From the Research
Yes, a woman can be in perimenopause even if she is taking testosterone gel and has high testosterone levels while her estradiol remains low. Perimenopause is primarily defined by changes in ovarian function and fluctuating hormone levels as the body transitions toward menopause. The key hormone in perimenopause is estradiol, which typically becomes more erratic and eventually declines. Taking testosterone gel does not prevent perimenopause because it doesn't address the underlying changes in ovarian function. In fact, externally administered testosterone can sometimes be converted to estrogen in the body through a process called aromatization, but this conversion varies greatly between individuals and may not be sufficient to maintain estradiol at pre-perimenopausal levels.
Some key points to consider:
- Perimenopause is characterized by changes in ovarian function, including erratically higher estradiol levels, decreased progesterone levels, and disturbed ovarian-pituitary-hypothalamic feedback relationships 1.
- Testosterone therapy has been shown to improve sexual function in postmenopausal women, but its effects on perimenopausal women are less clear 2.
- The use of testosterone therapy in women is not without risks, including a potential decrease in high-density lipoprotein (HDL) cholesterol levels 2 and unknown long-term effects on cardiovascular and cognitive health 3.
- Hormone testing, including FSH (follicle-stimulating hormone) levels, can help confirm perimenopausal status, as FSH typically rises as ovarian function declines, regardless of testosterone supplementation.
If you're experiencing perimenopausal symptoms despite testosterone therapy, you might consider discussing estrogen therapy with your healthcare provider, as low estradiol is responsible for many perimenopausal symptoms like hot flashes, vaginal dryness, and mood changes. It's also important to note that predicting menopause proximity with FSH or Inhibin B levels is not always effective, and anti-Mullerian hormone levels may be a better predictor 1.
Overall, the decision to use testosterone therapy in perimenopausal women should be made on a case-by-case basis, taking into account the individual's symptoms, medical history, and potential risks and benefits 4, 3.