The Truth About Testosterone Isn't What the Internet Sold You

PLUS: The hidden problem with compounded testosterone + new data on hormone therapy and Alzheimer's protection
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Estimated reading 6 - 7 minutes

Welcome to the September 15th edition of Menopaussible—bringing you the news you can use and the ⚡ energy ⚡ you need to support your menopause journey. I'm Maria Caracci Ciccolella—mindset coach and menopause advocate. (Connect with me on IG or LinkedIn!)

We’re halfway(!) through Perimenopause Awareness Month, a month designed to help create awareness of, and education about, this life transition, help end the associated social stigmas, and most importantly, support women entering and in the midst of this phase before menopause. In this issue, we dive into one of the most talked about, yet murkiest, areas of hormone therapy: testosterone. In some circles of the internet, testosterone is hailed almost as an almighty elixir, a secret long held from women, a key to their youth and their drive. Is it all hype or is there some role for this hormone to play in your menopause journey?

Let’s parse through what we really know, together.

Yes, Women Naturally Produce Testosterone

In the female body, testosterone is produced in roughly equal measure by the adrenal glands and the ovaries—about a quarter each—with the remaining half converted from precursor hormones in fat, skin, and muscle tissue. Levels are generally on the decline between the ages of 20 and 60, and it is in your 60s that testosterone may level off or even increase slightly.
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​Naturally occurring levels of testosterone in the blood have been at the core of much of the hype surrounding testosterone. The claim—touted by many an influencer (not to mention a few prescribing physicians)—is that women have more testosterone than estrogen during their reproductive years, an assertion that is not supported by modern evidence. (For those interested in how that claim may have originated and how the math really maths, Dr. Jen Gunter breaks it all down here.)

Hype, however, has an uncanny way of filling a void, and when it comes to the role testosterone plays in women, our understanding is fairly limited, given that the body of research on the subject is relatively small compared to that of men. What we do know is that it plays a role in sexual function and behavior, and contributes to the maturation of the vulva, vaginal tissues, and the brain. The relationship between testosterone and sexual function, however, remains obscure and associations with mood and memory are insufficiently supported by available data.

What the Evidence Actually Shows

With fervency for testosterone peaking late last year, a world authority and leading researcher on testosterone and female sexual health felt duty-bound to set the record straight. Professor Susan Davis (@professorsusandavis) joined the social sphere and took to the airwaves in a one-woman effort to educate women on what was known—while also clarifying what her research had determined when it came to testosterone therapy. As Davis points out in one of her video appearances, there is a large gap between what testosterone is marketed for (see: fix for energy, drive, youth, mood, cognition, bone density, muscle growth) and what clinical evidence currently supports.

So where does use of testosterone as part of a hormone therapy regimen primarily hold up? With one diagnosis: low desire for sexual activity that is not otherwise explained by an existing medical or psychiatric condition. Here, use of testosterone has been shown to improve desire, arousal, orgasm, satisfaction, and pleasure in postmenopausal women (unfortunately for those in peri, the evidence is not there; for pre-menopausal women, not enough data currently exists).

How It’s Prescribed

Ironically, even with such supporting evidence, the FDA does not currently have an approved testosterone product for women, leaving practitioners to turn to products with dosages designed for men and apportion the dose for women. Some have also turned to compounding pharmacies to prescribe pellets—small “seeds” implanted under the skin—which The Menopause Society has firmly cautioned against, given pellets have been found to deliver higher-than-recommended doses, and once implanted, cannot be removed.

Yes, There Can Be Too Much of a Good Thing

Like with any prescribed drug, testosterone use is meant to be intentional—at low, monitored doses—and with good reason: prolonged use at high doses (see again: pellets) can lead to unwanted changes, some permanent and irreversible, including:

• Voice deepening where thickening of the vocal folds can lower the pitch of a voice
• An enlargement of your Adam’s Apple
• Clitoral enlargement, known as clitoromegaly, an abnormal and permanent structural change
• Hair growth pattern changes—including excess body and facial hair growth OR male-pattern hair thinning and loss
• Acne and oily skin

In extreme cases, high doses of testosterone have been linked to mood changes, including irritability, anxiety, or, rarely, more significant shifts like paranoia or impulsivity. If you notice sudden or intense mood changes while on testosterone, it's worth checking in with your provider to review your dose.

So Where Does That Leave You?
​If low sexual desire is genuinely affecting your life, testosterone therapy—used at the right dose, monitored properly, and never as a pellet—has real evidence behind it. If you're hoping it'll hand back your energy, your focus, or your motivation, the data isn't there yet, no matter how good the marketing sounds. Knowing the difference is what lets you ask your provider the right question, instead of the one the internet told you to ask.

All the Paussibilities

Testosterone has a real job to do—just a narrower one than the internet promised. Sometimes what's at the heart of your drive—your energy, your focus, your motivation—has little to do with a waning hormone and more to do with what's actually filling, or draining, your days: your work, your relationships, the parts of your life you've been running on autopilot for years.

Discovering your drive again can start just by naming where.

You Named Where Your Drive Went Quiet. Now What?​ Naming it is the start. A free clarity conversation can help with the rest. Book a free clarity consult here.​

PLUS: News Items​
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​The Compounding Problem No One's Talking About
​The Vajenda, flagged an uncomfortable fact about compounded testosterone—the version many women use since no FDA-approved product is dosed for them. The only accuracy test ever run, back in 2015, checked only the men's dose—and found fewer than four in ten doses matched the label. Her advice: stick with an FDA-approved men's product at one-tenth the dose, the only version with real accuracy data, and test levels more often if you're already on a compounded formula. A public FDA meeting on testosterone for women is happening this month

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New Data Adds a Wrinkle to the Hormone Therapy–Brain Health Question
​Two new studies—one from the UK Biobank, one from Stanford—found women on hormone therapy had a lower risk of Alzheimer's, with the strongest effect, 32% lower, in women who went through surgical menopause, The New York Times reports. Starting hormone therapy between 51 and 56 showed the biggest benefit otherwise. Researchers caution the data is observational, not a controlled trial—women on HT may simply be healthier to begin with. Still, it adds to a growing case that estrogen matters for brain health well past the years it's typically prescribed, useful context if you have a family history of Alzheimer's or a surgical menopause.