmint or peppermint tea losing their sex drive. Given the apparent anti-androgenic effects, researchers decided to try it out on women concerned about excessive hairiness, and in a matter of just five days, were able to drop their free testosterone levels by about 30 percent with two cups (0.50 L) of mint tea a day. There’s a syndrome called PCOS, or polycystic ovarian syndrome, which can result in abnormally high testosterone levels in women, which can be successfully brought down with mint tea. But for women struggling with low libido, it might not be a good choice.
Please consider volunteering to help out on the site.
- Nappi RE. To be or not to be in sexual desire: the androgen dilemma. Climacteric. 2015;18(5):672-674.
- Davis SR, Wahlin-Jacobsen S. Testosterone in women--the clinical significance. Lancet Diabetes Endocrinol. 2015;3(12):980-992.
- Simon JA, Kapner MD. The saga of testosterone for menopausal women at the food and drug administration(Fda). J Sex Med. 2020;17(4):826-829.
- Randolph JF, Zheng H, Avis NE, Greendale GA, Harlow SD. Masturbation frequency and sexual function domains are associated with serum reproductive hormone levels across the menopausal transition. J Clin Endocrinol Metab. 2015;100(1):258-266.
- Smith T, Batur P. Prescribing testosterone and DHEA: The role of androgens in women. Cleve Clin J Med. 2021;88(1):35-43.
- Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. J Sex Med 2019;16:1331-1337
- Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7(10):754-766.
- Scavello I, Maseroli E, Di Stasi V, Vignozzi L. Sexual health in menopause. Medicina (Kaunas). 2019;55(9):559.
- Derman RJ. Effects of sex steroids on women’s health: implications for practitioners. Am J Med. 1995;98(1A):137S-143S.
- Pinkerton JV, Blackman I, Conner EA, Kaunitz AM. Risks of testosterone for postmenopausal women. Endocrinol Metab Clin North Am. 2021;50(1):139-150.
- Simon JA, Lukas VA. Distressing sexual function at midlife: unmet needs, practical diagnoses, and available treatments. Obstet Gynecol. 2017;130(4):889-905.
- Elraiyah T, Sonbol MB, Wang Z, et al. Clinical review: The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99(10):3536-3542.
- Fukui H, Yamashita M. The effects of music and visual stress on testosterone and cortisol in men and women. Neuro Endocrinol Lett. 2003;24(3-4):173-180.
- Akdoğan M, Tamer MN, Cüre E, Cüre MC, Köroğlu BK, Delibaş N. Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism. Phytother Res. 2007;21(5):444-447.
- Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res. 2010;24(2):186-188.
Motion graphics by Avo Media
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Title
Testosterone “Replacement” Therapy in Postmenopausal Women for Libido
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
I mentioned my Music as Medicine video.
Check out these other videos on menopause:
- Hormone Treatment (Estrogen Pills and Creams) for Vaginal Menopause Symptoms
- Soy Foods for Menopause Hot Flash Symptoms
- Menopausal Hot Flashes Are Not Inevitable
- How to Delay the Age of Menopause with Diet and Lifestyle Factors
Check out this podcast episode on hot flashes and this one on hormones and menopause.
For more on peppermint, see Peppermint Aromatherapy for Nausea and Peppermint Oil for Irritable Bowel Syndrome.
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