Testosterone Therapy and Women's Heart Health in 2026: What the New 8-Fold Risk Signal Really Means

Researchers led by Dr. Xuezhi Daniel Jiang, professor of obstetrics and gynecology at Drexel University College of Medicine, analyzed electronic health records from the TriNetX US Collaborative Network. According to The Menopause Society's announcement, the team compared more than 6,300 propensity-matched postmenopausal women aged 45 and older — half who started testosterone therapy and half with no testosterone exposure. Women with prior cardiovascular disease were excluded, and the groups were matched on factors including smoking, obesity, diabetes, high blood pressure, cholesterol problems, and use of menopausal hormone therapy.

Over a mean follow-up of nearly three years, 3.8% of women who started testosterone experienced a composite cardiovascular outcome — coronary artery disease (including heart attack and angina), cerebrovascular disease (including ischemic stroke), or heart failure — compared with 0.5% of non-users. That works out to a hazard ratio of 8.08 (95% CI 4.72–13.82). The association held in sensitivity analyses, including when women taking testosterone plus hormone therapy were compared with women on hormone therapy alone.

Two details are worth holding onto. First, the absolute numbers were low in both groups: the large relative difference sits on top of a small baseline risk over a fairly short window. Second, this is a conference presentation based on a press release and abstract — the full peer-reviewed paper is not yet available.

Independent statisticians who reviewed the announcement for the UK's Science Media Centre called the finding a potentially important safety signal — and then spent most of their commentary on its limits. This was an observational study, not a randomized trial, so it cannot prove testosterone caused the extra events. Cambridge biostatistician Stephen Burgess noted the matching narrows the possible explanations and called the eight-fold difference "concerning," while others pointed out that an unmeasured factor could still account for some or all of the gap.

There are other wrinkles. Database studies capture only prescriptions recorded in the network, so women getting testosterone from cash-pay or telehealth clinics outside the system may be misclassified as non-users. Women on testosterone may also simply see doctors more often, which means more opportunities for a diagnosis to be recorded. And the symptoms that lead women to seek testosterone — fatigue, low desire, feeling unwell — can occasionally be early signs of cardiovascular or metabolic disease, muddying cause and effect. The study's own lead author framed the results as a signal that "warrants further prospective investigation," not a final verdict.

Here is the context that often gets lost in the marketing: there is still no FDA-approved testosterone product for women in the United States. When women are prescribed testosterone, it is off-label, typically using low doses of creams or gels designed for men. The best-supported use is hypoactive sexual desire disorder (HSDD) — persistent, distressing low sexual desire — which is estimated to affect 10–15% of postmenopausal women. For the other things testosterone is widely promoted for, including fatigue, memory, weight, and bone density, The Menopause Society notes the evidence remains insufficient.

Regulators are paying attention from both directions. The FDA held a public meeting on testosterone use in menopausal women on September 17, 2026, exploring what an approval pathway for a female indication might look like. New safety data like this week's will almost certainly shape that debate — and it strengthens the case for getting testosterone, if at all, through a clinician who screens you properly rather than from an unregulated online storefront.

Testosterone in women also carries better-established dose-related side effects worth knowing about: acne, increased facial hair, scalp hair thinning, and voice deepening, some of which can be irreversible at higher doses.

This study says nothing about men. Testosterone replacement for men with confirmed low testosterone has its own, much larger evidence base, including dedicated cardiovascular safety trials, and the FDA updated how it frames those risks on product labels earlier this year — we covered that in detail in our breakdown of the FDA's 2026 testosterone changes. Men considering treatment still need real screening: confirmed morning testosterone levels, a review of cardiovascular history, and ongoing lab monitoring, which is exactly how telehealth TRT care should work.

If you are a postmenopausal woman currently using testosterone, this study is not a reason to stop abruptly on your own. It is a reason to have a conversation with your prescriber about why you are on it, whether it is working for the indication it was prescribed for, and how your personal cardiovascular risk factors — blood pressure, cholesterol, smoking, family history — stack up. As The Menopause Society's medical director Dr. Stephanie Faubion put it, cardiovascular disease remains the number one killer of women, so individualized risk-benefit decisions matter.

If you are considering testosterone because of low desire, fatigue, or weight changes in midlife, it is worth knowing that several of those symptoms have better-studied treatment paths — from menopausal hormone therapy to addressing sleep, mood, and metabolic health — and that any hormone decision should start with labs and a licensed clinician, not an influencer protocol.

JoeyMed's licensed providers help patients make exactly these kinds of evidence-based decisions every day — from sexual health treatments to wellness and preventive care, including hormone-related consultations for men. Every treatment plan starts with a real medical intake, screening for contraindications, and a provider who reviews your health history, and care is delivered discreetly through telehealth. If midlife symptoms are affecting your quality of life, start a consultation today and get guidance grounded in the current evidence — including studies like this one.