The Hormonal Connection of Massage During Menopause and Andropause

Why Deep Tissue and Lymphatic Massage May Be an Important Part of Healthy Aging

By Dr. Corina Ianculovici, DNP, FAAMFM, ABAAM-HP, AGNP

Medical Director & Founder, Mirelle Institute for Longevity & Regenerative Medicine

When we talk about menopause, andropause, hormone replacement therapy, metabolic health, or longevity, massage is probably not the first treatment that comes to mind.

Perhaps it should receive more attention.

Massage has traditionally been regarded as a luxury or a way to relax sore muscles. Yet human touch and mechanical stimulation of the skin, fascia, and muscle create signals that reach far beyond the tissues being manipulated.

These signals communicate with the nervous system, the hypothalamus, the autonomic nervous system, the immune system, and the endocrine system.

One of the most interesting mediators of this response is oxytocin.

Most people know oxytocin as the hormone associated with childbirth, breastfeeding, intimacy, and bonding. Its physiology is considerably broader than that.

Oxytocin is a neuropeptide produced primarily in the hypothalamus. It acts both within the brain and throughout the body and participates in the regulation of stress, autonomic function, pain, sexual behavior, appetite, sleep, emotional processing, social interaction, and other neuroendocrine functions. Research also demonstrates interactions between the oxytocin system and the hypothalamic pituitary adrenal axis, hypothalamic pituitary gonadal axis, thyroid signaling, gastrointestinal function, and immune regulation.

This makes massage particularly interesting during menopause and andropause.

Massage does not replace estrogen, progesterone, or testosterone. It should not be presented as a treatment for true hormone deficiency.

However, the neuroendocrine response generated by therapeutic touch, including oxytocin signaling, may influence many of the systems that determine how a person experiences menopause, andropause, stress, pain, sleep, metabolism, exercise recovery, and overall well being.

That is a much more interesting conversation than simply asking whether massage "raises hormones."

Oxytocin Is Much More Than a Bonding Hormone

Oxytocin is produced principally by neurons within the supraoptic and paraventricular nuclei of the hypothalamus.

From there, oxytocin can be released into the systemic circulation through the posterior pituitary, but it is also released within the central nervous system, where it functions as a neuromodulator.

Oxytocin receptors are distributed across multiple tissues and neural networks. Its effects therefore extend into areas involving autonomic regulation, emotional behavior, pain perception, sexual function, eating and drinking behavior, sleep and wakefulness, gastrointestinal signaling, cardiovascular physiology, and interactions with other hormonal systems.

This becomes especially relevant when we look at the effects of touch.

Recent research describes cutaneous sensory pathways through which pleasant or therapeutic touch can activate neural circuits involving the hypothalamic oxytocin system. Oxytocin signaling may subsequently contribute to calm, social engagement, vagal activity, restorative processes, and modulation of sympathetic nervous system and HPA axis activity.

In other words, massage is not simply manipulating muscle.

The skin is a sensory organ.

Pressure, touch, movement, temperature, and mechanical stimulation create neurological information.

That information travels to the brain.

The brain responds.

The endocrine system participates in that response.

Does Massage Increase Oxytocin?

There is direct human evidence suggesting that it can.

One human study evaluating massage found that massage was associated with an increase in circulating oxytocin and a decrease in adrenocorticotropic hormone, or ACTH, compared with quiet rest. The researchers also observed changes in other measured physiological mediators.

That is an important observation because ACTH is part of the HPA axis.

ACTH is released by the pituitary in response to hypothalamic signaling and stimulates adrenal cortisol production.

The relationship among oxytocin, stress, ACTH, and cortisol is complex rather than linear, but oxytocin clearly participates in regulation of the stress response.

At the same time, we should not overstate the evidence.

Not every massage study has demonstrated a measurable increase in oxytocin.

For example, a randomized trial involving women undergoing breast cancer treatment did not find significant differences in oxytocin or cortisol concentrations after a series of effleurage massage sessions.

A 2026 scoping review examined 72 human studies evaluating cortisol or oxytocin following manual therapy. The results were heterogeneous. Different massage techniques, populations, treatment durations, biological sampling methods, and timing of measurements produced different findings.

