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Menopausal transition and testosterone linked to X chromosome inactivation skew in femalesLow Testosterone May Affect How Your X Chromosomes Work

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Key Takeaway
Consider that menopausal transition and low testosterone polygenic scores are associated with XCI-skew, but causation is not established.

This cross-sectional observational cohort study with longitudinal measures analyzed data from 1,395 females in the TwinsUK population cohort, with a replication set of 149 individuals. The study examined associations between menopausal transition (early menopause <45 years, surgical menopause, natural menopause), sex hormone levels (testosterone), and polygenic scores with X chromosome inactivation skew (XCI-skew).

Early menopause (<45 years) was associated with increased risk of XCI-skew. In subset analyses, this association was restricted to surgical menopause. A low polygenic score for testosterone levels was significantly associated with XCI-skew and was replicated in the independent dataset (n=149). In contrast, a polygenic score for age at natural menopause was not associated with XCI-skew. XCI-skew was observed to be a stable cellular phenotype that typically increases over time.

Safety and tolerability data were not reported. Key limitations include the cross-sectional design for the primary analysis and that it was not reported if the study was preclinical or animal-based. The study design does not establish causation.

The practice relevance is that XCI-skew may have clinical relevance in postmenopausal females, but the evidence is observational and requires further validation.

Imagine your body is a city. In women, every cell has two X chromosomes. To keep things fair, each cell randomly shuts down one of those X chromosomes. This is called X chromosome inactivation.

Think of it like a coin flip. In a healthy system, about half the cells use the mother’s X, and half use the father’s. But what happens if the coin keeps landing on heads?

That is called skewed X inactivation. It means most cells are using the same X chromosome. A new study suggests that low testosterone and certain types of menopause may make this imbalance more likely.

X chromosome inactivation is a normal process. It ensures that women do not have too much X chromosome activity compared to men.

But when the balance is off, it can be a problem. This is called XCI-skew. It happens more often as women age. It is also linked to a higher risk of certain health issues.

Researchers wanted to know what causes this skew. They focused on the menopausal transition. This is a time of major hormonal change. It affects everything from bone health to heart disease.

The study looked at 1,395 women from the TwinsUK cohort. These women provided blood samples and health data. The goal was to see if hormones and menopause affect X chromosome balance.

The Old Way vs. The New Way

For years, scientists thought XCI-skew was mostly random. It was seen as a natural part of aging. There was no clear cause, and no way to prevent it.

But here’s the twist. This study suggests that hormones play a key role. Specifically, it points to testosterone. This is surprising because testosterone is often thought of as a male hormone. However, women make it too, just in smaller amounts.

The study found that low testosterone levels are linked to XCI-skew. This is a new idea. It suggests that hormone balance matters more than we thought.

Think of the X chromosome like a light switch. In each cell, one switch is turned on, and the other is turned off.

In a balanced system, the switches are flipped randomly. But if something tips the scales, one switch stays on more often. This creates a skew.

Testosterone might act like a hand on the switch. It could help keep the flipping random. If testosterone levels drop, the switch might get stuck. This could lead to more cells using the same X chromosome.

The study also looked at menopause. Menopause happens when the ovaries stop making hormones. This includes estrogen and testosterone. The drop in hormones might make the X chromosome switch less stable.

The researchers used data from the TwinsUK study. This is a long-term project tracking the health of identical and non-identical twins.

They looked at blood samples from 1,395 women. They measured XCI-skew using DNA analysis. They also collected data on menopause, hormones, and genetics.

The study was cross-sectional. This means it looked at a single point in time for most women. But they also had data for some women over 18 years.

The results were clear. Early menopause was linked to more XCI-skew. But only in one group: women who had surgery to remove their ovaries.

Natural menopause did not show the same link. This suggests that the sudden drop in hormones from surgery is different from the gradual change of natural menopause.

Low testosterone was also a big factor. Women with a genetic tendency for low testosterone had more XCI-skew. The researchers confirmed this in a second group of 149 women.

But here’s the catch. A genetic score for age at natural menopause was not linked to XCI-skew. This means the timing of menopause alone does not explain the imbalance.

This doesn’t mean this treatment is available yet.

Where Hormones Fit In

The study also looked at estrogen. But estrogen levels did not show a clear link to XCI-skew. This highlights the role of testosterone in women’s health.

Testosterone is often overlooked. It is important for energy, mood, and bone strength. This study adds a new layer: it may also help keep X chromosome activity balanced.

The link was strongest in women who had surgical menopause. This is when both ovaries are removed before natural menopause. It causes an immediate drop in hormones.

If you are going through menopause, this study does not mean you need to worry about X chromosomes. It is early research.

But it does highlight the importance of hormone balance. If you have had surgical menopause, talk to your doctor about hormone therapy. This study suggests that testosterone might be more important than we thought.

For now, there are no tests for XCI-skew in routine care. It is a research tool. But as we learn more, it could become a marker for health risks.

This study has some important limits. It is observational, so it cannot prove cause and effect. It only shows a link.

The study focused on women of European descent. We do not know if the results apply to other groups. More research is needed.

Also, the study used blood cells. XCI-skew might be different in other tissues, like the brain or heart. We need more data to know for sure.

The next step is to understand how testosterone affects X chromosomes. Researchers will look at how hormone therapy changes XCI-skew over time.

There are no clinical trials yet. But this study lays the groundwork. It suggests that hormone balance could be a key factor in women’s health as they age.

For now, the best advice is to talk to your doctor about menopause and hormone health. This research is a reminder that even small changes in hormones can have big effects.

Study Details

Study typeCohort
Sample sizen = 149
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
Background: X chromosome inactivation (XCI) is the mechanism which randomly silences one X chromosome to equalise gene expression between 46, XX females and 46, XY males. Though XCI is expected to result in a random pattern of mosaicism across tissues, some females display a significantly unbalanced ratio in immune cells, termed XCI-skew, in which [&le;]75% of cells have the same X inactivated. XCI-skew is associated with adverse health outcomes and its prevalence increases with age, particularly after midlife, yet the specific risk factors have yet to be identified. The menopausal transition, which is driven by profound shifts in sex hormone levels, has significant impact on chronic disease risk yet the molecular and cellular effects are incompletely understood. We hypothesised that the menopausal transition may impact XCI-skew. Methods: Using XCI data measured in blood-derived DNA from 1,395 females from the TwinsUK population cohort, along with questionnaires, genetic data, and sex hormone measures, we carried out a cross-sectional study to assess the impact of the menopausal transition and sex hormones on XCI-skew. Results: We demonstrate that early menopause (<45yrs) is associated with increased risk of XCI-skew. In subset analyses across those who had a surgically induced or natural menopause, we find the association restricted to those who underwent a surgical menopause. We next identify a low polygenic score (PGS) for testosterone levels is significantly associated with XCI-skew, which we replicate in an independent dataset (n=149), while a PGS for age at natural menopause is not associated. Finally, using longitudinal measures across two time points spanning ~18 years we show XCI-skew is a stable cellular phenotype that typically increases over time. Discussion: These data represent the first environmental and genetic risk factors of XCI-skew, both of which implicate endogenous sex hormone levels, particularly testosterone. We propose XCI-skew may have clinical relevance in postmenopausal females.
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