Do androgen levels in women decline with age and after menopause?

Androgen levels in women undergo a significant and predictable decline starting well before the menopausal transition, influenced by the aging of both the adrenal glands and the ovaries.

Hormonal decline and mechanisms

The decline in androgens is a dual-process involving the adrenal glands and the ovaries.

• Adrenal aging (Adrenopause): Dehydroepiandrosterone sulfate (DHEA-S) levels begin to drop in the late 20s or 30s due to structural atrophy of the adrenal zona reticularis and reduced activity of the enzyme 17,20-lyase. By age 70, circulating DHEA-S levels typically fall to just 10–20% of their peak young-adult values.
• Ovarian senescence: During and after menopause, the interstitial theca cells of the ovaries reduce their production of testosterone. While the ovaries continue to secrete some androgens post-menopause, the overall circulating levels of testosterone are significantly lower in post-menopausal women compared to their pre-menopausal peaks.

Clinical effects and sexual health

The physiological reduction in these hormones has measurable impacts on specific areas of female health, though the strength of evidence varies across symptoms.

• Sexual function: There is high-quality evidence that low testosterone levels contribute to Hypoactive Sexual Desire Disorder (HSDD) in postmenopausal women. Systematic reviews and consensus guidelines (e.g., ISSWSH 2021) demonstrate that physiological testosterone replacement significantly improves sexual desire, arousal, and orgasm frequency.
• Energy and musculoskeletal function: Androgens provide an anabolic stimulus to muscle and bone; however, the clinical link between age-related androgen decline and specific losses in energy or muscle mass is less robustly defined. While mechanistically plausible, clinical trials have not consistently shown that low androgen levels alone predict fatigue or muscle weakness in the absence of other factors, and large-scale data on replacement for these specific symptoms remain limited.

Bottom line

The decline of androgens with age and menopause is a confirmed biological reality. While the link to reduced sexual desire is clinically well-supported, the contributions of this decline to reduced energy and musculoskeletal function are plausible but lack definitive evidence from large-scale clinical trials.