This is common in neuroendocrine research.

Oxytocin is released dynamically and can act centrally without corresponding perfectly to a single peripheral blood or saliva measurement.

Therefore, the absence of a measurable rise in circulating oxytocin does not necessarily tell us everything occurring within the central nervous system.

The responsible conclusion is that massage and therapeutic touch can engage the oxytocin system, but the magnitude and consistency of measurable peripheral oxytocin release vary among individuals and interventions.

Oxytocin May Influence Other Neuroendocrine Systems

This is where the conversation becomes particularly relevant to hormone optimization.

Oxytocin does not simply circulate independently as an isolated hormone.

The hypothalamus is an integrated control center.

Oxytocin producing neurons communicate with neural pathways involved in the stress response, reproduction, autonomic function, appetite, pain, sleep, sexual behavior, and emotional regulation.

Oxytocin also interacts with the HPA axis.

The HPA axis regulates the body's physiological response to stress. It involves communication among the hypothalamus, pituitary gland, and adrenal glands.

Under chronic stress, this signaling system can affect far more than cortisol.

Stress related hypothalamic signaling can interact with reproductive function, thyroid regulation, growth hormone signaling, insulin sensitivity, body composition, inflammatory pathways, and sleep.

This is particularly important because chronic activation of stress pathways can suppress or interfere with other endocrine functions.

CRH and glucocorticoid signaling have been shown to interact with GnRH, gonadotropins, growth hormone, thyroid signaling, and metabolic pathways.

Therefore, when we discuss oxytocin and massage, the appropriate question is not:

"Does massage give me more estrogen?"

The better question is:

"Can massage create neuroendocrine signals that influence the physiological systems surrounding hormonal health?"

The answer is much more plausibly yes.

Menopause Is Not Just an Estrogen Problem

Menopause is characterized by declining ovarian hormone production, but the symptoms a woman experiences are generated within a much larger physiological network.

Estrogen interacts with the brain, vascular system, autonomic nervous system, musculoskeletal system, skin, connective tissue, bone, genitourinary system, metabolism, and sleep.

At the same time, many women in midlife are managing substantial psychological and physiological stress.

They may be sleeping poorly.

They may be experiencing hot flashes or night sweats.

They may have anxiety, fatigue, declining muscle mass, changing body composition, insulin resistance, joint pain, sexual changes, or chronic muscular tension.

The menopausal transition occurs inside all of that physiology.

This helps explain why hormone replacement therapy can be tremendously beneficial for the appropriately selected patient but may not, by itself, address every symptom she experiences.

Healthy menopause care should address the entire patient.

Massage and Menopausal Symptoms

Clinical research specifically evaluating massage during menopause is becoming more substantial.

A 2026 systematic review and meta analysis of randomized controlled trials examined the effects of massage on menopausal and postmenopausal symptoms.

Massage was associated with improvement in overall Menopause Rating Scale scores as well as psychological menopausal symptoms, anxiety, depression, and fatigue. Results for sleep and genitourinary symptoms were less consistent.

These findings are clinically meaningful.

Massage cannot restore ovarian estrogen production.

It cannot treat vulvovaginal atrophy or genitourinary syndrome of menopause in the way appropriate estrogen therapy can.

But menopause is not experienced only through estrogen receptors.

The nervous system matters.

Stress matters.

Muscle tension matters.

Sleep matters.

Pain matters.

Emotional health matters.

Autonomic regulation matters.

Oxytocin signaling may be one mechanism connecting therapeutic touch with some of these effects.

What About Andropause?

Men have received considerably less attention in massage research specifically related to age associated hormonal decline.

There is not enough evidence to state that massage meaningfully raises serum testosterone in a man with hypogonadism.

That is not the reason we should consider massage beneficial.

Men undergoing testosterone optimization are often simultaneously trying to rebuild muscle, decrease visceral adiposity, improve insulin sensitivity, exercise more consistently, sleep better, and recover from years of metabolic decline.

Massage may support several of those goals indirectly.

Pain reduction may improve exercise adherence.

