Normal Testosterone Levels in Perimenopause
There are no established "normal" or "optimal" testosterone reference ranges for perimenopausal women, and routine testosterone measurement is not recommended outside of research contexts. 1
Why Testosterone Testing Is Not Recommended
No validated reference ranges exist for what constitutes optimal testosterone in perimenopausal or postmenopausal women, making interpretation of any measured value clinically meaningless. 1
The American College of Physicians recommends against routine testosterone measurement in women outside research settings due to lack of established optimal levels or proven benefits for testosterone replacement therapy. 1
Physiological Changes During Perimenopause
If testosterone levels are measured for research purposes, understanding the physiological patterns is important:
Testosterone levels decline minimally during the menopausal transition itself, with most decline (approximately 50%) occurring earlier between ages 20-40 years. 2
During perimenopause, testosterone concentrations change little and may even rise slightly after menopause. 2
Free androgen index (FAI) actually increases during perimenopause, rising from a median of 1.33 in early perimenopause to 1.56 in late perimenopause. 3
In research studies of women aged 65-98 years, total testosterone levels declined with age until 80, whereas free testosterone levels did not vary significantly by age. 4
Research Reference Values (For Context Only)
When testosterone has been measured in research settings:
For premenopausal women (age 30), the 5th to 95th percentile ranges are: total testosterone 15-46 ng/dL (520-1595 pmol/L) and free testosterone 1.2-6.4 pg/mL (4.16-22.2 pmol/L). 5
In perimenopausal women, median testosterone levels range from 0.91-1.03 nmol/L (approximately 26-30 ng/dL). 3
For women with epilepsy being evaluated for reproductive dysfunction, testosterone >2.5 nmol/L (approximately 72 ng/dL) measured on days 3-6 of the cycle is considered abnormal. 6
Clinical Approach to Suspected Androgen Deficiency
If a perimenopausal woman presents with symptoms potentially attributable to androgen deficiency, focus on excluding other causes rather than measuring testosterone:
Evaluate for thyroid dysfunction (TSH, free T4). 1
Screen for depression using validated instruments. 1
Review medications that may cause similar symptoms. 1
Assess for other hormonal abnormalities including hyperprolactinemia and other endocrine disorders. 6, 1
Important Caveats
Hormone levels vary markedly during the menopausal transition, making FSH and estradiol unreliable guides to menopausal status—the same applies to testosterone. 2
Sex hormone-binding globulin (SHBG) remains relatively stable across age ranges in normally cycling women but can be affected by obesity, oral estrogen use, and other factors. 4, 5
Women with bilateral oophorectomy have approximately 23% lower total testosterone and 16% lower free testosterone compared to those with at least one intact ovary. 4