Testosterone in Women and Perimenopause: Could It Be Affecting How You Feel?

You're eating well. You're staying active. You're doing all the things that used to help you feel your best. Yet something still feels different.

Your energy isn't what it used to be. Recovery after exercise takes longer. Building strength feels harder. Your motivation has changed, and your libido isn't the same.

It's understandable to wonder... Could testosterone be the reason?

The answer is: possibly — but it's rarely the whole story. Testosterone in women during perimenopause and menopause is often overlooked, while it may play a role, it's rarely the whole story.

While testosterone is often thought of as a male hormone, it also plays an important role in women's health. During perimenopause and menopause, changing hormone levels can influence how you feel, but testosterone is just one piece of a much bigger picture.

What Does Testosterone in Women Actually Do?

Women naturally produce testosterone throughout their lives, although in much smaller amounts than men.

It contributes to many aspects of health, including:

• Energy levels
• Muscle strength and maintenance
• Bone health
• Libido and sexual wellbeing
• Motivation
• Cognitive function
• Overall sense of wellbeing

Like other hormones, testosterone levels gradually change with age. However, the way you feel isn't determined by testosterone alone.

Why You Can Feel Different Even If Your Testosterone Is 'Normal'

Many women are told their blood tests are "normal", yet they still don't feel like themselves.

This can be confusing. The reality is that hormone levels are only one part of the assessment.

During perimenopause and menopause, fluctuating oestrogen, changing progesterone levels, sleep disruption, stress, metabolic health, and lifestyle factors can all contribute to symptoms that overlap with those sometimes associated with low testosterone.

That's why a blood test doesn't always provide the complete answer.

Understanding your symptoms requires looking at the whole picture, not just one hormone result.

Recovery Changes During Perimenopause

One of the most common concerns I hear from women is that their bodies don't recover the way they used to.

Perhaps you're finding that:

• Exercise leaves you feeling sore for longer.
• Building strength feels more difficult.
• Your energy takes longer to return after a busy week.
• You're finding it harder to keep up with the demands of work, family, and everyday life.

These changes aren't simply about getting older.

Hormonal changes during perimenopause and menopause can influence muscle health, recovery, sleep, and energy, making it more important than ever to support your body with adequate nutrition, strength training, and recovery.

Metabolic Health Matters Too During Perimenopause

Many women notice changes in their body composition during midlife, particularly around the abdomen.

This isn't simply about eating too much or exercising too little.

Changing hormones can affect insulin sensitivity, muscle mass, and the way your body stores and uses energy.

You may notice:

• Increased abdominal weight gain
• Afternoon energy crashes
• More frequent cravings
• Difficulty maintaining muscle
• Feeling less energetic than you used to

These changes can influence how you feel day to day and may also affect your long-term metabolic health.

Sleep and Stress Influence Your Hormones

Poor sleep and ongoing stress can have a significant impact on your wellbeing during perimenopause and menopause.

When you're not sleeping well, everything feels harder.

Energy declines, concentration becomes more difficult, recovery slows, and motivation often suffers.

Rather than looking at testosterone in isolation, it's important to consider how sleep, stress, hormone changes, nutrition, and physical activity all work together to influence your health.

Is Testosterone Therapy Right for You?

Not necessarily.

While testosterone therapy can be appropriate for some women, it isn't recommended as a routine treatment for every perimenopausal and menopausal symptom.

Current evidence supports carefully prescribed testosterone therapy for women with hypoactive sexual desire disorder (HSDD) following a comprehensive assessment and after other contributing factors have been considered.

For some women, testosterone may form part of an individualised menopause management plan. For others, addressing sleep, stress, nutrition, metabolic health, or optimising oestrogen therapy may have a greater impact on how they feel.

The right treatment depends on understanding what's contributing to your symptoms.

Looking Beyond One Hormone

When women ask me whether they need testosterone, my first question isn't, "What was your blood test result?"

Instead, I want to understand the whole picture.

That includes:

• Your symptoms
• Your stage of perimenopause or menopause
• Sleep quality
• Stress levels
• Nutrition
• Physical activity
• Muscle and metabolic health
• Medical history
• Other hormones that may be influencing how you feel

Only then can we determine which treatment options are likely to be most beneficial for you.

Understanding Your Whole Hormonal Picture

If you've noticed changes in your energy, strength, motivation, or libido, it's worth exploring what's contributing to those symptoms rather than assuming testosterone is the answer.

Perimenopause and menopause are complex transition that affects many different systems throughout the body.

By taking the time to understand your hormones, metabolic health, lifestyle, and overall wellbeing, we can develop a personalised, evidence-based plan that's designed around your individual needs.

If you're wondering whether testosterone may play a role in how you're feeling, book a consultation today. Together, we'll explore your symptoms, discuss your options, and create a personalised plan to help you feel more like yourself again.