Breaking down the latest menopause research—and why understanding the science matters more than reacting to a headline.
If you’ve been following the news surrounding The Menopause Society’s 2026 Annual Meeting, you may have seen some alarming headlines about testosterone therapy and cardiovascular disease.
One study reported that postmenopausal women receiving testosterone had approximately eight times the rate of certain cardiovascular events compared with women who were not receiving testosterone.
Eight times.
That’s a number that understandably gets attention.
But before we conclude that testosterone is dangerous, or that women should stop taking it altogether, we need to examine what researchers actually studied.
Because in medicine, an association is not the same thing as causation.
And when we’re talking about hormone therapy, those distinctions matter.
What Did the Testosterone Study Actually Find?
Researchers analyzed electronic health records of postmenopausal women aged 45 and older, comparing those who initiated testosterone therapy with women who did not receive testosterone.
Women with previously documented cardiovascular disease were excluded, and researchers attempted to balance the groups for several known risk factors.
The study evaluated a composite cardiovascular outcome that included conditions such as coronary artery disease, ischemic stroke, and heart failure.
The findings were notable:
- 3.8% of women receiving testosterone experienced a cardiovascular event included in the composite outcome.
- 0.5% of women not receiving testosterone experienced one of those outcomes.
- The reported hazard ratio was approximately 8.08.
In absolute terms, that represents a difference of approximately 3.3 percentage points over the study’s follow-up period.
That is not insignificant.
But the study was retrospective, meaning researchers examined existing medical records rather than randomly assigning women to treatment.
Despite statistical adjustments, we cannot eliminate the possibility that differences between the groups influenced the findings.
And there are several additional questions we should be asking.
Not All Testosterone Therapy Is the Same
One of my biggest concerns when interpreting testosterone research is whether investigators adequately distinguish between formulations and dosing strategies.
Testosterone can be delivered through topical creams, gels, injections, and implanted pellets.
These approaches are not necessarily equivalent.
A carefully titrated transdermal preparation designed to maintain physiologic female testosterone concentrations is different from a regimen that produces substantially elevated or fluctuating concentrations.
The publicly available study summary does not provide enough formulation-specific information to determine whether cardiovascular outcomes differed by route, dose, or achieved testosterone level.
That’s an important limitation.
It would be inappropriate to assume that every testosterone regimen carries the same risk based on this study.
But it would be equally inappropriate to assume that physiologic dosing eliminates cardiovascular risk.
We simply don’t have sufficient long-term data to make that claim.
What Does the Existing Research Tell Us?
In 2019, an international panel of experts published the Global Consensus Position Statement on Testosterone Therapy for Women.
The statement concluded that the only evidence-based indication for systemic testosterone therapy in women is hypoactive sexual desire disorder, or HSDD, in appropriately evaluated postmenopausal women.
HSDD refers to persistently low sexual desire associated with personal distress.
Clinical trials have demonstrated modest but meaningful improvements in sexual function for some women receiving testosterone.
However, the consensus statement also identified important limitations in the safety literature.
Most randomized trials excluded women at elevated cardiometabolic risk, and long-term safety data extending beyond approximately 24 months were unavailable.
In other words, the absence of a clear cardiovascular safety signal in earlier trials does not establish long-term safety for every woman.
We need to distinguish between a treatment that has demonstrated benefit for a specific condition and one that has been proven safe for indefinite use across a broad population.
Those are two very different claims.
Should Testosterone Be Used for Fatigue, Weight Gain, or General Wellness?
This is where I believe we need to be especially careful.
Testosterone has become increasingly popular in the wellness industry, with claims that it improves energy, cognition, muscle mass, metabolism, and overall vitality.
But the clinical evidence supporting these claims in women is insufficient.
That doesn’t mean a woman reporting fatigue or low motivation isn’t experiencing real symptoms.
It means we shouldn’t automatically attribute those symptoms to a testosterone deficiency.
There is no universally accepted blood testosterone threshold that diagnoses a testosterone deficiency syndrome in otherwise healthy women.
And a low laboratory value alone does not establish an indication for treatment.
Sleep disruption, thyroid dysfunction, iron deficiency, mood disorders, medication effects, and menopausal symptoms can all contribute to changes in energy and well-being.
Good medicine requires evaluating those possibilities rather than reflexively prescribing another hormone.
What About Estrogen and Cardiovascular Health?
While testosterone has generated some concerning headlines, estrogen has a much more established role in menopause treatment.
Systemic menopausal hormone therapy remains the most effective treatment for bothersome hot flashes and night sweats and can help prevent bone loss and fractures.
But estrogen therapy also requires individualized risk assessment.
One of the most important concepts in menopause medicine is the timing of treatment initiation.
According to The Menopause Society’s hormone therapy position statement, the benefit-risk profile is generally more favorable for healthy symptomatic women who initiate treatment before age 60 or within 10 years of menopause onset, assuming no contraindications.
Starting systemic hormone therapy later in life, particularly more than 10 years after menopause, may carry greater absolute cardiovascular and thromboembolic risks.
Route of administration matters, too.
Transdermal estradiol avoids hepatic first-pass metabolism and may offer advantages regarding venous thromboembolism risk compared with oral estrogen, although direct randomized comparisons of cardiovascular outcomes remain limited.
This doesn’t mean transdermal estrogen is completely risk-free.
And importantly, systemic hormone therapy is not recommended solely for the primary prevention of cardiovascular disease.
It means we should consider the patient’s age, symptoms, medical history, cardiovascular risk, and treatment preferences before making recommendations.
