Understanding Testosterone vs Oestrogen in Midlife: What This New Study Reveals
Rethinking Midlife Hormones
For years, menopause has been described as a hormonal “fall off a cliff” — a story centred on oestrogen. While oestrogen production does indeed fall sharply around the final menstrual period, testosterone’s trajectory has been less clear. Many women are told that menopause brings “androgen deficiency,” driving fatigue, loss of libido, and low mood. But the latest Lancet eBioMedicine paper from the Monash Women’s Health Research Program paints a more nuanced picture.
This large-scale study measured blood levels of testosterone, DHEA, and androstenedione in over 1,100 women aged 40–69. The results redefine how we understand hormonal ageing in women — and, importantly, what this means for treatment.
Oestrogen: The Dramatic Decline
Oestrogen production is primarily ovarian. As follicle numbers fall, oestradiol levels drop rapidly during perimenopause and reach their lowest point around the time of the final period. This abrupt fall explains many of the classic menopausal symptoms — hot flushes, night sweats, brain fog, vaginal dryness, and reduced bone density.
The speed of oestrogen loss is what makes menopause so physiologically dramatic. Within a few years, circulating oestrogen can decline by over 90%, leading to sudden tissue changes in the brain, skin, and genitourinary tract. This is why HRT (hormone replacement therapy) remains the cornerstone of symptom relief and long-term bone and cardiovascular protection.
Testosterone: A Slow Drift, Not a Drop
In contrast, testosterone follows a different pattern. The new study shows that women’s testosterone levels decline gradually from age 40 to about 58–59, then rise slightly again in later life. Importantly, this trend was not linked to menopause itself. In other words, testosterone doesn’t suddenly collapse when periods stop.
The researchers found that:
Testosterone fell by around 25% between the early 40s and late 50s.
After 60, levels rose modestly, suggesting continued adrenal and peripheral conversion.
DHEA and androstenedione (the precursors for testosterone) declined steadily across life.
The only meaningful drop linked to menopause was in androstenedione, not testosterone.
This challenges the assumption that menopause inherently causes “androgen deficiency” — and supports a more individualised approach to testosterone therapy.
Why the Difference Matters
Understanding these contrasting hormone curves helps explain why women may experience certain symptoms at different stages.
Oestrogen loss causes vasomotor symptoms, vaginal dryness, and mood changes.
Testosterone decline, which is more gradual and peaks in its effect around the late 50s, may influence libido, energy, and sense of motivation.
However, since testosterone doesn’t sharply fall with menopause, the idea of “replacing” it for every menopausal woman is biologically unsound. This finding supports the current consensus that testosterone therapy is not a universal menopause treatment, but may help postmenopausal women with hypoactive sexual desire disorder (HSDD) who are distressed by low libido or select women who are experiencing particular problems with low energy and motivation.
What This Means for Treatment Decisions
This research reinforces the importance of precision in midlife hormone care:
Oestrogen replacement remains key for menopausal symptoms and long-term protection.
Testosterone supplementation may be appropriate in specific, well-defined cases — not as routine therapy.
DHEA supplements are sometimes discussed but should be used with caution: this study shows DHEA falls steadily, yet its conversion to testosterone depends heavily on tissue enzyme activity, not blood levels alone.
Women with bilateral oophorectomy (surgical menopause) had lower testosterone than those with natural menopause — these women are more likely to benefit from replacement.
Lifestyle factors such as smoking and BMI also subtly influence testosterone levels, reminding us that hormone balance is multifactorial.
Integrating This into Modern Women’s Health
This new dataset adds weight to the argument for age- and symptom-specific treatment, not one-size-fits-all HRT. While oestrogen and progesterone form the foundation of menopausal care, understanding androgens helps tailor treatment for mood, libido, and vitality.
In practice:
Oestrogen therapy should start early if symptomatic, ideally within 10 years of menopause.
Testosterone therapy can be considered when certain symptoms persists despite optimal oestrogen.
Monitoring is key: blood levels should stay within the normal premenopausal range, avoiding supraphysiological dosing.
Ultimately, this study underscores that ageing, not menopause itself, drives changes in testosterone, and that true deficiency is rare outside of surgical or adrenal dysfunction.
Key Takeaway
While oestrogen “falls off a cliff,” testosterone gently slopes downhill before levelling off. This difference matters — because it changes how we treat, when we intervene, and what expectations women should have of midlife hormone therapy. The goal isn’t to chase youth through supplementation, but to restore physiological balance where needed and support long-term health through evidence-based care.
FAQ
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No — unlike oestrogen, which drops steeply around the final period, testosterone declines gradually from the 40s through the 50s and then plateaus. It isn’t menopause itself that causes androgen decline, but ageing and reduced adrenal output over time.
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Oestrogen is made by the ovarian follicles, which diminish rapidly during perimenopause. Once ovulation stops, oestrogen production falls by more than 90% in just a few years, leading to classic menopausal symptoms.
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DesNo. Testosterone therapy is only recommended for postmenopausal women with low sexual desire that causes distress and doesn’t respond to oestrogen alone. It isn’t a “booster” for energy or mood in general use.
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Not reliably. Although DHEA is a precursor hormone, its conversion to testosterone depends on tissue-specific enzymes, so supplements don’t always translate into higher or more effective levels.
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Yes, for the right woman. If low desire is distressing and oestrogen therapy isn’t enough, low-dose testosterone can restore sexual satisfaction and confidence — provided blood levels are kept within the premenopausal range.