Testosterone therapy prescribed to help postmenopausal women with low sexual desire has come under renewed scrutiny after new research linked its use to higher rates of cardiovascular events, including heart attacks and strokes.

The study, presented at The Menopause Society's 2026 annual meeting in San Diego, examined more than 6,300 postmenopausal women aged 45 and older. Researchers reported that 3.8% of women who received testosterone experienced a first-time cardiovascular event, compared with 0.5% of those who did not receive the treatment.

The findings raise questions about the long-term safety of testosterone therapy in women, particularly because evidence on its cardiovascular effects remains limited. However, the study was observational and cannot establish that testosterone caused the events.

Testosterone Therapy Is Used to Treat Low Sexual Desire

Testosterone is commonly associated with male reproductive health, but women also naturally produce the hormone in their ovaries and adrenal glands. It contributes to sexual desire and other bodily functions, although levels generally decline with age.

Some postmenopausal women experience hypoactive sexual desire disorder (HSDD), a condition involving persistently low sexual desire that causes significant personal distress. For appropriately assessed patients, testosterone therapy may help improve sexual desire and sexual satisfaction.

A 2021 clinical practice guideline from the International Society for the Study of Women's Sexual Health supports systemic testosterone therapy for postmenopausal women with HSDD. It describes the treatment's benefits as moderate and recommends a thorough assessment of physical, psychological and relationship-related factors before prescribing it.

The treatment is not intended as a general remedy for ageing or every menopause-related symptom. Evidence does not support using testosterone to improve energy, memory, cognition or bone health in women.

Study Reports Higher Cardiovascular Event Rates

For the new research, investigators used data from the TriNetX US Collaborative Network to compare postmenopausal women who began testosterone therapy with women who had not received it. Participants with a history of cardiovascular disease were excluded, and researchers used propensity-score matching to account for several differences between the groups.

The analysis found that 3.8% of women who received testosterone experienced a cardiovascular event, compared with 0.5% of women who did not. The study reported a hazard ratio of 8.08, indicating that the testosterone group had a substantially higher hazard of experiencing a cardiovascular event during the observation period.

The researchers assessed a composite cardiovascular outcome that included coronary artery disease, angina, heart attacks, ischaemic heart disease, ischaemic stroke and heart failure. The average follow-up period was nearly three years.

The Menopause Society described the findings as a potential cardiovascular safety signal. However, the research was presented at a scientific meeting and has not yet been established as definitive evidence that testosterone therapy increases heart risks.

Because the study was observational, it cannot rule out other explanations for the difference. Despite efforts to match participants, unmeasured factors or differences between women receiving and not receiving testosterone may have influenced the results.

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Long-Term Safety Evidence Remains Limited

Earlier clinical trials found no significant increase in serious adverse events among postmenopausal women receiving testosterone at doses that maintained levels within the physiological range typically seen in premenopausal women. However, these findings were based on relatively short-term studies and do not establish long-term safety.

The 2019 Global Consensus Position Statement on the Use of Testosterone Therapy for Women noted that available evidence did not show an increase in serious adverse events among postmenopausal women receiving physiological doses. It also cautioned that many trials excluded women at high cardiometabolic risk and that safety data beyond 24 months were unavailable.

This means earlier findings may not apply to women with existing cardiovascular risk factors or to those using treatment for longer periods.

In the United States, there are currently no testosterone products specifically approved by the Food and Drug Administration for women. Clinicians may prescribe formulations approved for men at substantially lower doses, an approach known as off-label prescribing.

Women Should Discuss Benefits and Risks With Clinicians

Testosterone may be an option for some postmenopausal women with distressing low sexual desire, but treatment requires an individual assessment rather than relying on hormone levels alone.

Clinical guidance recommends checking testosterone levels before treatment and monitoring them after therapy begins to avoid excessive exposure. Patients should also be assessed for signs of androgen excess, which can include acne, increased facial or body hair, scalp hair thinning and voice changes.

The new findings do not mean that every woman taking testosterone will experience cardiovascular problems, nor do they establish that the hormone directly causes heart attacks or strokes. They do, however, highlight the need for more research into the treatment's long-term effects.

Women who are already receiving testosterone should not stop or change their medication based solely on the study. Instead, they should discuss their individual cardiovascular risk, treatment goals and monitoring plan with their healthcare provider.

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