A matched study linked testosterone use with cardiovascular events after menopause. Understand the findings, limitations and questions for clinical discussion.
On October 7, 2026, The Menopause Society reported that a retrospective analysis found more cardiovascular events among postmenopausal women who started testosterone than among women without testosterone exposure. The analysis included more than 6,300 matched women. It was led by Xuezhi Daniel Jiang of Drexel University College of Medicine.
The Society said the results were scheduled for presentation at its 2026 Annual Meeting in San Diego. The finding adds a cardiovascular safety question to decisions about testosterone for persistent and distressing low sexual desire. Understanding that question requires looking at the study’s design and the outcomes behind the headline.
According to The Menopause Society, researchers used data from the TriNetX US Collaborative Network. They compared postmenopausal women aged 45 and older who initiated testosterone therapy with women who had no testosterone exposure. This was a retrospective cohort analysis, meaning the researchers looked back at existing data rather than assigning treatment experimentally.
The groups were matched one-to-one using a method called propensity matching. Its purpose was to make the comparison groups more similar on recorded demographic and health factors.
The matching included smoking, obesity and diabetes. It also accounted for hypertension and dyslipidemia, which refers to abnormal blood fat levels. Menopause-related treatments and symptoms were included alongside surgical menopause.
Women with prior cardiovascular disease were excluded. The study also required a 12-month period without testosterone exposure before the index date, the starting point used for the analysis.
Researchers counted cardiovascular events occurring from 30 days to five years after that starting point. Average follow-up was nearly three years. That distinction matters: a study allowing follow-up for five years does not mean every participant was observed for that entire period.
The study assessed a composite outcome, which combines several diagnoses into one measure. The Menopause Society’s release identified these components:
The composite outcome occurred in 3.8% of women in the testosterone group and 0.5% of women without testosterone exposure. Those figures describe the proportions who experienced one of the included outcomes during the study’s observation period. They are not heart attack rates alone.
The reported hazard ratio was 8.08. This describes the relative rate of the composite outcome over time in the analysis. It is not an individual woman’s absolute risk or a prediction that any particular patient is eight times more likely to experience an event.
Both parts of the result deserve attention. The relative difference was substantial, while the reported absolute event proportions were low. Focusing only on the relative figure can make the finding sound more personally predictive than it is.
The Society also reported a sensitivity analysis comparing women who used testosterone plus hormone therapy with women who used hormone therapy alone. The association was present in that comparison as well.
Jiang described the finding as a “potentially important cardiovascular safety signal.” He said the consistency across analyses warranted further prospective investigation. In this context, a safety signal is a finding that deserves closer study rather than a settled explanation of why the events occurred.
The central limitation is that this was an observational analysis. It found an association but cannot establish that testosterone caused the cardiovascular events. There was no experimental assignment of women to testosterone or no testosterone.
Propensity matching can balance measured factors included in the analysis. It cannot establish that the groups were equivalent in every relevant way. Unmeasured differences or differences not fully captured in the data could have influenced the results, a problem known as residual confounding.
The study population also sets boundaries on interpretation. Because women with prior cardiovascular disease were excluded, the results do not directly describe that group. The findings should not automatically be extended to younger women or women who have not reached menopause.
The public release does not provide detailed treatment doses or durations. It also does not give route-specific results or full event counts for each component of the composite outcome. The headline figures therefore cannot identify a particular formulation as responsible or establish which cardiovascular diagnosis accounted for most events.
Finally, the Society described results scheduled for a conference presentation. Its public release should not be treated as a substitute for a full study report with detailed methods and results. Further prospective research is needed to clarify the safety signal.
The finding sits alongside an existing distinction between evidence of benefit and evidence of safety. A treatment may help a defined concern while still requiring careful evaluation of its risks. Those are related questions, but they are not interchangeable.
The Menopause Society says testosterone has demonstrated effectiveness for hypoactive sexual desire disorder, often shortened to HSDD. Its release describes this as a persistent and distressing loss of interest in sex. That is a more specific concern than a general wish to feel more energetic or to address menopause symptoms broadly.
The same release says evidence is insufficient for testosterone as a treatment for fatigue or memory loss. It also identifies weight gain and loss of bone density as uses without sufficient supporting evidence. Evidence for one sexual-health indication should not be stretched into a claim of general menopause benefit.
Sexential’s coverage of the specific role of testosterone in women’s desire provides further context for that distinction. The relevant question is not simply whether testosterone has an effect. It is whether the proposed benefit matches the concern being assessed.
The Society says testosterone is not routinely recommended for postmenopausal women and that long-term safety data remain limited. It also notes that no testosterone product is FDA-approved for women in the United States. Prescribing it for women is therefore off label.
The wider cardiovascular discussion includes a joint FIGO and WHF position paper addressing menopause hormone therapy in women with cardiovascular risk factors or established ischemic heart disease. That is a related but different scope. This testosterone analysis should not be treated as a conclusion about every form of menopause hormone therapy.
The Society’s medical director, Stephanie Faubion, said the findings reinforce the need to balance individual benefits and risks when prescribing testosterone. That places the update within individualized clinical assessment rather than a blanket conclusion for all women.
For someone considering testosterone because of low desire, the practical value of this study is a more focused discussion with a qualified clinician. The Society’s release supports reviewing cardiovascular history and personal risk factors alongside the benefit being sought.
Several questions can help organize that conversation without turning the study into a personal risk forecast:
These are discussion prompts, not a treatment plan. Decisions about an individual prescription belong with a qualified clinician who can assess the person’s circumstances. The reported association should not be used to make medication changes without that assessment.
A useful starting point is describing the concern in ordinary language: what has changed and what makes it distressing. That does not require arriving with a diagnosis or assuming a hormone is the explanation. Sexential’s discussion of why low desire needs a comprehensive assessment considers that broader clinical context.
It is also reasonable to keep the sexual-health question and the cardiovascular question visible at the same time. Concern about safety does not make a desire-related concern unimportant. Equally, distress about a sexual change does not remove the need to examine the evidence behind a proposed treatment.
For readers seeking broader background, Sexential’s coverage of heart-health context around menopause offers another place to frame questions before a clinical conversation. That context is separate from calculating an individual risk from this study.
Sexual wellbeing deserves careful evidence and room for honest questions, without fear setting the agenda.
A woman considering testosterone brings her concerns to a qualified clinician; Sexential’s role is to make the surrounding sexual health information easier to understand. For adults whose confidence has been shaken by changes in desire or function, the publication connects biology with real-life context without diagnosing the cause or choosing treatment.
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