The Role of Testosterone in Menopause

Despite the significant impact of menopause on women's health, there is a notable gap in menopause education within the medical community. Only 31% of OB/GYN residency program directors include menopause training in their curriculum, a modest increase from 20% in 2018. Although 84% of these directors agree on the need for more educational resources, progress has been slow.

Menopause symptoms can be unpredictable, subtle, and pervasive, often exacerbating existing conditions. Healthcare providers should ideally assess all female patients over 40 through the lens of their perimenopause or menopause status. Unfortunately, the current state of education leaves many providers unprepared to address these complex needs.

The Role of Testosterone in Menopause

A common misconception persists that testosterone is exclusively a "male" hormone. In reality, testosterone plays a crucial role in women's health, particularly during menopause. Testosterone is the most abundantly produced hormone in women, surpassing estrogen levels by three to four times. Both estrogen and testosterone are vital for the development and function of reproductive organs, bones, heart, brain, and liver.

During menopause, the production of estrogen and progesterone decreases significantly, but testosterone levels also decline. This decline can negatively impact libido, responsiveness, and orgasm, contributing to sexual dysfunction in over half of menopausal women. Despite recommendations from the American College of Obstetricians and Gynecologists (ACOG), many providers fail to address this issue, often prescribing antidepressants or recommending marriage counseling instead of examining hormonal imbalances.

Testosterone's Benefits in Menopause Management

Testosterone therapy can mitigate many menopausal symptoms, including urogenital, psychological, and somatic issues. It may also improve bone density, enhance cognitive performance, and positively affect mood, concentration, motivation, and energy levels.

For breast cancer survivors, traditional estrogen and progesterone hormone replacement therapy (HRT) may increase the risk of cancer recurrence. However, testosterone therapy has been safely and effectively used to treat menopausal symptoms in these patients for decades. Despite the observed benefits, there are no FDA-approved testosterone therapies for women in the U.S., highlighting the need for standardized guidelines and further education for healthcare providers.

Preventive Benefits of Testosterone

Emerging data suggest that testosterone may offer preventive benefits for women beyond menopause symptom management. For example, testosterone, along with estradiol, has been shown to help prevent osteoporosis. Studies also indicate that testosterone can improve bone mineral density outcomes in women aged 40 to 60, where traditional treatments like bisphosphonates may fall short.

Additionally, testosterone has been linked to reduced incidence of invasive breast cancer. A ten-year retrospective study showed that women who took testosterone via hormone pellets as part of bioidentical hormone replacement therapy had a 35.5% lower incidence of invasive breast cancer compared to their peers.

Testosterone may also have a role in reducing the risk of cardiovascular events in women. A recent study found that low testosterone levels in women over 70 doubled the risk of cardiac events, while testosterone therapy improved functional capacity and muscle strength in women with advanced chronic heart failure.

The Need for Ongoing Education

The field of menopause care is continually evolving, necessitating constant education for healthcare providers to stay updated on the latest research and treatment options. Effective menopause management involves balancing hormones through blood tests and basing treatment plans on patient symptoms rather than solely on lab values.

As researchers, educators, and providers, the goal is to ensure access to and understanding of the most up-to-date knowledge in hormone health. By continually adding to the repository of knowledge, the aim is to improve the standard of health care for women worldwide, particularly during the pivotal stage of menopause.