Low Libido, Low Energy, Low Mood? What Women Need to Know About Testosterone in Menopause

By Dr. Sara Poldmae, Doctor of Acupuncture & Chinese Medicine, Functional Medicine Practitioner

Something feels off. You're tired in a way that sleep doesn't fix. Your drive — for intimacy, for projects you used to love, even for the next day — feels muted. You have brain fog you can't shake. And if you're honest with yourself, your libido has quietly left the building.

You've mentioned it to your doctor and been told this is "normal" for your age. Or you've been handed a prescription for antidepressants. And neither feels like a real answer.

What no one may have mentioned? Testosterone.

Most women associate testosterone with men and are surprised to learn they produce it too — and that it plays a significant role in how they feel every day. In Episode 137 of Menopause Rise and Thrive, I sat down with Nurse Practitioner Monique Willingham, my colleague and co-practitioner at Meadow Hill Wellness, for an honest conversation about what testosterone actually does in women's bodies, how to know if yours may be low, and what your options are.

TESTOSTERONE IN WOMEN: WHAT IT DOES AND WHY IT MATTERS

Testosterone is produced by the ovaries and adrenal glands in women throughout their reproductive years — and its decline, which begins well before menopause, has real and measurable effects on quality of life.

Here's what testosterone actually does in a woman's body:

Libido and sexual function. This is the symptom most commonly associated with low testosterone, and the science is clear: testosterone is a primary driver of sexual desire in women. Declining testosterone is one of the leading physiological causes of low libido in midlife — not personality change, not relationship issues (though those can contribute), but hormonal shift.

Energy and motivation. Testosterone plays a role in mitochondrial function — the cellular machinery that generates energy. Women with low testosterone often describe fatigue that feels different from tiredness: a flattening of motivation, a lack of drive, a sense that the spark has dimmed.

Mood and emotional resilience. Testosterone interacts with serotonin and dopamine pathways. Low testosterone can contribute to low mood, emotional fragility, and a diminished sense of self that is sometimes misidentified as depression.

Cognitive clarity. Many women report brain fog — difficulty concentrating, slower recall, the sense of struggling to find words — as testosterone declines. This is because testosterone receptors are present throughout the brain, and adequate levels support cognitive sharpness and focus.

Muscle strength and body composition. Testosterone supports lean muscle mass, and its decline contributes to the loss of muscle and the gain of adipose (fat) tissue that many women experience in midlife, even without significant changes in diet or exercise.

Bone health. Testosterone contributes to bone density alongside estrogen. Its decline is one of the reasons midlife women are at increased risk for osteopenia and osteoporosis.

DEBUNKING THE MYTHS ABOUT TESTOSTERONE THERAPY FOR WOMEN

One of the most important things Monique and I covered in this conversation is the fear and misinformation that surrounds testosterone therapy for women. Let me be direct about the two biggest myths:

Myth 1: Testosterone will make you masculine, bulky, or aggressive.

Women use testosterone at far lower doses than men — doses calibrated to restore physiological female levels, not to create male levels. When dosed appropriately by a knowledgeable provider, testosterone therapy does not produce masculinizing effects. The very small number of cases where this occurs are almost always related to inappropriate dosing.

Myth 2: Testosterone therapy isn't safe for women.

The evidence does not support this. Research consistently shows that physiological testosterone therapy in women is safe and effective for improving libido, energy, mood, and cognitive function. Part of the reason this myth persists is that testosterone for women remains off-label in the US — meaning pharmaceutical companies haven't funded the large trials needed for FDA approval for this specific use — but this is a regulatory reality, not a safety concern.

HOW TO TELL IF LOW TESTOSTERONE MY BE CONTRIBUTING TO HOW YOU FEEL

There is no single lab number that tells the whole story. Testosterone testing in women requires interpretation in the context of symptoms, since lab ranges are often set based on population averages rather than optimal health. This is why working with a provider who specializes in women's hormone health matters enormously.

Signs that testosterone may be a missing piece include:

- Low or absent libido that doesn't have an obvious relationship explanation

- Fatigue that doesn't resolve with adequate sleep

- Mood flatness or emotional fragility

- Difficulty concentrating or persistent brain fog

- Loss of muscle tone or unexplained changes in body composition

- Vaginal dryness (testosterone has a local effect on vaginal tissue as well)

If several of these resonate, it may be worth requesting a full hormone panel that includes free and total testosterone, DHEA-S, and SHBG — and working with a provider who will interpret your results in the context of your symptoms, not just a lab reference range.

WHY SOME PROVIDERS DON’T OFFER TESTOSTERONE THERAPY — AND WHAT TO DO INSTEAD

Unfortunately, many OB/GYNs and primary care providers are not trained in women's testosterone therapy and may dismiss your questions or be unfamiliar with the current evidence. If you've raised the issue and been brushed off, this is a real gap in the healthcare system — not a reflection of whether your symptoms are valid.

Your options:

- Seek a provider who specializes in women's hormone health or functional medicine

- Look for a Menopause Society Certified practitioner, who has specific training in this area

- Ask directly: "Can we discuss testosterone therapy and whether it might be appropriate for me?"

You deserve a provider who takes these questions seriously.

At Meadow Hill Wellness, both Dr. Sara and NP Monique are Menopause Society Certified and specialize in comprehensive hormone assessment and care for women in midlife. Our RenewHer Concierge Membership includes your initial hormone assessment and ongoing, personalized care. Book a discovery call or learn more at https://renewher.meadowhillwellness.com/hormone-assessment

Listen to the full conversation with NP Monique Willingham on Episode 137 of the Menopause Rise and Thrive podcast.