Does testosterone get affected during perimenopause?

Testosterone Changes During Perimenopause

Yes, testosterone levels are affected during perimenopause, with most women experiencing a decline in testosterone production that begins years before the final menstrual period.

Hormonal Changes During Perimenopause

• Perimenopause is characterized by fluctuating hormone levels, particularly estrogen, but testosterone is also significantly affected 1, 2
• While estrogen levels fluctuate and eventually decline dramatically during perimenopause, testosterone changes include:
  • Gradual decline in testosterone production that begins years before final menstrual period
  • Reduced contribution of testosterone pro-hormones from adrenal glands 2
  • Continued but diminished testosterone production from the ovaries even after menopause 3

Testosterone Production in Women

• In premenopausal women, testosterone is produced by:
  • Ovaries (25%)
  • Adrenal glands (25%)
  • Peripheral conversion of precursor hormones (50%) 4
• During perimenopause:
  • Ovaries remain important sites of testosterone production 2
  • Adrenal contribution of testosterone pro-hormones falls significantly 2
  • Net result is a decline in circulating testosterone levels

Clinical Significance of Perimenopausal Testosterone Changes

• Declining testosterone levels during perimenopause can contribute to:

  • Reduced sexual motivation and arousal 2
  • Decreased vaginal lubrication 2
  • Changes in mood and cognitive function 5
  • Decreased muscle mass and increased body fat 6
  • Reduced bone mineral density 6

• Recent research shows that testosterone therapy in perimenopausal women with persistent symptoms may help with:

  • Improved mood (47% of women reported improvement) 5
  • Enhanced cognitive function (39% reported improvement) 5
  • Increased libido (52% reported improvement) 5

Diagnostic Considerations

• Diagnosing testosterone deficiency in perimenopausal women is challenging because:
  • Symptoms are often nonspecific 4
  • Laboratory measurement of testosterone levels in women is often inaccurate with commonly used techniques 4
  • No specific testosterone level has been clearly linked to clinical symptoms 7

Treatment Considerations

• Testosterone replacement therapy may be considered for perimenopausal women with:

  • Decreased sexual desire associated with personal distress 7
  • No other identifiable causes for symptoms 7
  • Persistent symptoms despite adequate estrogen therapy 7

• Treatment options include:

  • Transdermal patches and topical gels/creams (preferred over oral formulations) 7
  • Testosterone cream or gel for targeted symptoms 5

Important Cautions

• Testosterone therapy in perimenopausal women:

  • Should be used at the lowest effective dose for the shortest time needed 7
  • Is contraindicated in women with breast or uterine cancer, cardiovascular disease, or liver disease 7
  • May cause side effects including hirsutism and acne 7
  • Lacks long-term safety data in premenopausal women 4

• Common pitfalls to avoid:

  • Initiating therapy without proper baseline evaluation 6
  • Not monitoring for adverse effects 6
  • Using testosterone for non-specific symptoms without ruling out other causes 7

Monitoring Recommendations

• For women receiving testosterone therapy:
  • Monitor testosterone levels to avoid supraphysiologic levels 7
  • Assess subjective improvements in symptoms 7
  • Evaluate for potential adverse effects 7
  • Regular follow-up every 3-6 months initially 6