If you've seen headlines this fall about testosterone and women's hearts, they come from two pieces of research. A large US records study presented at The Menopause Society's 2026 meeting found that postmenopausal women prescribed testosterone had more heart and blood-vessel problems than similar women who weren't. A separate review found too little evidence to say testosterone helps memory or brain fog. The heart finding is an association, not proof that testosterone caused the problems.
Taken together, they line up with what experts already recommend. Testosterone therapy for women has its strongest evidence for one thing: low sexual desire that causes distress after menopause, known as hypoactive sexual desire disorder (HSDD). Whether it makes sense for you is a decision for a licensed clinician who knows your health history.
The heart study: what researchers found
The study, led by Dr. Xuezhi Daniel Jiang of Drexel University, used the TriNetX database of US health records. According to The Menopause Society's press release, researchers compared more than 6,300 women aged 45 and older, matched so the testosterone group and the comparison group looked similar on paper. Women with existing heart or blood-vessel disease were left out, and so were women who'd used testosterone in the previous 12 months.
Over an average of nearly three years, the researchers counted coronary artery disease (including angina and heart attack), strokes caused by blocked blood vessels and other artery blockages, and heart failure as one combined outcome. The results:
- 3.8% of women who used testosterone had one of these events
- 0.5% of women who didn't use testosterone had one
On paper that's about eight times the risk (a hazard ratio of 8.08, with a 95% confidence interval of 4.72 to 13.82). The pattern held when the researchers compared women using testosterone plus hormone therapy with women using hormone therapy alone. Healio's report on the presentation adds that each group had 3,164 women.
Dr. Jiang called it a "potentially important cardiovascular safety signal" and noted that "absolute event rates were low." Dr. Stephanie Faubion, The Menopause Society's medical director, said the findings are "a reminder for healthcare professionals to carefully balance individualized risks and benefits when prescribing testosterone."
What eight times higher means in real numbers
Relative risk ("eight times") compares the two groups, while absolute risk tells you how many people were affected. In this study, 3.8% works out to about 38 women in every 1,000 who used testosterone, compared with about 5 in every 1,000 who didn't. That gap is worth taking seriously. It also means most women in both groups didn't have one of these events during follow-up.
What this study can't tell us yet
A few big limits matter here, and the researchers named several of them themselves.
It shows an association. Health-record studies can match people on recorded details, but they can't account for everything. As reported by Healio, the authors wrote that their results "should be considered hypothesis-generating and warrant prospective validation," and pointed to possible residual confounding, meaning differences between the groups that the records didn't capture.
It hasn't been through full peer review. The findings were presented as a conference abstract at The Menopause Society's annual meeting in San Diego (October 20 to 24, 2026). As of November 11, 2026, we couldn't find a published journal paper, so the full methods and data aren't available to check.
Key details are unknown. In Healio's coverage, Dr. Adrian Dobs of Johns Hopkins University School of Medicine noted that large databases are "more hypothesis-yielding" and that the doses used, the reasons women were prescribed testosterone and the levels they reached aren't known from the database. He also said he was hesitant to conclude that testosterone causes heart disease, noting that the doses used in women are quite low. Those unknowns matter, because experts recommend dosing that keeps women's levels in the normal premenopausal range, and the 2019 Global Consensus Position Statement says its recommendations don't apply to injectables, pellets, formulations that push levels above that range, or compounded preparations.
How it fits with earlier research
Earlier trials weren't designed to pick up a signal like this one. The 2019 Global Consensus Position Statement on testosterone therapy for women, endorsed by major menopause and endocrine societies, found that testosterone in doses matching premenopausal levels wasn't linked to serious adverse events in trials. It also pointed out that those trials were relatively short, mostly included women also taking estrogen, and left out women at high cardiometabolic risk. Its bottom line was that "the safety of long-term testosterone therapy has not been established." A 2019 meta-analysis in The Lancet Diabetes & Endocrinology reached similar conclusions about the limits of long-term safety data.
The new study speaks to a gap those trials left open, using a different and less controlled kind of study, and it's a reason for better long-term trials.
According to The Menopause Society, there are no FDA-approved testosterone products for women in the US. Clinicians who prescribe it use very low doses of products made for men, usually as a cream or gel, which is off-label use. The FDA explains that healthcare providers generally may prescribe an approved drug for an unapproved use when they judge it medically appropriate.
The brain-fog review: what researchers found
Brain fog is one of the most common reasons women ask about testosterone, so this one hits close to home. A systematic review and meta-analysis in Reproduction and Fertility by Faulkner and colleagues looked for every study of testosterone and thinking skills in menopause.
They found five studies. Three were randomized trials that could be pooled, with 244 postmenopausal women in total, lasting between 4 and 26 weeks. Testosterone made no measurable difference to executive function, verbal learning and memory, or visuospatial skills compared with placebo. The researchers rated the certainty of the evidence as very low, and they found no studies at all in perimenopause or on how women themselves rated their thinking. Two smaller studies that couldn't be pooled, one of them not randomized, reported some improvements, which is part of why the authors call the evidence inconclusive.
The authors were careful about what that means: the results are "insufficient to establish an effect rather than as evidence of no effect." In UCL's announcement of the review, senior author Professor Aimee Spector said social media "is flooded with claims that testosterone improves memory and brain fog," and the evidence doesn't back those claims up yet.
This matches the 2019 Global Consensus, which found insufficient evidence to support testosterone for thinking skills or to delay cognitive decline in postmenopausal women.
What this means if you're on testosterone, or thinking about it
If you're on testosterone or considering it, take these questions to your clinician before you start or stop anything:
- Why am I using testosterone, and is that reason supported by evidence?
- What dose am I on, what form is it, and are my blood levels in the expected range?
- What's my personal heart risk? Think blood pressure, cholesterol, blood sugar, smoking, weight and family history.
- Am I also on estrogen or other hormone therapy, and how does that change things?
- How will we monitor me over time, and when should we reassess?
If brain fog is the main thing bothering you, it's worth looking at the other things that can cause it, like poor sleep, stress, mood changes and other health conditions. Our guide to what causes brain fog and when to seek help is a good place to start.
And if you ever have chest pain, sudden weakness or numbness, trouble speaking or sudden shortness of breath, call emergency services right away.
Where female TRT at AlphaMD fits
Through AlphaMD, a licensed clinician reviews your symptoms, medical history and lab results before deciding whether testosterone is appropriate, and monitors you if it's prescribed. Your clinician can weigh a study like this one against your own risks and goals. If you want to know what treatment can realistically look like, read what to expect from female TRT, and for the questions women ask most, see the female TRT FAQs.
Frequently asked questions
Does testosterone cause heart disease in women?
That hasn't been shown. A 2026 health-records study linked testosterone use after menopause with more heart and blood-vessel events, but studies like this can't prove cause, and the results haven't yet been published in a peer-reviewed journal.
Is the heart risk really eight times higher?
The relative risk in the study was about eight times higher. In absolute terms, about 38 in 1,000 women using testosterone had an event during follow-up, compared with about 5 in 1,000 who didn't.
Does testosterone help menopause brain fog?
There isn't enough evidence to say. A 2026 meta-analysis found no measurable effect on thinking skills in three small trials, and its authors said the evidence is too limited to show whether testosterone helps.
Is testosterone FDA-approved for women?
Not in the US. According to The Menopause Society, clinicians who prescribe testosterone for women use low doses of products made for men, which is off-label use.
Should I stop my testosterone after this news?
Talk with your prescribing clinician before making any change. They can review why you're using it, your dose and levels, and your personal heart risk.