The Missing Link in Mood and Menopause: Testosterone’s Role in Women’s Mental Health

Menopause marks a significant turning point in a woman's life, bringing with it various physical and emotional changes that can feel daunting. While most discussions focus on estrogen and progesterone, testosterone's role often gets overlooked. This post highlights testosterone's critical role in women's mental health during menopause, revealing why it is a crucial piece of the puzzle in understanding mood changes.

The Connection Between Testosterone and Mood

As estrogen decreases during menopause, testosterone may also decline, disrupting hormonal balance and intensifying mood disorders. Studies suggest that women with higher testosterone levels experience improved mood stability.

Testosterone and Antidepressant Use

One of the most intriguing findings comes from a 2025 menopause clinic analysis (J Sex Med). Researchers observed that women on hormone replacement therapy (HRT) who also received testosterone were more likely to reduce or stop antidepressants compared to those on HRT alone. Roughly 39% of women reduced or discontinued antidepressants overall, and the rates were even higher in those prescribed testosterone. While this study was observational and can’t prove causation, it suggests testosterone may play a supportive role in mood regulation for some women.

Mood Improvement with HRT + Testosterone

A large retrospective cohort study (Br J Psychiatry, 2025) evaluated outcomes in peri- and postmenopausal women receiving body-identical 17β-estradiol–based HRT, often alongside testosterone. Results showed significant improvements in both depression and anxiety scores, pointing toward testosterone as a booster in the HRT toolkit.

Testosterone Alone for Depression

The largest randomized controlled trial to date (Am J Psychiatry, 2020) tested adjunct low-dose transdermal testosterone in 101 women with antidepressant-resistant major depression. Results showed no superiority compared with placebo, highlighting that testosterone by itself is not a reliable antidepressant.

Additional smaller prospective clinic-based studies (2025) have reported that transdermal testosterone was associated with mood and cognitive improvements after several months of use in peri- and postmenopausal women. While promising, these findings still require confirmation in larger, controlled trials.

What This Means in Practice

Testosterone is not a stand-alone therapy for depression, but may play a supportive role in comprehensive HRT.

• Best results are seen when testosterone is layered on top of estradiol and progesterone, not as a replacement.

• Transdermal formulations at low, physiologic doses are preferred.

• Close monitoring with labs (total T, SHBG, free T) and individualized dosing are key.

• Patients should never stop antidepressants without medical supervision; testosterone may complement—not replace—psychiatric care.

The Bottom Line when it comes to mood

For midlife women, testosterone can be more than a libido hormone—it may also support mood stability and even help some women reduce their need for antidepressants. Evidence is strongest for its role as an adjunct within comprehensive HRT, rather than as a primary treatment for depression. Future randomized trials will clarify exactly who benefits most, but the emerging data are promising.

Signs of low testosterone in women

Recognizing the signs of low testosterone can be critical for women dealing with mood changes during menopause. Symptoms may include:

• Fatigue and low energy levels

• Decreased sexual desire

• Frequent mood swings and irritability

• Difficulty focusing

• Increased feelings of anxiety or depression

  
  

If you notice these signs, it might be time to discuss testosterone levels with a healthcare provider. A simple blood test can reveal whether your testosterone levels are within the standard range.

Exploring Treatment Options

For women experiencing mood changes during menopause, considering treatment options is vital. While hormone replacement therapy (HRT) is often used to address estrogen and progesterone deficiencies, testosterone therapy is emerging as a significant option.

Testosterone therapy can be delivered through patches, gels, or injections. It's essential to consult a healthcare professional to determine the right method for you. They can assess hormone levels and discuss the potential benefits and risks of testosterone therapy to help you make an informed decision.

The Importance of Seeking Support

Menopause can be challenging, and seeking support from healthcare professionals, friends, and family is essential. Openly discussing hormonal changes and mental health can minimize stigma and promote understanding.

Consider joining support groups or online communities (see our Circle community at https://heriq.co) where women share their experiences. Connecting with others facing similar challenges can provide encouragement and valuable insights.

Empowering Your Journey Through Menopause

Understanding the relationship between testosterone and women's mental health during menopause highlights its crucial role in mood regulation. By recognizing the signs of low testosterone, exploring treatment options, and making lifestyle changes, women can navigate menopause with increased confidence and resilience.

You are not alone in this journey. Seeking support is a vital step toward achieving optimal mental well-being. Embrace this new chapter with knowledge and empowerment, and remember that it is okay to ask for help when you need it.

References

• Dichtel LE et al. Am J Psychiatry. 2020. Adjunctive transdermal testosterone for antidepressant-resistant depression in women: a randomized placebo-controlled trial.

• Glynne S et al. Br J Psychiatry. 2025. Retrospective cohort study on HRT (with adjunct testosterone) and mood outcomes in peri- and postmenopausal women.

• Quaile H et al. J Sex Med. 2025 (conference abstract). Rates of antidepressant deprescribing with HRT + testosterone compared to HRT alone.

• Additional clinic-based prospective studies, 2025: transdermal testosterone associated with improvements in mood and cognition in peri- and postmenopausal women.