The Menopause
Signs of low testosterone in women – and what to do about it
Testosterone is often associated with masculinity and muscles, but it’s important for women and their health, too.
As we enter midlife, our bodies undergo a hormonal rollercoaster, with oestrogen levels taking a nosedive during menopause. However, testosterone levels also naturally decline. This helpful hormone plays a significant role in maintaining muscle mass, bone density, and cognitive function. It also contributes to libido and sexual satisfaction.
Here, we chat to Dr Elise Dallas, a GP who specialises in women’s and menopausal health at The London General Practice, to find out what we can do about declining testosterone levels through midlife and beyond.
Why is testosterone important for women in midlife?
While it’s not often said, women actually produce approximately three times as much testosterone as oestrogen before the onset of menopause.
“Testosterone is a member of the androgen group of hormones,” says Elise. “In both women and men, it influences many physiological processes.
“By the time a woman reaches menopause, blood testosterone levels are about one-quarter of their peak levels. This decline primarily results from the physiological effects of ageing and the consequent reduction in hormone production, largely attributed to the loss of ovarian function.”
How do you know if you’re lacking testosterone?
While there are no diagnostic tools that can determine low testosterone in the female body, insufficient testosterone levels in women can lead to a spectrum of physical and emotional consequences.
“Symptoms can include reduced libido, diminished sexual responsiveness, and alterations in mood and energy levels,” says Elise.
Testosterone deficiency can also contribute to a loss of muscle mass along with decreases in bone density, cardiovascular health, and cognitive performance.
“The effects of testosterone deficiency can vary from one woman to another,” adds Elise. “Not all women will experience these symptoms but, if you’re concerned, it’s important to share any changes you notice with your GP.”
How to boost your testosterone levels
Maintaining healthy testosterone levels often involves lifestyle changes and, in some cases, treatment from your GP. However, there are a few simple ways you can boost this particular hormone at home.
Nutrition
A well-balanced diet rich in essential nutrients is fundamental to supporting healthy testosterone levels.
“Two critical nutrients are vitamin D and zinc,” says Elise. “Research has established a reciprocal relationship between vitamin D and testosterone levels. Zinc is another crucial mineral that supports the processes necessary for proper cell function. Insufficient zinc can result in low testosterone levels.
“Adult women should aim for a daily intake of 8mg of zinc and include zinc-rich foods such as oysters, beef, lamb, pumpkin seeds, and spinach in their diet to maintain adequate levels.
“Testosterone production in the body is also influenced by cholesterol, particularly healthy fats found in oily fish and avocados. Magnesium, B vitamins (especially vitamin B6), and quality protein can also help with hormonal balance.”
Exercise
Studies show that regular physical activity, especially strength-training exercises, can help to stimulate testosterone production.
“Full-body workouts that target major muscle groups are good for women to aim for, with 2-4 sets per exercise and 6-12 repetitions per set,” says Elise. “To optimise testosterone response, maintain shorter rest periods between sets and aim for a total workout duration of 60 minutes or less.”
Stress management
“Elevated stress triggers the release of cortisol [a stress hormone], which can subsequently lower testosterone,” says Elise. “While it may be challenging to eliminate stressors like work and family responsibilities, learning how to manage stress can be incredibly helpful for our hormones.”
Engaging in calming practices like mindfulness, yoga, and meditation can help to ease stress levels and maintain a better hormonal equilibrium.
Sleep
As Elise explains, getting good quality sleep is one of the most effective ways to improve testosterone levels, as it influences the body’s production of hormones.
“Sleep provides a restorative period during which the body can optimise hormone synthesis,” she says. “Aim for eight hours on average, ideally heading to bed at around 10pm, to produce enough testosterone.”
When to consider HRT
With its clear benefits for women’s health and wellbeing, it can be surprising to know that testosterone isn’t a routine prescription in the UK.
Part of the problem is the limited education doctors receive about menopause at medical school.
The other barrier is that we don’t currently have a licensed preparation for women in the UK. This doesn’t mean you can’t get a prescription. GPs regularly prescribe off-licence medication. The International Menopause Society recommends that ‘if a formulation for women is not available, a small amount of an approved male formulation can be used, with regular blood monitoring to check blood levels do not exceed those of young women’. This takes a skilled and confident GP and may put a less than up-to-date doctor off.
“It’s worth knowing that oral oestrogens, particularly conjugated oestrogens, may decrease the effectiveness of testosterone in the body by increasing sex hormone binding globulin levels,” says Elise. “Switching from oral to transdermal oestrogen can be beneficial in resolving this, but any adjustment should be discussed with and guided by a healthcare professional experienced in hormonal therapies.”