Improved relaxation may improve sleep.

Musculoskeletal recovery may support resistance training.

Reduced sympathetic activation may assist recovery.

Touch mediated oxytocin signaling may influence stress physiology and general well being.

Again, hormone replacement and massage perform different jobs.

They can still complement each other.

The Relationship Between Stress and Hormonal Health

One reason massage may become increasingly valuable during midlife is the relationship between chronic stress and endocrine function.

The HPA axis does not operate independently of the reproductive system.

Stress signaling interacts with hypothalamic and pituitary regulation of multiple hormonal axes.

CRH, ACTH, glucocorticoids, catecholamines, reproductive hormones, thyroid signaling, growth hormone signaling, and metabolic hormones participate in a complex communication network.

Chronic stress can therefore affect sleep, glucose regulation, appetite, visceral fat deposition, reproductive function, muscle recovery, and emotional health.

Oxytocin appears capable of modulating components of this stress response.

This does not mean that one massage turns off cortisol.

In fact, a quantitative review of massage studies found that the average measurable effect of massage on cortisol was relatively small and often not statistically significant.

That finding is useful rather than disappointing.

It tells us that the benefits of massage cannot be explained by a simplistic model in which massage merely "flushes cortisol out of the body."

The mechanisms are likely neurological, autonomic, sensory, psychological, musculoskeletal, and neuroendocrine simultaneously.

The human body is more sophisticated than a single laboratory value.

Why Massage Can Matter During Hormone Replacement Therapy

Patients sometimes ask why they still experience muscular tension, poor sleep, fatigue, or stress after their hormones have been optimized.

The answer is simple.

Hormone replacement corrects hormone deficiency.

It does not erase life.

Estrogen cannot eliminate occupational stress.

Testosterone cannot resolve a painful trigger point.

Progesterone cannot replace resistance training.

Hormone therapy does not correct every aspect of sleep hygiene, mobility, chronic pain, psychological stress, or musculoskeletal dysfunction.

At Mirelle Institute for Longevity & Regenerative Medicine, we view hormone replacement as one component of a broader physiologic optimization program.

For appropriate patients, regular massage can complement HRT by addressing systems that hormonal therapy does not directly treat.

Massage and Muscle Recovery

Maintaining skeletal muscle is one of the most important priorities in longevity medicine.

Muscle is not simply something that makes us strong.

Skeletal muscle is a metabolically active organ involved in glucose disposal, insulin sensitivity, mobility, bone health, metabolic rate, fall prevention, and long term independence.

Both menopause and aging in men increase the risk of loss of lean body mass.

This makes resistance exercise critical.

Massage may have a role in supporting recovery from that exercise.

In an important mechanistic study, investigators examined muscle tissue following exercise induced muscle damage.

Muscle biopsies demonstrated that massage influenced cellular signaling related to mechanotransduction and mitochondrial biogenesis while attenuating aspects of inflammatory signaling.

This showed that mechanical manipulation of muscle can generate measurable biological responses at the cellular level.

The significance is not that massage replaces exercise.

It does not.

The value is that massage may help patients recover well enough to continue exercising.

Consistency is where the longevity benefit occurs.

Deep Tissue Massage and Lymphatic Massage Are Different

Deep tissue massage and manual lymphatic drainage are frequently grouped together, but they are physiologically different techniques.

Deep tissue massage involves greater mechanical pressure directed toward muscle, fascia, and connective tissue.

It may be useful for patients experiencing muscular tightness, restricted movement, discomfort, or increased training demands.

Manual lymphatic drainage is very different.

True lymphatic drainage is usually gentle.

The superficial lymphatic vessels do not require aggressive pressure.

The therapist uses specific directional and rhythmic techniques designed to facilitate movement of lymphatic fluid toward functioning lymphatic pathways.

A lymphatic treatment should therefore not simply be an unusually aggressive massage marketed as "lymphatic drainage."

Technique matters.

Training matters.

Patient selection matters.

The Lymphatic System and Healthy Aging

The lymphatic system has important roles in fluid homeostasis, immune surveillance, transport of macromolecules, and return of interstitial fluid toward the venous circulation.

