The Truth About Testosterone in Menopause — What NZ Women Need to Know
By Rene Schliebs — Clinical Nutritionist, Medical Herbalist & Menopause Expert
If you've been experiencing low libido, persistent fatigue, brain fog that won't shift, difficulty building or maintaining muscle, or a flat, unmotivated feeling that isn't quite depression but isn't quite right either, there's a hormone that almost certainly isn't being tested.
Testosterone.
Yes, in women. It's not a male hormone. It's your hormone too, and in perimenopause, it declines significantly, often years before estrogen does. And yet it is rarely tested, rarely discussed, and rarely treated in standard GP care in New Zealand.
That's a problem. And this post is here to change it.
What testosterone actually does in women
Testosterone is produced in women by the ovaries and adrenal glands. It plays a fundamental role in:
Libido and sexual function — it is the primary driver of sexual desire in women. Not estrogen. Testosterone.
Energy and motivation — testosterone drives dopamine activity. When it's low, the world feels flat. Motivation drops. The drive to do things you used to enjoy diminishes.
Muscle mass and metabolism — testosterone is essential for muscle protein synthesis. Without adequate levels, building or maintaining muscle becomes significantly harder regardless of how much you exercise or how well you eat.
Cognitive function — concentration, mental sharpness, verbal fluency. These all depend partly on testosterone. Brain fog is not just an estrogen problem.
Bone density — testosterone contributes to bone mineral density alongside estrogen. Declining testosterone is an underappreciated contributor to osteoporosis risk in midlife women.
Mood — low testosterone in women is associated with low mood, irritability and emotional flatness that often doesn't respond well to antidepressants because the driver isn't serotonin; it's androgens.
When does testosterone decline?
Testosterone peaks in women in their mid-20s and declines gradually from there. By the time women reach perimenopause, which can begin in the late 30s, testosterone levels may already be significantly lower than they were at peak.
Unlike estrogen, which fluctuates dramatically in perimenopause before dropping, testosterone declines more steadily, which means the symptoms creep in slowly and are often attributed to other things: stress, getting older, not exercising enough, relationship problems.
Surgical menopause, removal of the ovaries, causes an immediate and dramatic drop in testosterone alongside estrogen, often with severe consequences for energy, libido and mood that are frequently underaddressed.
Why it's almost never tested
This is where I get frustrated on behalf of my clients.
Testosterone is rarely included in standard female hormone panels in NZ. When it is tested, the reference ranges used are often borrowed from male ranges and unhelpfully broad, meaning a result technically within range may still be suboptimal for a woman experiencing symptoms.
The conversation about testosterone therapy for women is also lagging significantly behind the evidence. AndroFeme 1 — a female-specific transdermal testosterone cream- is Medsafe-approved in New Zealand. The evidence for its use in women with low testosterone and sexual dysfunction is strong. And yet most women with classic low testosterone symptoms are never offered it, never tested for it, and never told it exists.
What to ask your GP
If you recognise yourself in the symptoms above, ask specifically:
"I'd like my testosterone and SHBG tested. I've been experiencing symptoms that may be related to low androgen levels, and I'd like to understand my levels before we discuss options."
SHBG — sex hormone-binding globulin — is important alongside testosterone because it determines how much of your testosterone is actually free and available to your body. You can have a normal total testosterone but very high SHBG, meaning very little testosterone is actually doing anything.
If your GP is unfamiliar with testosterone therapy for women, ask for a referral to a gynaecologist or endocrinologist with experience in female hormone therapy. This is a reasonable and appropriate request.
What I can do alongside this
While testosterone therapy itself requires a prescription, there is a significant amount we can do nutritionally and with herbal medicine to support androgen levels and the symptoms associated with low testosterone, particularly around energy, mood, muscle function and libido.
Zinc is a critical cofactor for testosterone synthesis. Adequate dietary fat, particularly saturated and monounsaturated fats, supports steroid hormone production. Specific adaptogenic herbs support adrenal androgen production. And addressing the gut and inflammatory picture that often underlies hormonal dysregulation in perimenopause can improve how your body uses the hormones it does produce.
This is the kind of layered, personalised work I do in consultations — and it often makes a significant difference even before any medical treatment is initiated.
👉 Explore my Reclaim Your Spark — Libido & Intimacy Course
Rene, XO.
Rene Schliebs is a Clinical Nutritionist and Medical Herbalist with over 20 years of experience. menopausenaturally.co.nz