Testosterone Therapy and Heart Health in Postmenopausal Women: What Does the Research Really Tell Us?

If you use testosterone after menopause, a headline about heart disease can make you question your treatment. The useful answer is neither “ignore the study” nor “the headline proves harm.” A recent observational study reported a cardiovascular safety signal worth taking seriously. It does not, by itself, establish that testosterone caused the events. Equally, uncertainty is not proof of safety.

This guide separates the study announcement, EVEXIAS’s response, and professional guidance so you can have a more informed conversation. It is educational—not a recommendation to start, stop, or change a prescription. Research was checked on November 11, 2026.

What did the new study report?

The Menopause Society’s release, dated October 20, 2026 in its text, describes a retrospective study using TriNetX medical records. Researchers compared more than 6,300 matched postmenopausal women aged 45 or older, with and without recorded testosterone initiation. Women with prior cardiovascular disease were excluded; average follow-up was nearly three years. [1]

Reported cardiovascular outcomes occurred in 3.8% of the testosterone group versus 0.5% of the comparison group—approximately 38 versus 5 per 1,000 women. The reported hazard ratio was 8.08. That statistic describes the relative rate of events over follow-up, not an individual patient’s probability. The combined outcome included coronary disease, stroke-related disease, and heart failure; it was not a count of heart attacks alone. [1]

The difference deserves investigation. These group-level findings cannot tell you your personal risk, or whether a particular product or dose explains the association.

Why an association does not establish causation

In a randomized trial, researchers assign treatments. This study looked backward at care that had already happened. Matching tries to make comparison groups similar on measured characteristics, but cannot balance information that is missing or inaccurately recorded. That leaves room for other explanations without ruling out a genuine treatment effect.

For example, reasons for seeking treatment, differences in healthcare contact, and details of medication use may matter. Those are questions to investigate, not established explanations for this result. A responsible reading keeps both possibilities open: treatment could contribute to risk, and the study design could influence the size of the association.

What EVEXIAS adds—and what remains unanswered

EVEXIAS’s November 10 commentary highlights gaps in the public announcement: product, route, dose, treatment duration, achieved hormone levels, and confirmation of actual medication use are not described. That limits how confidently the findings can be applied to a specific treatment plan. Missing information in a press release does not establish that researchers never collected it. [2]

EVEXIAS is a hormone-therapy company, and its article is a critique rather than an independent clinical guideline. It is useful for identifying questions, but should not be treated as proof that testosterone—or pellets specifically—is cardiovascularly safe. Our review relies on the public announcement and established guidance, not a full peer-reviewed report of this particular study.

What professional guidance says about testosterone for women

The Global Consensus Position Statement identifies postmenopausal hypoactive sexual desire disorder, or HSDD, as the evidence-based indication. This means persistent low sexual desire that causes distress, assessed in the context of physical health, emotional wellbeing, relationships, and medications. A low testosterone result alone does not establish that diagnosis. [3]

The same statement cautions that trials were generally short, often included estrogen use, and excluded women at high cardiometabolic risk. Findings therefore cannot establish long-term cardiovascular safety or be assumed to apply to higher-risk patients. Evidence is insufficient to determine effects on heart attack or death. Testosterone should not be presented as a heart-protection treatment. [3]

Testosterone is also not interchangeable with estrogen-based menopause hormone therapy. Your reason for treatment matters: a conversation about distressing low desire is different from one about hot flashes, sleep, or vaginal discomfort.

Why the formulation and monitoring plan matter

The ISSWSH clinical guideline favors carefully monitored transdermal testosterone for appropriately evaluated women with HSDD. It advises against compounded testosterone, pellets, injections, and oral formulations. It recommends avoiding levels above the normal premenopausal range and monitoring both clinical response and signs of excess testosterone. These recommendations should be part of informed discussion when comparing options. [4]

Possible androgen-related effects include acne, unwanted facial hair, and scalp hair thinning; excessive exposure can also cause voice changes. Baseline assessment and follow-up are important, but regular blood tests cannot guarantee that cardiovascular complications will not occur. [4]

Likewise, “bioidentical” is not a safety guarantee. FDA’s summary of the National Academies review describes insufficient rigorous evidence supporting the safety and effectiveness of compounded bioidentical hormone therapies. Ask which exact medication is proposed, whether it is compounded, and what evidence supports that formulation. [5]

Bring these questions to your hormone consultation

• What specific symptom or diagnosis are we treating, and what other explanations should we consider?
• How do my blood pressure, cholesterol, diabetes history, smoking, and family history affect this decision?
• What are the alternatives, including not using testosterone?
• Is the proposed use off-label, and why is this formulation being considered?
• What improvement would justify continuing, and what would prompt a change or referral?
• Which follow-up tests and appointments will we plan, and who should I contact about new symptoms?

Bring your medication and supplement list, any recent laboratory results, and a short record of what has changed and when. If you already receive treatment, include the product name and dates of use. That turns a broad discussion about “hormone optimization” into a review of your actual care.

A personalized conversation in Gulf Gate, Sarasota

Jessica Simone, AGNP-C, provides hormone optimization consultations for women at Harmony Med Spa in Gulf Gate, Sarasota. If you are researching BHRT in Sarasota or reconsidering an existing menopause hormone therapy plan, request an evaluation focused on your symptoms, medical history, options, and follow-up needs.

A personalized plan should leave room for uncertainty, ongoing monitoring, and referral when appropriate—not promise that hormones are safe for everyone. Ask how emerging evidence may affect your care before making changes on your own.

Sources and further reading

1. The Menopause Society: Testosterone Therapy May Increase Risk of Cardiovascular Disease in Postmenopausal Women (October 2026). https://menopause.org/press-releases/testosterone-therapy-may-increase-risk-of-cardiovascular-disease-in-postmenopausal-women
2. EVEXIAS: Testosterone Therapy and Cardiovascular Risk in Postmenopausal Women (November 10, 2026); industry commentary on the announcement. https://www.evexias.com/testosterone-therapy-and-cardiovascular-risk-in-postmenopausal-women/
3. Davis et al.: Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019). https://pmc.ncbi.nlm.nih.gov/articles/PMC6821450/
4. Parish et al.: ISSWSH Clinical Practice Guideline for Systemic Testosterone for HSDD in Women (2021). https://pmc.ncbi.nlm.nih.gov/articles/PMC8064950/
5. FDA: National Academies assessment of compounded bioidentical hormone therapy. https://www.fda.gov/drugs/human-drug-compounding/national-academies-science-engineering-and-medicine-nasem-study-clinical-utility-treating-patients