Can a “male” hormone be the key to your post-menopausal pelvic health concerns?
You’re out for a walk with friends, laughing at a joke, when suddenly you feel that familiar, panic-inducing sensation. You stop in your tracks, hoping no one noticed you just peed a little…my sister in-law calls it “J-PAL”, sounds cute, but it’s not!.
UGH. If this scenario sounds familiar, you aren’t alone. As we navigate the transitions of menopause, our bodies undergo significant changes that can feel isolating or embarrassing to talk about.
While hot flashes and night sweats often get the most attention, changes to pelvic floor health—like stress urinary incontinence—are incredibly common. Many women feel like they just have to “live with it” as a natural part of aging. But what if there was a way to more easily strengthen those muscles and regain confidence while doing pelvic floor physical therapy?
For years, the conversation around menopause management has focused heavily on estrogen. While estrogen is vital, it’s not the only hormone that drops significantly during this time. Testosterone, often mistakenly thought of as just a “male hormone,” plays a crucial role in women’s health. Emerging research suggests that testosterone therapy might be a missing piece of the puzzle for maintaining a strong, healthy pelvic floor.
Understanding Testosterone and Pelvic Floor Health
It is a common misconception that testosterone belongs solely to men. In reality, women produce testosterone naturally, and it is essential for our overall well-being. During our reproductive years, we actually produce three to four times more testosterone than estrogen. However, as we approach perimenopause and menopause, those levels decline.
So, why does this matter for your bladder? The muscles that make up your pelvic floor—specifically the levator ani muscles—are packed with androgen receptors. These receptors are like tiny locks waiting for a key, and testosterone is that key. When testosterone levels drop, these muscles can lose mass and strength, much like the other muscles in our body do as we age.
By replenishing these levels through bioidentical hormone therapy, we may be able to stimulate those receptors, helping to maintain muscle tone and structural support for the bladder and urethra.
Potential Benefits of Testosterone Therapy
When we look at the body through a holistic lens, we see that hormones rarely act in isolation. Restoring testosterone levels to a healthy physiological range can offer a cascade of benefits, particularly for women struggling with the physical changes of menopause.
Improving Stress Urinary Incontinence
The most exciting potential benefit for many women is the improvement of stress urinary incontinence (SUI). SUI occurs when the pelvic floor muscles are too weak to keep the urethra closed during moments of pressure, like coughing, sneezing, or exercising. By potentially increasing muscle mass and strength in the pelvic floor, testosterone therapy may offer a treatment option that addresses the root cause of the weakness rather than just managing symptoms.
Enhancing Muscle Function
Just as testosterone helps maintain lean muscle mass in your arms and legs, it supports the integrity of the pelvic muscles. Stronger muscles mean better control and function, which is essential for preventing prolapse and incontinence.
Improving Libido and Sexual Satisfaction
This is the most well-documented benefit. Low libido is a hallmark of low testosterone in women. Therapy has been shown to improve sexual desire, arousal, and satisfaction, which are often intimately connected to how we feel about our pelvic health. When you feel strong and functional physically, it often translates to better confidence and intimacy.
Supporting Mood and Energy Levels
Many women report a “lifting of the fog” when their testosterone levels are balanced. Improvements in mood, motivation, and energy levels are frequently reported, helping you feel more like yourself again. When you’re not distracted or anxious, it is easier to “lock in” for practicing your pelvic floor exercises.
Contributing to Bone Density
Estrogen isn’t the only guardian of our bones. Testosterone also contributes to bone density, which is vital for preventing osteoporosis and protecting your long-term post-menopausal pelvic health. Believe it or not, these benefits extend to the pelvic bones as well! The bones that form the structure (the bony pelvis) that the pelvic floor muscles attach to are the sacrum, coccyx, and the fused ilium, ischium, and pubis (hip bones), creating a bony basin that supports the pelvic floor muscles and organs. The pelvic floor itself is primarily a muscular sling, but it’s anchored to these key bony landmarks, like the “sitting bones” (ischial tuberosities) and the pubic bone.
