Written by Rev. Dr. Joanne Angel BarryColon, Founder of Wholistic Fitness NY LLC and a wholistic integrative teacher with over 40 years of experience in health, fitness, and emotional healing, supporting women over 40 to reconnect with their strength and release emotional weight.
What Every Woman Should Know Before Saying Yes
As more women begin talking openly about perimenopause and menopause, testosterone therapy has become part of the conversation. Women are hearing that testosterone may improve libido, energy, muscle strength, mood, motivation, and even brain fog.
But does every woman experiencing perimenopause need testosterone?
The answer is no.
Testosterone is naturally produced in a woman’s body by the ovaries and adrenal glands, and through conversion of hormone precursors in other tissues. Although we often associate testosterone with men, women need this hormone too. It plays a role in sexual function and contributes to several processes throughout the body.
However, experiencing fatigue, weight changes, decreased muscle mass, brain fog, mood changes, or low libido during perimenopause does not automatically mean you have “low testosterone.”
Perimenopause Is a Hormonal Transition
Perimenopause can begin years before a woman’s final menstrual period. During this transition, estrogen and progesterone can fluctuate significantly. Sleep disturbances, stress, nutritional deficiencies, thyroid conditions, medications, relationship concerns, and other health issues can also produce symptoms that resemble hormonal imbalance.
This is why treating symptoms without investigating the bigger picture may not provide the answers a woman needs.
Testosterone therapy has its clearest evidence for postmenopausal women experiencing persistent, distressing low sexual desire, known as hypoactive sexual desire disorder (HSDD), after other potential causes have been evaluated. Evidence before menopause is more limited. It is not currently recommended as a universal treatment for every symptom associated with perimenopause.
What Are the Potential Benefits?
For appropriately selected women, testosterone therapy may improve sexual desire, arousal, responsiveness, and sexual satisfaction.
Some women also report improvements in energy, mood, motivation, or overall well-being. However, there isn’t currently enough strong evidence to routinely prescribe testosterone specifically for fatigue, brain fog, depression, muscle building, weight loss, or anti-aging purposes.
That distinction matters.
Just because a woman feels better while taking testosterone does not mean testosterone should automatically become part of every woman’s perimenopause treatment plan.
What Are the Possible Downsides?
Testosterone therapy isn’t without potential side effects.
Women may experience acne, oily skin, and increased facial or body hair. When testosterone levels become too high, thinning scalp hair, voice deepening, and other masculinizing effects can occur, some of which may not be completely reversible.
There are also unanswered questions regarding the long-term effects of testosterone therapy on cardiovascular and breast health.
This is one reason appropriate dosing and medical monitoring are important. The goal should not be to create testosterone levels similar to those of men. When testosterone is prescribed to women, treatment generally aims to maintain concentrations within the normal physiological range for premenopausal women.
Women should also understand that compounded hormones aren’t automatically safer simply because they’re marketed as “natural” or “bioidentical.”
Look at the WHOLE Woman
This is where I believe the conversation needs to expand.
A woman is more than a laboratory number.
When a woman over 40 tells me she has lost her energy, sexual desire, strength, motivation, or connection to her body, I believe we need to ask more questions before assuming one hormone is responsible.
How is she sleeping? Is she eating enough protein and nourishing her body? Is she strength training? How much stress is she carrying? What medications is she taking? What is happening emotionally and within her relationships? What other medical conditions could be contributing?
These questions don’t replace appropriate medical evaluation; they complement it.
Before Saying YES to Testosterone
Testosterone can be a valuable therapy for certain women, but perimenopause itself isn’t an automatic indication for testosterone therapy.
Work with a qualified healthcare professional who understands menopause and is willing to evaluate your symptoms, health history, medications, risks, goals, and other possible causes before recommending treatment.
Your perimenopause journey isn’t about chasing individual hormones. It is about learning to listen to your changing body and giving it the individualized support it needs as you transition into your next season of womanhood.
“Your body isn’t asking you to become who you were at 30. It may be inviting you to understand who you are becoming after 40.”
Rev. Dr. Joanne Angel BarryColon
This article is educational information only and is not intended to diagnose, treat, or replace individualized medical advice.
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