Study Links Testosterone Use After Menopause to Higher Heart Risks
A study links testosterone use after menopause to more cardiovascular disease, but observational findings cannot establish cause and effect.
Summary
Testosterone therapy after menopause was associated with more cardiovascular disease in a study of electronic health records. Researchers compared 3,164 women starting testosterone with 3,164 similar women who did not use it. Within the five-year analysis window, cardiovascular disease occurred in 3.8% of testosterone users versus 0.5% of nonusers. The findings raise questions about long-term safety, but they do not prove testosterone caused the difference. Average follow-up was only 2.6 years, and unmeasured differences between groups could influence the results. No testosterone products are FDA approved for women, although clinicians sometimes prescribe male formulations off-label for low sexual desire. Women considering or already using testosterone should discuss expected benefits, cardiovascular risk factors, and uncertainties with their clinician rather than change treatment based on this conference report alone.
Detailed Summary
Testosterone therapy for postmenopausal women may warrant closer attention to heart health as its use expands beyond approved indications. Some women receive testosterone to address low sexual desire, but no testosterone product is FDA approved for women. Evidence that it relieves broader menopausal symptoms remains insufficient, and its cardiovascular safety over many years remains uncertain.
A retrospective study presented at the Menopause Society annual meeting compared postmenopausal women aged 45 and older who started testosterone with women who did not receive it. Researchers used electronic health records and matched 3,164 women in each group on measured characteristics. Women with existing cardiovascular disease and certain other conditions were excluded. Average follow-up was 2.6 years.
Within the five-year analysis window, cardiovascular disease was recorded in 3.8% of testosterone users versus 0.5% of matched nonusers, an absolute difference of 3.3 percentage points. The estimated rate of developing disease over time was about eight times higher among users. The outcome combined coronary artery disease, cerebrovascular disease, and heart failure. Associations also appeared in longer follow-up analyses.
These findings raise a safety question rather than establish that testosterone causes cardiovascular disease. Women considering treatment should discuss the intended benefit, their cardiovascular risk factors, and the uncertainties with a clinician. Women already taking testosterone should arrange an individualized review rather than change treatment based solely on this report. Longer randomized trials would help clarify potential cardiovascular harms.
Important limitations remain. This was conference poster coverage, not a complete study report, and the supplied article is truncated. Matching cannot eliminate unmeasured differences between treated and untreated women. Testosterone dose, formulation, treatment duration, and detailed adjustment methods were not provided in the excerpt. The average follow-up was much shorter than the five-year and ten-year analysis windows, making follow-up completeness and the underlying event counts important details to verify.
Key Findings
- Within the five-year analysis window, cardiovascular disease occurred in 3.8% of testosterone users versus 0.5% of matched nonusers.
- The five-year cardiovascular hazard ratio was 8.08, but this observational association does not establish causation.
- Researchers matched 3,164 women per group; average follow-up was 2.6 years.
- No testosterone products are FDA approved for women; discuss potential benefits and cardiovascular uncertainties before starting or changing treatment.
Methodology
This MedPage Today news report covers a conference poster presented at the Menopause Society annual meeting and includes investigator and independent expert commentary. The evidence comes from a retrospective TriNetX electronic health record study using propensity score matching, not a randomized trial.
Study Limitations
The supplied article is truncated, and conference coverage does not provide the methodological detail of a full study publication. Residual confounding, exposure classification, and incomplete follow-up could affect the association; verify dosing, formulations, event counts, adjustment methods, and follow-up completeness in the primary research.
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