Could Estrogen Also Influence Weight Loss Medication Outcomes?
Another study presented at the 2026 meeting explored whether hormone therapy influences weight loss among women receiving semaglutide or tirzepatide.
Researchers evaluated 3,855 women using these medications.
Among semaglutide users, hormone therapy was associated with greater sustained weight loss.
At 15 months, women receiving hormone therapy had lost approximately 11.6% of their body weight compared with 9.7% among women not receiving hormone therapy.
However, the same sustained benefit was not demonstrated among tirzepatide users.
This is an interesting finding, especially given estrogen’s involvement in fat distribution and metabolic regulation.
But the research does not establish that adding estrogen will improve weight loss.
Women who choose hormone therapy may differ from women who do not in ways that influence treatment response.
Prospective randomized studies are needed before we can determine whether hormone therapy directly changes GLP-1 effectiveness.
For now, menopausal hormone therapy and weight management medications should each be prescribed for their own appropriate clinical indications.
Cardiovascular Risk Deserves More Attention During Menopause
One thing I hope comes out of these discussions is greater attention to women’s cardiovascular health.
Cardiovascular disease remains a leading cause of death among women.
And the menopause transition is an important time to reassess risk.
Changes in body fat distribution, blood pressure, lipid profiles, and insulin sensitivity may become more apparent during midlife.
When evaluating cardiovascular risk, I believe it’s important to look beyond a single cholesterol number.
Depending on the patient, that may include:
- A comprehensive lipid profile and consideration of apolipoprotein B (ApoB).
- Lipoprotein(a), or Lp(a), which is largely genetically determined.
- Blood pressure, glucose regulation, and diabetes risk.
- Family history of premature cardiovascular disease.
- Smoking history, physical activity, and body composition.
- Additional cardiovascular testing when clinically indicated.
Not every woman needs every test.
But every woman deserves an assessment that reflects her individual risk factors.
This is especially important when considering therapies for which long-term cardiovascular safety data remain limited.
What Should Women Currently Using Hormone Therapy Do?
First, don’t panic.
A single observational study should not automatically determine whether you continue or discontinue treatment.
But new research should prompt thoughtful conversations.
If you’re currently using testosterone, it’s reasonable to review why it was prescribed, whether it is providing a meaningful benefit, what formulation you’re using, and whether your testosterone levels are being maintained within an appropriate physiologic range.
It’s also important to periodically reassess cardiovascular risk and treatment goals.
For women receiving systemic estrogen, the same principle applies: treatment should be based on appropriate indications, individualized risk assessment, and ongoing evaluation.
And if you’re considering hormone therapy for the first time, the goal should be informed shared decision-making—not fear, pressure, or promises of reversing aging.
My Perspective: We Need Better Research, Not More Extreme Headlines
What concerns me most about the conversation surrounding hormone therapy is how quickly it can become polarized.
On one side, hormones are portrayed as dangerous medications that women should avoid.
On the other, they’re marketed as the answer to nearly every symptom of aging.
Neither approach reflects the complexity of women’s health.
The truth is that hormone therapy can be incredibly valuable for appropriately selected patients.
It can also carry risks, and some of those risks are not yet fully understood.
As clinicians, we should be comfortable acknowledging both.
I don’t believe responsible medicine means avoiding every treatment with unanswered questions.
But I also don’t believe enthusiasm for hormone optimization should replace clinical evidence.
Our responsibility is to understand what we know, acknowledge what we don’t, and help patients make decisions that reflect their individual needs.
At Limitless Health Spa, that’s the foundation of our approach to menopause care.
We look at the whole patient: symptoms, medical history, metabolic health, cardiovascular risk, and quality of life.
Because the goal isn’t simply to optimize a hormone level.
It’s to help women feel better while making thoughtful decisions about their long-term health.
And sometimes, the most important part of that process is knowing when the evidence supports treatment—and when it doesn’t.
References
Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J., Rymer, J., Simon, J. A., Vignozzi, L., & Wierman, M. E. (2019). Global consensus position statement on the use of testosterone therapy for women. The Journal of Clinical Endocrinology & Metabolism, 104(10), 4660–4666. https://doi.org/10.1210/jc.2019-01603
The Menopause Society. (2026). Testosterone therapy may increase risk of cardiovascular disease in postmenopausal women [Press release]. https://menopause.org/press-releases/testosterone-therapy-may-increase-risk-of-cardiovascular-disease-in-postmenopausal-women
The Menopause Society. (2026). Hormone therapy may increase weight loss effectiveness of GLP-1s [Press release]. https://menopause.org/press-releases/hormone-therapy-may-increase-weight-loss-effectiveness-of-glp-1s
The North American Menopause Society Advisory Panel. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794. https://doi.org/10.1097/GME.0000000000002028
U.S. Food and Drug Administration. (2025). FDA requests labeling changes related to safety information to clarify the benefit/risk considerations for menopausal hormone therapies. https://www.fda.gov/drugs/drug-alerts-and-statements/fda-requests-labeling-changes-related-safety-information-clarify-benefitrisk-considerations
Castaneda, R., et al. (2026). Menopause hormone therapy and weight loss response to GLP-1–based therapies in midlife women: A retrospective cohort study [Conference abstract]. The Menopause Society 2026 Annual Meeting. https://menopause.org/wp-content/uploads/2026/10/MENOPAUSE26_Regular-LB_Abstracts-4-1.pdf
Medical disclaimer: This article is educational and is not a substitute for individualized medical evaluation. Conference findings are preliminary and should be interpreted alongside established clinical evidence.