It is not merely a waste disposal pipe.

Lymphatic vessels interact with immune cells, adipose tissue, inflammatory mediators, and the vascular system.

Manual lymphatic drainage has been studied most extensively in conditions associated with edema and lymphedema.

Evidence suggests that it may improve swelling or symptoms in some populations, although results vary and it is not universally beneficial for every type of edema.

This is another reason individualized recommendations are important.

Why We Recommend Massage After Body Contouring

At Mirelle Institute, we do not currently provide massage therapy.

We do, however, frequently recommend appropriately selected massage therapy as part of recovery and body optimization.

This is particularly relevant following certain body contouring treatments.

Body contouring can temporarily alter local tissue physiology.

Depending upon the technology used, treatment may produce transient inflammation, alterations in extracellular fluid, tissue remodeling, muscular activation, or localized tenderness.

Appropriate massage or lymphatic techniques may support patient comfort, tissue mobility, and fluid movement during recovery.

Clinical literature from postoperative body contouring also provides a physiological precedent for this approach.

Studies of patients following procedures such as liposuction and lipoabdominoplasty have evaluated manual lymphatic drainage as part of postoperative recovery and reported improvements in parameters including swelling, pain, and tissue fibrosis.

Surgical procedures obviously cannot be considered equivalent to noninvasive body contouring.

However, these studies demonstrate why attention to lymphatic flow and tissue recovery can be relevant whenever tissue has undergone significant mechanical or metabolic stress.

Massage During a Metabolic Reset

Massage may be particularly valuable during significant weight loss.

Patients undergoing a metabolic reset are changing far more than the number on the scale.

Adipose tissue is changing.

Fluid distribution may change.

Exercise activity frequently increases.

Musculoskeletal loading changes as body weight falls.

Patients begin resistance training.

Posture can change.

Connective tissues adapt.

Sleep and energy may change.

Patients using GLP 1 based medications or other incretin therapies also require careful attention to preservation of skeletal muscle.

At Mirelle Institute, our goal is not simply weight loss.

Our goal is fat loss while preserving or improving lean mass and metabolic health.

That requires adequate protein, resistance training, appropriate hormonal evaluation, micronutrient sufficiency, sleep, hydration, and recovery.

Massage belongs in the recovery category.

It cannot preserve muscle without resistance training and adequate nutrition.

It may, however, help a patient remain comfortable, mobile, and consistent with the exercise program that does preserve muscle.

Oxytocin, Appetite, Metabolism, and Body Composition

Another interesting area of research involves oxytocin and metabolism.

Oxytocin participates in the neural regulation of eating and drinking behavior. It also interacts with autonomic and gastrointestinal signaling.

Researchers are studying oxytocin pathways in relation to appetite regulation, energy balance, metabolic health, and obesity.

This does not mean that massage should be marketed as a weight loss treatment.

It should not.

But once again, it illustrates the interconnected nature of human physiology.

Touch influences sensory nerves.

Sensory nerves communicate with the central nervous system.

The hypothalamus integrates those signals.

The hypothalamus is also one of our major centers for regulation of appetite, reproduction, stress, temperature, autonomic function, and hormonal signaling.

Everything is connected.

Oxytocin and Sexual Health

Oxytocin also participates in sexual behavior and sexual response in both women and men.

It is involved in pathways associated with intimacy, arousal, orgasm, penile erection, ejaculation, maternal behavior, social bonding, and emotional attachment.

Sexual health during menopause and andropause is multifactorial.

Estrogen matters.

Testosterone matters.

Vaginal and vulvar tissue health matters.

Erectile physiology matters.

Vascular health matters.

Pelvic floor function matters.

But so do stress, body image, fatigue, pain, relationship dynamics, autonomic tone, and the ability to experience relaxation and intimacy.

Massage cannot replace treatment for sexual dysfunction.

It may nevertheless support a physiological state more conducive to relaxation, connection, and sexual well being.

Pain, Oxytocin, and the Nervous System

Oxytocin also participates in nociception and pain modulation.

This adds another potential mechanism through which massage may help patients dealing with chronic muscular discomfort or exercise related soreness.

