Women's endocrinology – Nord-HRT-F – clinical longevity

Testosterone is also a decisive part of women's health.

Between the ages of 20 and 50, women's bioactive testosterone halves, while oestrogen falls sharply in perimenopause. Here is what research shows about hormones and symptoms in women, and what it does not show.

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Free testosteronefrom age 20 to 45

MRS

Validatedsymptom questionnaire

ISO 15189

Gold standardLC-MS/MS analysis

Davison et al. JCEM28-39 pmol/L

Sex hormones affect bone, muscle and the brain throughout life.

Biochemistry by age – Davison et al. 2005

Total and free testosterone across the lifespan

Measured values from 1,423 healthy women. Testosterone falls with age, and low values after menopause are common. A low value alone is not a diagnosis.

90th centile for ageMedian10th centilenmol/L · ng/dL

Biomarker	10th centile	Median	90th centile	Young reference (18-24)
Total testosterone	0.2 – 0.4 nmol/L	0.55 – 0.8 nmol/L	1.1 – 1.4 nmol/L	1.55 – 2.47 nmol/L
Free testosterone	3 – 5 pmol/L	8 – 12 pmol/L	17 – 24 pmol/L	20 – 39 pmol/L

28-39 pmol/L

Young reference

Typical values for women aged 18–24. A reference position, not a treatment target.

Reference

14-28 pmol/L

Upper premenopausal

Upper part of the usual premenopausal range. A reference position, not a treatment target.

Reference range

9-14 pmol/L

Median (ages 40-60)

Typical midlife value. Some women report symptoms in this range, others do not.

Midlife median

5-9 pmol/L

Low range

Low values are common here. Symptoms such as low sexual desire need a clinical assessment.

Assess if symptoms

< 5 pmol/L

Very low

Often seen after removal of both ovaries or in late postmenopause.

Very low

Mechanistic endocrinology

The biochemical paradox: unwanted facial hair and hair loss at once

Why do women with low measured testosterone often still have androgen-related complaints? The explanation is physiological ratios, local conversion and metabolic dysfunction – not a true surplus of testosterone.

The oestrogen/testosterone ratio shifts

Oestrogen falls by up to 90% in menopause, while testosterone only halves. She is left in a relative functional androgen dominance – not because testosterone has risen.

Ratio shift – perimenopause

5-alpha-reductase and local DHT

Insulin resistance upregulates 5-alpha-reductase. The limited testosterone is converted locally in the hair follicle to DHT, which triggers crown hair loss and chin hair.

Enzymatic conversion

Endocrine disruptors and SHBG

Xenoestrogens, BPA and phthalates raise SHBG. That binds the remaining testosterone, so free hormone falls, while the total result can still look normal.

Binding and environment

Dermal thickness and receptors

Papa (1967) showed that topical testosterone thickened atrophic skin. The receptors sit in the tissue – a blood level and a local effect are not the same number.

Tissue and receptors

Clinical model

The endocrine interplay: the 3 hormonal pillars

Oestrogen, progesterone and testosterone affect each other. Oestrogen without progesterone thickens the endometrium when the uterus is intact. That is why the values are measured together and assessed as a whole by a physician.

Pillar 01

Oestradiol (E2)

Follicular, typically 70-220 pmol/L

Affects hot flushes, genital tissue, bone turnover and sleep.

Primarily: bone, thermoregulation, CNS

Pillar 02

Testosterone (T)

Free, typically 8-25 pmol/L before 40

Linked to sexual desire and studied for muscle and mood. It often falls years before menopause and is rarely measured.

Primarily: muscle, motivation, desire

Pillar 03

Micronised progesterone

Luteal, while a cycle remains

Sleep via GABA/allopregnanolone and endometrial balance. Not a scaled male TRT protocol.

Primarily: sleep, endometrium, GABA

Method A — cyclical / sequential

For a woman who still menstruates or is perimenopausal. The natural cycle is imitated.

