Can Postmenopausal Women Produce New Testosterone?
Yes, postmenopausal women continue to produce testosterone, primarily from their ovaries, even years after menopause. 1
Ovarian Testosterone Production After Menopause
The postmenopausal ovary remains hormonally active and contributes significantly to circulating testosterone levels:
Direct evidence from ovarian vein sampling demonstrates statistically significant gradients between ovarian venous blood and peripheral blood for testosterone, androstenedione, and DHEA in postmenopausal women. 1
Testosterone production persists long-term, with measurable ovarian venous-to-peripheral gradients documented in women who were menopausal for more than 10 years. 1
Surgical removal confirms ovarian contribution: Postoperative testosterone levels were statistically significantly lower than preoperative levels after bilateral oophorectomy, directly proving the ovaries' ongoing testosterone production. 1
Sources of Testosterone Production
Postmenopausal women produce testosterone through two main pathways:
Ovarian stromal cells continue direct testosterone synthesis even after follicular depletion occurs. 1
Adrenal glands contribute through production of DHEA and androstenedione, which are peripheral precursors that convert to testosterone. 1
The ovarian contribution appears to be the dominant source, as evidenced by the significant drop in circulating testosterone following oophorectomy. 1
Clinical Implications
The continued production of testosterone has important clinical relevance:
Testosterone levels naturally decline during the postmenopausal period, which is associated with sexual dysfunction, decreased sense of well-being, and reduced quality of life. 2, 3
Premature ovarian insufficiency (POI) results in loss of this endogenous testosterone production, which is one reason guidelines recommend considering testosterone supplementation for women with POI who have sexual dysfunction. 4
Hypoactive sexual desire disorder (HSDD) in postmenopausal women represents the sole evidence-based indication for testosterone therapy, precisely because endogenous production may be insufficient for some women. 5
Common Pitfalls to Avoid
Do not assume all postmenopausal women are testosterone-deficient—endogenous production continues, though at reduced levels compared to premenopausal years. 1
Do not recommend bilateral oophorectomy without considering the loss of testosterone production and its potential impact on sexual function and well-being. 1
Recognize that women with surgical menopause (bilateral oophorectomy) lose a major source of testosterone production and may be more likely to benefit from testosterone supplementation if they develop HSDD. 4, 1