Pain is not simply a signal coming from injured tissue.

Pain perception is produced by the nervous system after integrating sensory input, emotional state, previous experience, inflammation, sleep, autonomic activity, and central nervous system processing.

This explains why stress and poor sleep can make pain feel worse.

It also helps explain why therapeutic touch may alter the perception of pain even when no structural tissue has dramatically changed during the treatment.

The Sleep Connection

Sleep disruption is extremely common during menopause and becomes more common in aging men as well.

Hormonal changes, hot flashes, obstructive sleep apnea, anxiety, alcohol use, nocturia, metabolic dysfunction, pain, and sympathetic activation can all contribute.

Oxytocin participates in sleep and wake regulation, while therapeutic touch may facilitate parasympathetic activity and relaxation.

The clinical studies investigating massage and sleep have not produced uniformly positive results.

That means massage should not be marketed as a treatment for insomnia.

It may still be valuable for the individual patient whose sleep difficulty is worsened by muscular tension, stress, pain, or an inability to transition into a relaxed state before sleep.

Massage Does Not "Detox" the Body

This is another area where we prefer science over marketing.

We frequently hear claims that lymphatic massage "removes toxins."

That language is overly simplistic.

The body manages metabolic waste and foreign substances through highly coordinated systems involving the liver, kidneys, gastrointestinal tract, lungs, immune system, vascular system, and lymphatic circulation.

Massage does not replace any of those organs.

What manual lymphatic drainage may do is facilitate movement of lymph and interstitial fluid in appropriately selected patients.

That is legitimate physiology.

There is no need to exaggerate it.

Recovery Is a Medical Issue

One of the major lessons of longevity medicine is that recovery should not be regarded as optional.

We spend enormous amounts of time discussing exercise.

We should.

Exercise is medicine.

But the adaptations produced by exercise occur during recovery.

The same principle applies to many interventions.

Patients undergoing hormone optimization, metabolic treatment, body contouring, increased resistance exercise, or major weight loss are asking their physiology to change.

Those changes require recovery.

Massage can be one component of that recovery strategy.

How Often Should Someone Have Massage?

There is no clinically established universal massage schedule for menopause or andropause.

The appropriate frequency depends upon why the patient is receiving treatment.

A patient undergoing intensive resistance training may have different requirements than someone seeking stress reduction.

A patient receiving manual lymphatic drainage after a body contouring procedure may initially need a different schedule than someone receiving monthly massage for general recovery.

For many people, a session every one to four weeks may be reasonable.

During periods of intensive treatment, exercise, or body transformation, massage may temporarily be more frequent.

The patient's medical history and response should guide the schedule.

Who Should Be Careful With Massage?

Massage is generally well tolerated, but it is not appropriate in every situation.

Unexplained unilateral swelling should not simply be massaged.

A patient with possible deep venous thrombosis requires medical evaluation.

Active skin infections, cellulitis, acute injuries, unstable cardiovascular disease, significant uncontrolled edema, and certain postoperative conditions also require appropriate medical assessment.

Patients with cancer related lymphedema or lymph node removal should work with clinicians and therapists specifically trained in lymphatic management.

Deep tissue massage may also be inappropriate for patients taking certain anticoagulants or those with substantial bleeding or bruising risk.

The technique should always match the patient.

Our Approach at Mirelle Institute

At Mirelle Institute for Longevity & Regenerative Medicine, we do not provide massage services.

We do recommend massage when we believe it can complement a patient's treatment plan.

We commonly see a role for appropriately selected massage during:

Hormone replacement and optimization programs

Menopause and andropause management

Metabolic reset and medical weight loss

GLP 1 based weight reduction programs

Resistance training and muscle building

Body contouring

Post treatment recovery

Stress management

Musculoskeletal recovery

The goal is not to add another procedure simply for the sake of doing more.

The goal is to create the best physiological environment for healing, adaptation, metabolism, movement, and healthy aging.

The Bigger Lesson About Hormones

Hormones do not operate independently.

