Testosterone Therapy Linked to Higher Cardiovascular Risk in Postmenopausal Women

This article is based on that report. The study itself was not reviewed.

Testosterone is not routinely recommended for postmenopausal women, according to The Menopause Society. Long-term safety data are limited. Still, doctors prescribe it off label for low sexual desire. The society says no testosterone products are approved by the FDA for women in the United States. Clinicians use very low doses of male formulations, usually as a cream or gel.

The society says testosterone has proven effective for hypoactive sexual desire disorder. It describes this as a persistent, distressing loss of interest in sex, estimated to affect about 10% to 15% of postmenopausal women. It adds that evidence is insufficient to show benefit for many other menopause symptoms, including fatigue, memory loss, weight gain or loss of bone density.

According to the society's report, the researchers used data from the TriNetX US Collaborative Network. They included more than 6,300 propensity-matched women, meaning women were paired to be similar on factors such as smoking, obesity, diabetes, high blood pressure and cholesterol problems. Women aged 45 and older who started testosterone were compared with women who had no testosterone. Women with earlier cardiovascular disease were excluded. Follow-up averaged nearly three years.

The reported result: 3.8% of women on testosterone had a cardiovascular event, compared with 0.5% of those not on it. The hazard ratio was 8.08, with a 95% confidence interval of 4.72 to 13.82. Put plainly, the rate of events over time was about eight times higher in the testosterone group. The events counted included angina, heart attack, ischemic heart disease, ischemic stroke and heart failure.

The society reports the finding held when women taking testosterone plus hormone therapy were compared with women taking hormone therapy alone. It also reports the link appeared across multiple ways of defining the groups.

There are limits. The study is described as retrospective, meaning it looked back at existing records. Such studies can show a link. They cannot prove that testosterone caused the events. The society's release says results will be presented at its 2026 Annual Meeting, and it does not say the work has been published in a peer-reviewed journal. The weakest point is that we have only a press summary, not the paper, so we cannot check how the groups were built or whether unmeasured differences between them explain the size of the gap.

Lead author Dr. Xuezhi Daniel Jiang of Drexel University College of Medicine said: "Our findings identify a potentially important cardiovascular safety signal associated with testosterone therapy in postmenopausal women. Although absolute event rates were low, the consistency of the association across multiple analyses warrants further prospective investigation."

Dr. Stephanie Faubion, the society's medical director, said the findings are a reminder for clinicians to carefully balance individual risks and benefits when prescribing testosterone. She noted that cardiovascular disease remains the number one killer of women.

For women considering testosterone, or already using it, here are questions we suggest raising with a prescriber. What specific symptom is the treatment meant to address, and is there evidence it works for that symptom? Low sexual desire is the use the society says has proven benefit. Given my own heart risk factors, such as blood pressure, cholesterol, diabetes and smoking, how does this change the balance? What dose and form would be used, and how would benefit be judged? When would we review whether to stop? Are there other options?

The authors say prospective research, which follows people forward in time, is needed. We would also suggest watching for the full study to appear in a peerreviewed journal, where its methods and numbers can be checked.

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