Research and Studies
The scientific community is increasingly recognizing the importance of testosterone for women. While research into the specific anabolic effects on the pelvic floor is evolving, the data we have is promising.
For instance, a systematic review published in The Lancet found that testosterone supplementation significantly improved sexual desire, pleasure, arousal, and orgasm in postmenopausal women. This highlights the hormone’s powerful role in restoring function and quality of life.
Regarding pelvic floor specifically, ongoing research, such as studies conducted at Mass General Brigham, are investigating whether testosterone can increase the mass and strength of pelvic floor muscles to improve urinary function. These studies are crucial because they move beyond subjective feelings and look at “urodynamic measures”—clinical ways to test how well the bladder and sphincter are actually working.
Furthermore, The Global Consensus Position Statement on the Use of Testosterone Therapy for Women has endorsed the use of testosterone therapy for postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD), acknowledging its safety and efficacy when used correctly.
Safety and Considerations
Hearing the word “testosterone” often brings up fears of developing masculine traits. I want to reassure you that when used correctly under medical supervision, these risks are minimal.
The goal of pelvic floor physical therapy is to restore your sexual function to its former levels. Discussing testosterone treatment with your OBGYN or primary care provider can be a great accompaniment to your physical therapy, as it can aid your muscle endurance and health. Your doctor may tell you experts generally prefer transdermal formulations—like gels, creams, or patches—applied to the skin. This allows for steady absorption and avoids the highs and lows associated with other methods.
However, like any treatment, it isn’t for everyone. Potential side effects can include:
- Acne or oily skin
- Increased hair growth at the application site
- Weight gain in some cases
More serious side effects, like voice deepening or hair loss, generally only occur if testosterone levels exceed the normal female range. This is why working with a qualified provider is non-negotiable. They will monitor your blood levels regularly to ensure you are in the “Goldilocks zone”—enough to get the benefits, but not so much that you experience unwanted side effects.
Other Therapeutic Modalities
You have many choices for treatment. If testosterone therapy isn’t right for you, or if you are looking for more types of treatments for your pelvic floor issues, there are many paths to stronger pelvic health.
Pelvic Floor Exercises
Targeted physical therapy remains the gold standard for pelvic floor issues. Working with a pelvic floor physical therapist, like myself, can teach you how to engage and relax these muscles correctly (it’s more complex than just “squeezing”!). I use biofeedback, breath work, myofascial release, and other modalities to provide you with real tools you can use to rebuild pelvic floor strength. Treating low testosterone levels can be a great accompaniment to the work we do in the clinic but not strictly necessary to see results.
Estrogen Therapy
Local estrogen therapy (applied vaginally) can be incredibly effective for improving the tissue quality of the urethra and vagina, reducing dryness and irritation that often accompanies incontinence. Many of my postmenopausal and perimenopausal clients use topical and systemic estrogen to great effect.
Lifestyle Adjustments
Simple changes can make a big difference. Reducing bladder irritants like caffeine and alcohol, managing fluid intake, and maintaining a healthy weight all relieve pressure on the pelvic floor. These are great tweaks that can benefit you at any point in your pelvic health cycle,
Taking Control of Your Journey
Navigating menopause can feel overwhelming, but you don’t have to do it alone, and you certainly don’t have to accept symptoms like incontinence as your new normal.
Testosterone therapy represents a promising frontier in women’s health, offering potential benefits that extend far beyond libido to the very structural integrity of our bodies. It highlights the importance of looking at the whole person and addressing the root causes of our symptoms.
If you are struggling with pelvic floor issues, low energy, or changes in intimacy, I encourage you to start a conversation. Consult with a healthcare professional who understands the nuances of hormone replacement therapy and pelvic health. Together, you can create a personalized plan that helps you feel vibrant, strong, and empowered in your body. I stand ready to support you as your post-menopausal pelvic health specialist in the West Seattle area. Reach out if you have any questions.