The endocrine system communicates constantly with the brain, immune system, autonomic nervous system, gastrointestinal tract, adipose tissue, skeletal muscle, cardiovascular system, reproductive organs, and even our sensory environment.

This is one of the reasons I believe that menopause and andropause need to be approached as whole body transitions.

Replacing deficient hormones may be extremely important.

But hormonal optimization is not the entire longevity strategy.

• A patient also needs muscle.
• A patient needs sleep.
• A patient needs metabolic health.
• A patient needs movement.
• A patient needs adequate nutrition.
• A patient needs recovery.
• A patient needs an autonomic nervous system capable of transitioning out of chronic stress.

Human touch may be one of the biological signals that helps facilitate that transition.

The emerging science of oxytocin gives us one possible explanation.

Massage does not directly restore estrogen or testosterone.

What massage may do is influence a neuroendocrine environment in which oxytocin, autonomic function, stress signaling, pain perception, sleep, emotional health, immune signaling, appetite regulation, sexual function, and recovery are interconnected.

That distinction is important.

It also makes massage much more medically interesting than simply calling it "relaxation."

Final Thoughts

At Mirelle Institute, our philosophy has never been to chase one laboratory number.

Our goal is to optimize physiology.

For a woman in menopause, that may include appropriate hormone replacement, preservation of muscle, metabolic treatment, cardiovascular risk reduction, sexual health, sleep optimization, nutrition, exercise, and recovery.

For a man experiencing age related androgen decline, the same principle applies.

Testosterone is important when testosterone deficiency is present.

But testosterone alone does not create health.

Healthy aging is the result of multiple biological systems functioning together.

Massage can be one small but meaningful part of that process.

Not because massage magically creates sex hormones.

Not because it "detoxifies" the body.

But because therapeutic touch creates real sensory input to the nervous system, and the nervous system communicates directly with our endocrine physiology.

Oxytocin appears to be one of the important messengers in that conversation.

The more we understand that connection, the more we realize that recovery, touch, movement, hormones, metabolism, and healthy aging were never separate subjects to begin with.

They are all parts of the same human physiology.

Selected Clinical References:

Cao and colleagues. Physiological changes of cortisol and oxytocin following manual therapy: a scoping review. Published 2026. The review evaluated 72 human studies examining cortisol and oxytocin responses to manual therapies and found heterogeneous neuroendocrine responses across different interventions and populations.

Uvnäs Moberg and colleagues. Oxytocin release patterns and effects, with a focus on touch, social interaction, and closeness. The review describes cutaneous sensory activation of oxytocin pathways and potential downstream effects involving vagal activity, restorative physiology, HPA axis regulation, and sympathetic activity.

Yang and colleagues. Neural Functions of Hypothalamic Oxytocin and its Regulation. This review details the role of hypothalamic oxytocin in autonomic regulation, sleep, pain, eating, sexual behavior, emotional processing, and interactions with multiple endocrine systems.

Morhenn and colleagues. Massage increases oxytocin and reduces adrenocorticotropin hormone in humans. Massage was associated with increased oxytocin and decreased ACTH compared with quiet rest.

Althammer, Eliava, and Grinevich. Central and peripheral release of oxytocin: relevance of neuroendocrine and neurotransmitter actions for physiology and behavior. This review discusses the central and peripheral actions of oxytocin involving socioemotional behavior, sexual function, and pain processing.

Moyer, Seefeldt, Mann, and Jackley. Does massage therapy reduce cortisol? A comprehensive quantitative review. Journal of Bodywork and Movement Therapies. 2011;15(1):3 to 14. The review found that average between group cortisol changes following massage were generally small, demonstrating that massage benefits cannot be reduced to a simple cortisol lowering mechanism.

Chrousos and colleagues. Hypothalamic pituitary adrenal axis, neuroendocrine factors and stress. The review describes interactions of stress signaling with reproductive, thyroid, growth, metabolic, and other endocrine functions.

Gimpl and Fahrenholz. Oxytocin: crossing the bridge between basic science and pharmacotherapy. The review discusses oxytocin's involvement in sexual activity, stress physiology, pain regulation, metabolic function, social behavior, and peripheral physiology.