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Study Links Testosterone Therapy to Heart Risks in Older Women
Experts say more research is needed on both short- and long-term effects of the treatment in women
4-minute
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Key takeaways
- Testosterone prescriptions for women have skyrocketed in recent years, especially among those ages 45 to 64.
- The therapy is not FDA-approved for use in women, and experts say more research is needed to better understand its short- and long-term risks.
- Research presented at the 2026 annual meeting of the Menopause Society links testosterone therapy to increased cardiovascular risks in postmenopausal women.
More women are turning to testosterone therapy for menopausal symptoms, with off-label prescriptions more than doubling over the past decade, according to a recent study. Yet testosterone is not federally approved for women, and questions remain about its long-term safety. New research is adding to those concerns.
An abstract presented at the 2026 annual meeting of the Menopause Society suggests testosterone therapy in postmenopausal women may be linked to a higher risk of heart attack, stroke, heart failure and other events. This indicates “a potentially important cardiovascular safety signal” for women who take it, lead study author Dr. Xuezhi Daniel Jiang, professor of obstetrics and gynecology at the Drexel University College of Medicine, said in a news release.
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The research, which has not yet been peer-reviewed and published, involved more than 6,000 postmenopausal women aged 45 years and older. Researchers compared women on testosterone therapy with women who were not taking it. Women with a history of cardiovascular disease were excluded.
The research team found that testosterone therapy was associated with a significantly higher risk of a first-time cardiovascular event, like a heart attack or stroke. The study was observational, meaning it cannot establish cause and effect. But the results, experts say, point to the need for more research.
“Cardiovascular disease remains the number one killer of women, and studies like this are important as long-term safety data on testosterone use in women are lacking,” Dr. Stephanie Faubion, a clinician and researcher at the Mayo Clinic and medical director of the Menopause Society, said in a news release.
More than 60 million women (44 percent) in the United States are living with some form of heart disease, according to the U.S. Centers for Disease Control and Prevention. In 2023, it was responsible for about 1 in every 5 female deaths.
Why are women taking testosterone?
Testosterone — which plays a role in libido, muscle and bone health as well as mood and cognition — is a sex hormone that women produce in the ovaries and adrenal glands. Low levels in women can lead to a lack of energy, brain fog, insomnia and a diminished sex drive, according to the Cleveland Clinic. Experts caution that these symptoms can have many other causes.
Unlike estrogen and progesterone, which sharply decline during the menopause transition, testosterone production declines more gradually, starting around age 30, says Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine.
“So there’s this misconception that women go through menopause and suddenly they have no testosterone left, and that they must therefore supplement it. And that’s simply not true,” says Streicher, author of the forthcoming AARP book Menopause Matters.
In fact, there’s insufficient evidence that testosterone therapy can help with many of the symptoms women experience during the menopausal transition, such as brain fog, weight gain or loss of bone density. There is data to support that it can help with low libido, but only in some women, since loss of sexual desire can be due to a number of things, including medications or other medical issues.
“We know that [testosterone therapy] boosts libido in about 50 percent of women at best,” Streicher says. “So this idea that testosterone should be part of the post-menopause cocktail is not founded in science.”
It is, however, heavily promoted on social media, and that enthusiasm may be showing up in prescribing trends.
A study led by researchers at the University of California San Diego School of Medicine found that testosterone prescribing rates for women shot up nearly 60 percent (58.7) from 2024 to 2025 and that women ages 45 to 64 accounted for more than 60 percent of all prescriptions last year.
What do we know about the risks?
Because testosterone therapy is not approved by the U.S. Food and Drug Administration for women — it is approved for some men — safety data comes predominantly from trials in men, experts say.
“We don’t have these long-term studies [in women],” Streicher says.
Physicians who prescribe it to women do so using a compounding pharmacy or off-label at small doses, typically as gels or creams applied to the skin. Potential side effects of testosterone therapy in women can include voice changes, hair growth, acne, male-patterned baldness, an enlarged clitoris and blood lipid (fat) abnormalities, according to the Cleveland Clinic.
The findings from this latest study, Faubion said, “are a reminder for health care professionals to carefully balance individualized risks and benefits when prescribing testosterone.”
While more research is needed on the risks of testosterone therapy in women, including its potential effects on heart health, it’s important for women to know that their risk of heart disease already increases after menopause.
Increasing physical activity, getting enough sleep, eating a healthy diet and managing high blood pressure and cholesterol can help women lower their risks, according to the American Heart Association.
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