Do the ovaries continue to contribute meaningfully to circulating testosterone across midlife?

The ovaries remain a physiologically active source of androgens throughout a woman’s life, including during and after the menopausal transition. While often overshadowed by the precipitous decline in estrogen, the transition through midlife involves significant shifts in the availability and source of circulating testosterone.

Clinical and physiological evidence

Research confirms that the ovaries contribute significantly to the female androgen pool, particularly during the reproductive years and midlife.

• Production sources: In premenopausal women, approximately 25% of circulating testosterone is secreted directly by the ovaries (specifically via theca cells), 25% by the adrenal glands, and the remaining 50% is derived from the peripheral conversion of precursors like androstenedione.
• Stability during transition: Data from the Study of Women's Health Across the Nation (SWAN) indicate that while estradiol levels collapse during the menopausal transition, total testosterone levels often remain relatively stable. This stability results in a state of "relative androgen excess," as the ratio of testosterone to estradiol increases significantly.
• The postmenopausal ovary: The ovary does not become steroidogenically null after menopause. Longitudinal studies show that women who undergo bilateral oophorectomy (surgical removal of ovaries) experience a significantly sharper drop in circulating testosterone (roughly 40-50%) compared to women undergoing natural menopause, confirming that the postmenopausal ovary continues to contribute to the androgen pool.

Mechanistic explanations

The reduction in androgen availability during midlife is a dual process involving both ovarian aging and adrenal involution.

• Ovarian shift: As ovarian follicles deplete, the primary site of steroidogenesis shifts. However, the ovarian stroma remains capable of producing androgens in response to elevated luteinizing hormone (LH) levels, which characterize the postmenopausal state.
• Adrenal contribution: Parallel to declining ovarian function, the adrenal glands undergo age-related changes. The adrenal zona reticularis experiences gradual involution, leading to a steady decline in the secretion of dehydroepiandrosterone (DHEA) and DHEAS. Because these are primary precursors for peripheral testosterone conversion, their decline further reduces overall androgen availability.

Bottom line

The ovaries are a primary source of testosterone in midlife, contributing roughly one-third of direct secretion. While total testosterone levels may appear stable relative to the sharp drop in estrogen, the functional decline of the ovaries and the age-related reduction in adrenal precursors together reduce the total pool of available androgens as women age.