Part 2: The Testosterone Question in Women's Mental Health
By Guest Blogger: Kelley DeFilippis, CRNP, MSN, NP-C, Menopause Specialist, Owner/Founder of The Menopause Wellness Center
When people think about menopause, they usually think about estrogen. Testosterone rarely comes up, even though it plays a real role in women's brains, mood, and quality of life.
Testosterone Isn't Just a Male Hormone
Women produce testosterone in the ovaries and adrenal glands, in smaller amounts than men. It acts on brain regions involved in motivation, reward, sexual response, and emotional processing, and it interacts with dopamine pathways that contribute to interest, pleasure, and engagement with life.
When testosterone activity shifts, some women notice reduced sexual desire, diminished motivation, lower energy, feeling emotionally flat, lower confidence, or trouble concentrating.
Why These Symptoms Are Hard to Pin Down
The tricky part is that these experiences overlap heavily with depression, medication side effects, chronic stress, poor sleep, thyroid disease, iron deficiency, and shifting estrogen and progesterone levels. Symptoms alone can't tell us whether testosterone is actually the cause.
Sexual health and mental health are closely linked. Persistent loss of desire can affect confidence, body image, and relationships. At the same time, depression, anxiety, pain, poor sleep, relationship stress, and some psychiatric medications, particularly certain antidepressants, can also lower desire. That's why a full picture, biological, psychological, and social, is essential before assuming testosterone is the issue.
Why Testosterone Gets Left Out of the Conversation
A few reasons testosterone is so often missing from menopause care:
It's been labeled a "male hormone," so menopause education has focused mainly on estrogen and progesterone
Female testosterone research has received far less attention than male testosterone research
There's no single blood level that defines low testosterone in women, and levels don't consistently match symptoms
Measuring it accurately is harder in women, since concentrations are so much lower than in men
There's no FDA-approved testosterone product made specifically for women in the U.S.
A blood test can support safe prescribing and monitoring, but on its own, it can't prove testosterone is responsible for low mood, fatigue, or reduced desire.
Can Testosterone Therapy Help?
Research is ongoing into whether testosterone therapy can improve mood, motivation, cognition, or energy in certain women. Some women report real improvement, but the current evidence isn't strong enough to recommend testosterone as a treatment for depression, anxiety, cognitive issues, or general fatigue.
The clearest, evidence-based use is for hypoactive sexual desire disorder (HSDD): persistent, distressing low sexual desire in postmenopausal women that isn't better explained by medication, a psychiatric condition, relationship issues, pain, or another medical problem.
When treatment improves distressing low desire and intimate connection, emotional well-being can improve as a result. But testosterone shouldn't replace psychiatric evaluation or evidence-based treatment for depression or anxiety, and when it is prescribed, it requires careful, physiologic (not high) dosing and monitoring by an experienced clinician. Doses that are too high can cause unwanted androgenic side effects.
Testosterone is biologically relevant to women's brains and well-being, but biological plausibility isn't the same as proven therapeutic benefit.
In Part 3, we'll look at what actually helps, and why the most effective care usually treats the whole person rather than choosing between "hormonal" and "psychiatric."
Selected References: Davis et al., Global Consensus Position Statement on Testosterone Therapy for Women, JCEM (2019); Parish et al., ISSWSH Clinical Practice Guideline, Journal of Sexual Medicine (2021); Islam et al., Lancet Diabetes & Endocrinology (2019).
This series is for general education and is not a substitute for individualized medical or psychiatric care. Hormone therapy and psychiatric treatment should be selected through an individualized assessment of symptoms, medical history, risks, preferences, and treatment goals.