The Truth About Testosterone in Perimenopause
Testosterone: A love letter.
January 9, 2025
Alright, let’s pull back the curtain on testosterone—arguably the most underappreciated hormone in women’s health. Sure, it’s dubbed the “male hormone,” but it’s just as crucial for us. As perimenopause sets in, testosterone quietly sneaks out, and it takes more than your sex drive with it. This hormone deserves a bigger spotlight, so let’s break it down.
Spoiler: this little hormone is a big deal to your overall health - for right now and for your longevity. Ignoring it is like ignoring a toddler with an uncapped sharpie —dangerous.
Testosterone: Kind of a big deal
First, let’s set the record straight: testosterone is not just for dudes. Women actually produce more testosterone than estrogen throughout their lives, and it’s responsible for way more than you think.
Testosterone is integral to maintaining muscle strength, sharp cognition, and mood stability, while also playing a critical role in bone health and sexual well-being. Boom.
In women, it peaks in our 20s and begins a slow decline in our 30s, but perimenopause kicks it into a sharper downward spiral. Unlike estrogen or progesterone, which fluctuate wildly during this time, testosterone’s decline is quieter but no less significant.
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Why should you care about testosterone?
Look, I get it. “Testosterone” might not sound like a YOU problem—it’s got a gym-bro vibe, right? Wrong. This hormone is the glue holding your energy, metabolism, and sanity together. When it starts ghosting you during perimenopause (or earlier!), things go sideways fast. Here’s why you should give a damn:
Energy & Motivation
It fuels your drive—whether for work, workouts, or simply keeping up with the momlife circus. Feeling like a soggy dishrag every afternoon? That’s what happens when testosterone peaces out. It’s your body’s motivational speaker, and without it, you’re left scrolling Netflix, wondering why you can’t get your ass off the couch and motivate to do your 26 step skincare routine and go to bed. Research shows testosterone boosts mitochondria (your cell’s energy factories), making it crucial for overall vitality.
Body Composition
Ah, belly fat, the uninvited guest that won’t leave. Testosterone keeps your muscle mass intact and helps your metabolism do its job. When it dips, your body starts storing fat like it’s auditioning for Hoarders. Even if — and this is important — you have not changed a single thing about your diet and exercise.
Brain Function & Mood
You’re not losing your mind; you’re losing your hormones. Testosterone is your brain’s secret weapon for clarity and focus. Without it, welcome to the brain-fog Olympics, where you forget why you walked into a room 12 times a day.
Testosterone supports focus, memory, and emotional resilience. Studies confirm its role in preventing brain fog and enhancing cognitive function. No, you’re not losing your mind—your hormones are shifting.
Bone Health
You thought brittle bones were an “old lady” problem? Think again. Testosterone pulls its weight in keeping your skeleton sturdy by stimulating bone-forming cells, reducing the risk of osteoporosis and fractures as you age. We talk about estrogen for bone strength, but testosterone is just as important.
Sexual Health
Let’s be honest: when your libido is MIA, it’s not just about “not feeling it.” Low testosterone can mess with your whole sexual vibe—libido, satisfaction, the works. Adequate testosterone levels also help maintain vaginal tissue health, which becomes critical as estrogen levels drop.
Symptoms of low testosterone: it’s not just in your head
If you’re nodding along to any of these, low testosterone could be the issue:
Fatigue that sleep can’t fix
Brain fog that makes basic tasks feel like calculus
Loss of muscle tone despite regular workouts
A libido that’s gone MIA
Mood swings and irritability
Weight gain (especially around the middle)
Hm…. sounds an awful lot like the “it’s just getting older” garbage we hear from our providers when we bring this up at our yearly physical amiright?!
Why testosterone drops during perimenopause
Testosterone doesn’t go down just for funsies. Just like all of your other hormones, its adaptive to its environment. When something’s off, testosterone reacts.
Chronic Stress
When cortisol (your stress hormone) stays elevated, it suppresses testosterone production. Stress is like a hormonal bully—it pushes testosterone out of the way to keep cortisol in charge.
Poor Sleep
Night sweats, insomnia, and revenge bedtime procrastination disrupt your body’s ability to produce and regulate testosterone. Research confirms that sleep deprivation is a major factor in hormonal imbalance.
Diet Deficiencies
Low protein intake, insufficient healthy fats, and nutrient deficiencies (looking at you, zinc and vitamin D) impair testosterone synthesis. A diet high in processed carbs and sugars makes it even worse.
Lack of Strength Training
Strength training not only builds muscle but also stimulates testosterone production. Always prioritize weight lifting over cardio, even if you only have 5 minutes, grab a toddler or a teenager and do some squats.
Hormonal birth control (“the pill”)
The pill cranks up sex hormone-binding globulin (SHBG), which binds testosterone and locks it away, leaving you with less to work with. Even after quitting the pill, SHBG can stay high for a while, making it feel like your libido and energy levels are on a permanent vacation.
How to naturally support testosterone
Good news: you don’t need to rely on fancy treatments to boost testosterone. You can support your body’s own ability to churn out some more vitality hormone. Start here:
Nutrition First (always)
Protein: 100g daily is the sweet spot for most women. Think eggs, chicken, beef, and soy (in moderation).
Healthy Fats: Fats (particularly saturated, if you can believe it!) and omega-3s are critical for hormone production. Avocado, fatty fish, egg yolk and nuts are your friends.
Zinc-Rich Foods: You need zinc to make testosterone! Go to town on oysters, pumpkin seeds, and red meat to support your zinc levels.
Vitamin D: Sunshine in food form—found in salmon, egg yolks, and fortified dairy.
The Right Exercise
Strength Training: Prioritize compound movements like squats and deadlifts for the biggest hormonal boost.
Recovery Matters: Overdoing cardio or skipping rest days backfires. Balance is key.
Lifestyle Tweaks
Sleep: Aim for 7-9 hours a night. If insomnia strikes, focus on sleep hygiene: no screens before bed, consistent routines, and maybe a magnesium supplement.
Stress Management: Yoga Nidra, meditation, or even guided relaxation apps like Insight Timer can help. Chronic stress isn’t your friend.
Sunlight Exposure: Vitamin D from natural sunlight helps regulate testosterone levels.
When to consider testing
You don’t have to wait until your ovaries have completely called it quits to get tested. Testing can provide clarity when you don’t feel well, and give you a good baseline if you are feeling hormonally awesome. To look under the hood at testosterone ask your doctor or dietitian to run:
Free and total testosterone
DHEA
Thyroid panel (TSH, Free T3, Free T4)
Cortisol
Sex Hormone Binding Globulin
Key nutrients like vitamin D, zinc, and magnesium
The bigger picture: testosterone and its hormone squad
Hormones don’t work solo—they’re part of a team. Testosterone collaborates with estrogen, progesterone, cortisol, and insulin to keep your body humming along. Addressing one imbalance without considering the others? That’s like fixing a flat tire on a sinking ship. Or something.
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Interested in learning more about working with Alison, a functional dietitian specializing in hormonal help for mothers?
Check out my Mother Reboot program to cntrl + alt + delete your mom bod.
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