Testosterone: NOT Just for Men
By Bridget Hagen, DNP, APRN, FNP-C, Bridget@WellesleyTestosterone.com
Testosterone is the most abundant sex hormone in both men and women. Yes, you heard that correctly. While it is often thought of as a “male hormone,” testosterone plays a crucial role in female health as well. Women consistently have at least twice as much testosterone as they do estrogen, and often many times more than that. [1] [2] Figure 1. provides a visual representation of the general hormone ranges for women over the course of the menstrual cycle.
Beyond that, all estrogen is derived chemically from testosterone (or a similar precursor). [3] Testosterone is converted into estrogen via an enzyme (aromatase) that changes the chemical structure (see Figure 2.) [4] Consider this oversimplified analogy: testosterone is to cookie dough as estrogen is to a baked cookie. Aromatase acts as the oven, converting the cookie dough into a baked cookie. Although slightly different in structure, the baked cookie could not exist without the cookie dough.
While testosterone is an essential part of the formula and notably, often overlooked, it generally is not a solution within itself in the same way it is for men. For young women (in their 30s, early 40s), testosterone may offer a sole solution but, once a woman begins to experience the symptoms of menopause, progesterone and estrogen will likely need to be added into the mix.
The average age of menopause is 52. [5] Perimenopause, literally meaning “around menopause” can begin up to 10 years earlier. [6] What that means is that women in their 40s are often experiencing symptoms of menopause. Hormonal declines begin even earlier than that though. Like men, testosterone levels peak in a woman’s 20s and begin to steadily decline thereafter, unrelated to the menopause transition. [7] The decline in progesterone is not far behind. [8] Progesterone tends to be the forgotten sister in the hormone family but plays an important role in sleep and mood and is often the first hormonal indication that perimenopause has begun. This means that by the late 30s it is not uncommon for women to have symptoms of both testosterone and progesterone deficiency. By the early 40s more symptoms of perimenopause can begin to emerge with or without changes to the menstrual cycle. Lesser-known symptoms of perimenopause may include things like brain fog, sleep disturbances, dry eyes, dry mouth, and joint pain among others. [9] The more classic symptoms e.g., hot flashes, night sweats, mood changes, weight gain, etc. tend to emerge as fluctuations in hormone levels cause cycles to become irregular. [10] Hormone replacement therapy has been proven to be the most effective therapy for managing some of the most common symptoms of menopause [11] and when initiated early (within 10 years of menopause) has been shown to decrease cardiac disease, osteoporosis related fractures, and death from all causes. [12] Hormone therapy, like most things is not a one-size-fits-all approach and even for the same individual might change significantly as they progress through the menopause transition. It is essential to work with a knowledgeable provider who understands the complexities of this therapy and is committed to guiding you throughout your journey for optimal management.
Key takeaways by age group:
For the woman in her 30s…
Hormone mapping can be used to gain insight into your specific hormone production during reproductive years and can provide valuable insight for hormone therapy in later years. If you are already having symptoms of testosterone and/or progesterone deficiency it might be time to consider therapy.
For the woman in her 40s…
More symptoms of perimenopause may be developing which can precede changes in the menstrual cycle. If you are having menstrual cycle changes, absent another cause, you are likely in perimenopause. Now is the time to give hormone therapy some thought as the literature suggests it is safest when started early.
For the woman in her 50s…
The symptoms of menopause can continue and often worsen after the cessation of the menstrual cycle. If you are still struggling with symptoms of menopause, you are still well within the recommended time frame to start hormonal therapy.
For the woman in her 60s and beyond…
At this age hormone therapy requires a more thorough risk benefit analysis and potentially fewer treatment options. That said, options do exist, and it is worth working with a knowledgeable provider to determine what may be best for you.
[1] Atukorala, K.R., Silva, W., Amarasiri, L., Fernando, D.M.S. (2002). Changes in serum testosterone during the menstrual cycle – an integrative systematic review of published literature. GREM Gynecological and Reproductive Endocrinology & Metabolism 3 (1), 009-020 doi: 10.53260/grem.223012
[2] Access Medical Laboratories. (2024). Female Reference Ranges.
[3] Elzenaty, R.N., du Toit, T., & Flück, C.E. (2022). Basics of androgen synthesis and action. Best Practice & Research Clinical Endocrinology & Metabolism, 36 (4), https://doi.org/10.1016/j.beem.2022.101665.
[4] Ibid.
[5] National Institute on Aging. (2024). What is menopause? https://www.nia.nih.gov/health/menopause/what-menopause
[6] Harvard Health. (2022). Perimenopause: Rocky road to Menopause. https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause#:~:text=Perimenopause%20varies%20greatly%20from%20one,many%20have%20no%20bothersome%20symptoms.).
[7] Skiba, M.A., Bell, R.J., Islam, R.M., Handelsman, D.J., Desai, R., & Davis, S.R. (2019). Androgens During the Reproductive Years: What Is Normal for Women?, The Journal of Clinical Endocrinology & Metabolism, 104(11), 5382–5392, https://doi.org/10.1210/jc.2019-01357
[8] Harvard Health. (2022). Perimenopause: Rocky road to Menopause. https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause#:~:text=Perimenopause%20varies%20greatly%20from%20one,many%20have%20no%20bothersome%20symptoms.).
[9] Mayo Clinic. (2025). Could this be menopause? exploring lesser-known symptoms – and what to do about them. https://mcpress.mayoclinic.org/menopause/could-this-be-menopause-exploring-lesser-known-symptoms-and-what-to-do-about-them
[10] National Institute on Aging. (2024). What is menopause? https://www.nia.nih.gov/health/menopause/what-menopause
[11] Duralde, E. R., Sobel, T. H., & Manson, J. E. (2023). Management of perimenopausal and menopausal symptoms. British Medical Journal Clinical Research Edition 382. https://doi.org/10.1136/bmj-2022-072612
[12] Lobo R. A. (2017). Hormone-replacement therapy: current thinking. Nature Reviews Endocrinology, [13] (4, 220–231. https://doi.org/10.1038/nrendo.2016.164








































