The Testosterone Conversation in 2026: What the Evidence Actually Says For Women and Men

Testosterone has a branding problem. Mention it and most people picture bodybuilders or midlife-crisis TV ads instead of a hormone that both men and women make, lose, and need as they age. This issue looks at where the science on testosterone therapy stands for women navigating menopause, and for men with age-related low testosterone.

Testosterone Therapy for Women in Menopause

It’s not just a “male” hormone. Why do women need testosterone?

Women produce testosterone in the ovaries and adrenal glands. Women’s testosterone levels decline gradually from their mid-20s onward, driven mainly by age rather than by menopause itself. The exception is surgical removal of the ovaries, which causes an abrupt drop.

Is testosterone FDA-approved for women?

No. There is currently no testosterone product approved specifically for women by the FDA or most other regulators. Any use in women is “off-label,” typically by compounding a product made for men down to a much lower, female-appropriate dose, or by carefully using a fraction of a male-dosed patch or gel.

What the evidence supports

In 2019, ten major medical societies including the International Menopause Society, the Endocrine Society, and the International Society for Sexual Medicine released a joint global consensus statement on this exact question. Their conclusions, still the reference point today: 

• The one well-supported indication is Hypoactive Sexual Desire Disorder (HSDD), which is a persistent, distressing loss of sexual desire in postmenopausal women. Testosterone therapy shows a modest but real benefit here in clinical trials.
• Evidence does not currently support using testosterone for other menopause complaints including mood, energy, cognitive fog, muscle mass, or general well-being, even though these are commonly why women ask about it. That may change as more research is done, but the current data doesn’t back it yet.
• Dosing should stay in the normal female physiological range. Blood levels are monitored specifically so a woman isn’t pushed into male-range testosterone, which is where side effects (acne, extra hair growth, voice changes) become more likely.
• Testosterone formulations such as gel, or cream is preferred, partly because oral forms may have a less favorable effect on cholesterol. These are preferred over pellets due to risk of extremely high levels that are difficult to adjust.

What do we know about the long-term safety of testosterone therapy for woman?

The consensus panel was explicit that long-term safety data, especially for breast and cardiovascular health over many years, is still limited, simply because large, long-duration trials haven’t been done.

Bottom line for women: if low libido after menopause is significantly bothering you, testosterone therapy is a legitimate, evidence-backed option to discuss with a menopause-literate clinician.

Testosterone Therapy for Men

Does Testosterone Replacement Therapy increase Heart Attack Risk? What the TRAVERSE trial tells us

No — in men with confirmed low testosterone, TRT did not increase risk for heart attack, stroke, or cardiovascular death as reported in the TRAVERSE trial published in 2023.

For years, testosterone replacement therapy (TRT) in men carried an FDA-mandated warning about possible heart risks, based on some earlier, smaller studies with mixed results. The FDA required a definitive trial to settle it.

The trial TRAVERSE, published in 2023 in the New England Journal of Medicine enrolled over 5,000 men aged 45–80 with documented hypogonadism (confirmed low testosterone, below 300 ng/dL on two separate morning blood tests) who also had heart disease or were at high risk for it. Men were randomized to daily testosterone gel or placebo for an average of 22 months.

The finding: testosterone therapy was non-inferior to placebo for the primary outcome -no increased rate of heart attack, stroke, or cardiovascular death. Follow-up analyses from the same trial also found no meaningful increase in prostate cancer risk.

That’s the headline, and it’s genuinely reassuring. Worthwhile to mention that the trial also turned up secondary signals worth knowing about: men on testosterone had higher rates of atrial fibrillation, pulmonary embolism, and acute kidney injury than men on placebo. These weren’t part of the primary endpoint and the trial wasn’t designed to settle whether they’re causal, but they were statistically significant findings in the trial’s own published results. This is why ‘appropriately monitored’ matters: it’s the difference between the reassuring headline and the risks the trial also found.

A 2024–2025 expert consensus from European urology and andrology societies has since aligned its guidance with the overall trial, treating the cardiovascular question as largely settled for appropriately diagnosed men while still flagging these secondary findings as reasons for ongoing monitoring rather than dismissal.

Who should and who should not take TRT?

That reassurance applies specifically to men who meet real diagnostic criteria of persistent symptoms (low libido, fatigue, low mood, loss of muscle mass) plus consistently low testosterone on repeat morning blood tests. It does not extend to normal, healthy aging men using testosterone to feel younger or perform better in the gym without a true deficiency that population wasn’t what TRAVERSE studied, and self-directed or unsupervised use still carries real risks (including suppressing natural fertility, elevated red blood cell counts, and sleep apnea worsening) on top of the AFib, clotting, and kidney signals above, which make unsupervised use riskier, not less risky.

This is a meaningfully reassuring result, and a 2024–2025 expert consensus from European urology and andrology societies has since aligned its guidance with it: in appropriately diagnosed, appropriately monitored men, TRT does not appear to raise cardiovascular risk.

The key word is “appropriately use of TRT in men”

That reassurance applies specifically to men who meet real diagnostic criteria persistent symptoms (low libido, fatigue, low mood, loss of muscle mass) plus consistently low testosterone on repeat morning blood tests. It does not extend to normal, healthy aging men using testosterone to feel younger or perform better in the gym without a true deficiency that population wasn’t what TRAVERSE studied, and self-directed or unsupervised use still carries real risks (including suppressing natural fertility, elevated red blood cell counts, and sleep apnea worsening).

How is TRT is being diagnosed and monitored?

• Two separate morning blood tests confirming genuinely low testosterone before starting therapy
• Monitoring of hematocrit (red blood cell concentration) periodically, since testosterone can thicken the blood
• Ruling out and treating reversible causes first such as obesity, poor sleep, uncontrolled diabetes, and certain medications can all suppress testosterone and improve without hormone therapy at all
• Ongoing monitoring rather than a “set it and forget it” prescription

Bottom line for men: the biggest fear associated with TRT — heart risk — now has solid trial evidence behind it, for the men it’s actually meant to treat. That’s good news, but it’s not a green light for casual or unsupervised use.

In both cases, the theme is the same: testosterone therapy has moved from “controversial and poorly studied” to “narrowly but genuinely evidence-based” for a specific problem, in a specific population, at a specific dose, with monitoring. It’s neither the miracle anti-aging hormone some wellness marketing suggests, nor the dangerous relic some older warnings implied. The honest answer is that for both women and men it can help a real problem, in the right person, done carefully — and the research is still actively evolving.

Our view is that Testosterone Therapy can be helpful when there is a clear reason to use it, realistic expectations, and appropriate monitoring. If you have questions about your own hormone health, bring them to your next visit.

We’re always happy to discuss how this evidence applies to you and individualize your care.

Review by Dr. Armellini & Dr. Satchi