Testosterone in Menopause: A Heart Safety Signal, Not a Verdict

On October 21, 2026, MedPage Today reported higher cardiovascular event rates among postmenopausal women who started testosterone than among matched women without testosterone exposure. The findings were presented as a poster at The Menopause Society’s annual meeting.

Testosterone already had a narrow evidence-supported role

Before this report, the evidence-supported role described by MedPage Today was already limited. Testosterone had demonstrated benefit for hypoactive sexual desire disorder. Evidence was insufficient for treating fatigue or memory loss. The same applied to weight gain and bone-density loss.

For women seeking help with desire, that distinction matters. A treatment with evidence for a particular sexual health concern is not automatically an evidence-based answer to every change associated with menopause. Taking sexual wellbeing seriously means being specific about the concern and the expected benefit, rather than treating testosterone as a broad midlife remedy.

The report also described a prescribing gap. It said there were no FDA-approved testosterone products for women in the United States. Some clinicians prescribed low doses of formulations made for men off label. That context makes the evidence behind the proposed use particularly relevant to a treatment discussion.

On cardiovascular safety, selected clinical-trial populations had not shown a demonstrated safety signal, according to the report. The observational findings therefore challenge the reach of that reassurance rather than overturning an established treatment for menopause as a whole.

The distinction between a defined indication and wider treatment claims also sits at the centre of evaluating testosterone evidence for sexual wellbeing.

The study found more cardiovascular events in the testosterone group

MedPage Today reported the following findings from the analysis:

• The matched comparison included 6,328 women. Researchers used TriNetX records to compare 3,164 women who initiated testosterone with 3,164 women without testosterone exposure. Participants were postmenopausal and aged 45 and older. Women with prior cardiovascular disease were excluded.
• The primary outcome combined several cardiovascular diagnoses. Researchers assessed incident coronary artery disease and cerebrovascular disease together with heart failure. These formed a composite outcome assessed within five years of treatment initiation. The result concerns that combined measure rather than a separate estimate for each diagnosis.
• The reported five-year event rates were 3.8% and 0.5%. The higher rate was in the testosterone group. The reported hazard ratio was 8.08. The report noted that absolute event rates were low, making it useful to read the percentages alongside the relative measure.
• Secondary analyses also reported higher rates in the testosterone group. At ten years, the reported rates were 5.3% versus 0.5%. In an unrestricted follow-up analysis, they were 6.2% versus 1%. These were additional analyses rather than the primary five-year outcome.
• A comparison involving menopausal hormone therapy also found an association. Researchers compared testosterone plus menopausal hormone therapy with hormone therapy alone. The reported five-year hazard ratio was 6.73. This comparison examined an additional treatment context within the same retrospective research.

The absolute rates and the hazard ratio serve different purposes in understanding the findings. The percentages show how often the report recorded the composite outcome in each group. The hazard ratio expresses the relative difference over the analysis period. Reading them together avoids letting a large relative figure obscure the low absolute event rates or letting those low rates erase the difference between groups.

Missing treatment details limit the interpretation

This was a retrospective observational study, not a randomized clinical trial. Matching addresses measured factors but cannot remove residual confounding, meaning other differences between groups may still help explain the association. The findings do not establish that testosterone caused cardiovascular disease.

MedPage Today reported possible misclassification and few cardiovascular events as further limitations. Mean follow-up was 2.6 years, which is short beside the five-year outcome window. The poster findings were preliminary and had not yet been peer-reviewed when reported.

The database also lacked information on testosterone dose and formulation. Route and delivery details were unavailable, along with the reason treatment was prescribed. Those gaps prevent the analysis from assigning the finding to a particular regimen or treatment goal.

Lead author Xuezhi (Daniel) Jiang cautioned against applying the result to all women receiving guideline-concordant, physiologic-dose transdermal testosterone. The postmenopausal cohort also does not directly answer the same question for every woman in perimenopause. Jiang’s interpretation was that the association warranted further investigation rather than a conclusion that appropriately prescribed testosterone causes cardiovascular disease.

Together, these limitations define the question the study leaves open: which treatment circumstances might account for the observed difference? They also explain why reassurance from selected clinical-trial populations is not the same as proof of long-term safety across broader populations.

The treatment goal belongs at the centre of the discussion

For someone weighing testosterone therapy, the practical implication is a more precise conversation with a qualified clinician. The report’s expert advice was to balance individual risks and benefits carefully. That discussion needs to connect the reason for prescribing with the evidence supporting it, rather than beginning and ending with a hormone level or a general promise of feeling better.

Useful questions include:

• What specific concern is treatment intended to address? Naming the goal makes it possible to discuss whether the evidence actually supports that use. It also separates a sexual wellbeing concern from a collection of unrelated midlife changes.
• What benefit is realistically expected, and what alternatives exist? A meaningful discussion includes the hoped-for outcome and other available approaches. The aim is to understand the decision rather than assume that treatment is the only response to a legitimate concern.
• Which formulation and dose are proposed, and what evidence supports that approach? This is a question for the prescriber, not a dosing decision to make from a headline. It connects the proposed treatment with the evidence being used to justify it.
• How will personal cardiovascular risks and treatment response be reviewed? The conversation can cover known longer-term safety information and how adverse effects will be assessed. Reviewing benefit matters alongside reviewing risk.

These questions are useful whether the main concern is sexual desire or another proposed reason for treatment. They allow a clinician to explain the basis for an individual recommendation without asking a woman to interpret a population-level finding as her own medical forecast.

The finding is not a reason to start, stop or change prescribed testosterone without discussing it with a qualified clinician. It is a reason for the safety conversation to be explicit and connected to the actual treatment being offered.

Sexual health also deserves enough room in that conversation to distinguish the reader’s concerns. Desire and comfort are legitimate subjects in their own right, rather than matters to collapse into a single treatment question. Refemina’s coverage of intimacy and treatment discussions in menopause offers related context for framing those questions.

Access advocacy does not settle the safety question

On October 22, 2026, NCPA reported that it and the Alliance for Pharmacy Compounding had submitted joint comments urging the FDA to take steps to expand access to testosterone for menopausal women. That was an advocacy position, not an announcement that the FDA had approved a testosterone product for women.

The distinction matters when an access story appears alongside a safety story. One concerns the availability of treatment. The other concerns the evidence needed to judge its benefits and risks. Neither story should be read as answering the other.

A woman can want her sexual wellbeing taken seriously while also expecting a clear account of uncertainty. Those are compatible expectations. The useful standard is neither automatic enthusiasm nor automatic dismissal, but a defined treatment goal supported by an honest discussion of the evidence.

Future care needs a more explicit safety discussion

Going forward, this study should make cardiovascular risk and the reason for prescribing more explicit parts of testosterone discussions while further research tests the signal.

How Refemina helps

Testosterone decisions for low desire involve potential benefits and unresolved safety questions, a balance Refemina examines through careful interpretation of research. For women encountering contradictory claims about intimacy, its editorial coverage gives comfort and sexual confidence serious attention while making the strength of the evidence easier to judge.

Explore Resources

Sources

1. Testosterone for Menopause May Carry Heart Risks
2. NCPA, APC call for greater access to testosterone for menopausal women