The Role of Androgens in Perimenopause

by | | Female Hormones

Testosterone and DHEA in Women’s Health

Androgens, like testosterone and DHEA (dehydroepiandrosterone) are often thought of as “male hormones.” However, they play critical roles in maintaining the mental and physical well-being of women, especially during perimenopause.

While estrogen dominates discussions of menopause, declining androgen levels—starting as early as a woman’s mid-30s—can contribute to a wide array of symptoms and health risks as women approach and pass through menopause.

Why Androgen Support Matters

During perimenopause, some women experience a drop in androgens that may lead to:

Fatigue
Low mood or depression
Loss of muscle mass and strength
Reduced libido and sexual satisfaction
Cognitive challenges, such as poor concentration and memory
Bone loss contributing to osteoporosis

When these symptoms are significant and persist despite other therapies, androgen support in the form of low-dose testosterone or DHEA supplementation may be indicated—always under the guidance of a knowledgeable healthcare provider.

How Testosterone and DHEA Help Women Thrive

1. Mental Health and Cognition

Androgens influence neurotransmitters like serotonin and dopamine, helping to stabilize mood, combat fatigue, and reduce the risk of depressive symptoms.
Support for cognitive function—including improvements in focus and memory—has also been reported, making these hormones essential for mental sharpness and emotional resilience.

2. Physical Health and Vitality

Androgens help maintain muscle mass and physical strength, countering age-related declines and supporting daily activity.
Contribute to bone density by acting as precursors for estrogen synthesis and directly through androgen receptors, helping to reduce the risk of osteoporosis and related fractures.
Enhance libido, sexual arousal, and satisfaction, improving intimate relationships and overall quality of life.

3. Global Well-being

Addressing androgen deficiency can lead to restored energy, vitality, and a sense of well-being, translating to better work productivity, enjoyment of life, and self-esteem.

Health Consequences Without Proper Support

When hormonal transitions are not addressed, the following risks increase:

Negative Outcomes	Contribution of Androgen Deficiency
Increased cardiovascular events	Loss of protective muscle and metabolism
Greater risk of osteoporosis & fracture	Diminished bone density
Higher rates of mood disorders	Impaired neurotransmitter function
Reduced quality of life & disability	Fatigue, decreased motivation
Increased mortality in some populations	Compounding health issues

Research indicates that women, especially those who lose ovarian function surgically, are at even higher risk for cardiovascular disease, bone loss, and depression when androgen support is lacking.

Summary Table: Benefits of Testosterone & DHEA

Benefit	Testosterone	DHEA
Mood/Energy	Supports mood, reduces fatigue	Supports mood, stabilizes energy
Cognition	Improves focus, memory	Supports cognition
Sexual function/libido	Increases desire, satisfaction	May improve libido
Muscle mass & strength	Maintains muscle	Supports metabolic health
Bone health	Increases density	Supports bone density

Evidence-Based Recommendations

The strongest evidence for androgen therapy is in the treatment of diagnosed hypoactive sexual desire disorder (HSDD) in postmenopausal women
Other benefits (such as mood, cognition, and muscle mass) are supported by clinical experience, but more large-scale, long-term trials are needed for broader recommendations17.
When considering therapy, individualized assessment, regular monitoring, and safe dosing are critical.

Conclusion

While not all women need androgen support, a functional approach recognizes that for some perimenopausal and postmenopausal women, targeted supplementation with testosterone or DHEA can restore well-being, protect against decline, and enhance quality of life. Evaluation and management should always be evidence-based, judicious, and done in partnership with a healthcare provider who understands the unique needs of women in this hormonal transition.