Oestrogen: taken every day.
Progesterone: taken for part of each month, typically 12–14 days.
This usually gives a regular withdrawal bleed.
The physician sets the product and dose.

Method B — continuous

After menopause, when bleeds are no longer wanted and the hormones are kept flat and stable.

Oestrogen: taken every day.
Progesterone: taken every day, without a break.
Usually no withdrawal bleed.
The physician sets the product and dose.

Reference values · context, not treatment targets

How hormone values are read in context

A laboratory report compares a woman's result with women of the same age. Low oestrogen and testosterone after menopause are expected and are not a disease in themselves. Whether treatment makes sense depends on symptoms, medical history and risks, assessed by a physician. The values below are published reference data, shown for orientation.

Reference data: younger women

Roughly 18–35 years, published reference data

Oestradiol: 300 – 600 pmol/L
Total testosterone: 1.55 – 2.47 nmol/L
Progesterone: Cyclical
SHBG: Mid-range

Reference data describe a population. They are not a goal for an individual woman.

Values after menopause

What is typically measured, and what treatment does not aim for

Oestradiol: often < 100 pmol/L
Total testosterone: often 0.3 – 0.7 nmol/L
Progesterone: Set by the physician
Treatment decision: Individual

Hormone therapy can relieve menopausal symptoms for many women, but the effect varies, and benefits and risks are weighed individually.

How treatment is chosen

Oestrogen, progesterone and testosterone are absorbed and broken down differently. The product, form and dose are chosen by the prescribing physician and adjusted at follow-up on symptoms and blood tests.

	Typical form	Why it matters
Oestrogen	Often a transdermal gel or patch	Transdermal forms avoid first-pass metabolism in the liver
Testosterone	Only where indicated, in doses intended for women	Women's doses are far lower than men's, and levels are checked with blood tests
Progesterone	Micronised progesterone or another progestogen	Required with oestrogen when the uterus is intact

Progesterone and endometrial protection

If a woman still has her uterus and uses oestrogen, she also needs progesterone or another progestogen. Oestrogen makes the endometrium grow, and without a progestogen the risk of endometrial hyperplasia and cancer rises. Micronised progesterone is a commonly used option. The choice of product, including the different risk profiles, is made together with the physician.

In the brain, progesterone is converted to allopregnanolone, which acts on GABA receptors. Some women report better sleep when progesterone is taken in the evening, but the effect varies, and it is not a sleep treatment in itself.

The consensus statement this rests on

The Global Consensus Position Statement on the Use of Testosterone Therapy for Women concludes that testosterone therapy, in doses that approximate physiological premenopausal testosterone concentrations, is effective for postmenopausal women with hypoactive sexual desire dysfunction, and that blood testosterone concentrations should not exceed the physiological range for premenopausal women.

Two points follow. First, the statement's only evidence-based indication for testosterone in women is hypoactive sexual desire dysfunction after menopause. Other effects that are sometimes described, such as on energy, mood, muscle or cognition, are not established indications. Second, blood levels should not exceed the premenopausal physiological range.

Source: Global Consensus Position Statement on the Use of Testosterone Therapy for Women (Davis et al., 2019) — published simultaneously in Climacteric, The Journal of Clinical Endocrinology & Metabolism, Maturitas and others, and endorsed by the International Menopause Society, the Endocrine Society, the European Menopause and Andropause Society and further international societies.

Clinical consequence: Assess symptoms and follow blood values. Levels above the premenopausal range are not recommended.

Dr Abraham Morgentaler on the FDA expert panel on testosterone
Abraham Morgentaler, a urologist at Harvard Medical School and one of the leading international researchers on testosterone, reviews the research and the international debate discussed at an expert panel of the US Food and Drug Administration (FDA), including the question of testosterone and prostate cancer.
The views in the video are the speakers' own and are not a treatment recommendation. The video loads only when you press play.

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