The New Study That Made Me Rethink Taking Testosterone

When it comes to any treatment in menopause, I always encourage every woman to ask four questions: What are the risks of taking it? What are the benefits of taking it? What are the risks of NOT taking it? And what are the benefits of NOT taking it? If you’ve been following me for a while, you’ve heard me cite these four questions dozens and dozens of times.

This week, I had to ask those four questions about myself and it’s a textbook example of how to use these questions to chart your own course of action with respect to your health.

The study that caught my attention

At The Menopause Society’s annual meeting in San Diego last week, researchers presented a study that should make all of us pause. Surprisingly, it didn’t get anywhere near the coverage it should have gotten on social media, likely because a lot of the meno-influencers out there who have been hyping testosterone for the past few years rarely mention its risks or unknowns. In a study of more than 6,300 postmenopausal women aged 45 and up, researchers compared those who started testosterone therapy with similar women who didn’t—matching for smoking, obesity, diabetes, and high blood pressure, and excluding anyone with prior heart disease. Over roughly three years of follow-up, 3.8% of women on testosterone had a new cardiovascular event (coronary artery disease, stroke, or heart failure) compared with 0.5% of women not on it. The difference held even when women on testosterone plus hormone therapy were compared with women on hormone therapy alone.

That is a big gap. It’s also an observational study, which means it shows an association, not proof that testosterone caused those events. It also hasn’t been peer-reviewed yet, and we don’t know which forms or doses of testosterone the women used. The total number of events was small, and this needs more research. But it’s a real safety signal, and it lands on top of something we already knew: long-term safety data for testosterone in women is thin, and there is still no FDA-approved testosterone product for women in the US.

Here’s where my personal story comes in

Seven weeks ago, after speaking with my own great gynecologist, I started a testosterone cream. Not for libido. I’m happy to report that that department is doing just fine! What I discussed with Dr. Reilly, as a doctor and as a 57-year-old woman, is whether it would do anything else. Energy? Strength? Body composition changes? Mental sharpness or boost in mood? Some secret glow everyone on social media seems to be getting?

The result: nothing. Zippo. I feel no different. I look no different. I checked. Now, to be accurate, I felt pretty good BEFORE, so whenever a therapy is aimed at going from great to greater, the bar is higher for assessment.

My labs, on the other hand, definitely noticed. My total testosterone went from 24 to 75. My LDL cholesterol went from 99 to 107, which may simply be normal variation between tests, but it’s moving in a direction I’d rather it didn’t. And my blood count went up slightly, which is an expected effect of testosterone, and one that isn’t always a good thing, as it can make the blood “thicker” and more likely to form an abnormal clot somewhere.

So let me run my own four questions and take you through how I answered them

Risks of taking it? A possible cardiovascular signal, a lipid number creeping the wrong way, and a rising blood count. In women who take too much testosterone, add in acne, excess body hair where we don’t want it, hair loss where we don’t want it, enlargement of the clitoris, and deepening of the voice (which may not be reversible).

Benefits of taking it? For the 10 to 15% of menopausal women with hypoactive sexual desire disorder (HSDD), a persistent and distressing loss of desire, testosterone has real evidence behind it. For fatigue, brain fog, weight, mood, or bone health, the evidence just isn’t there yet. And in my personal experiment of one, I got zero.

Risks of NOT taking it? For me, honestly, none that I can identify. I’m not giving up a benefit, because I never got one.

Benefits of NOT taking it? I avoid exposure to a hormone with unresolved questions about the organ that kills more women than anything else: the heart.

Even before this study, I was already thinking: If I can’t see it or feel it, why am I using it? Now, with this data, the answer is easy. I’m stopping, and I’ve already talked with my gynecologist about it.

I’m stopping, but that doesn’t mean you need to

To be clear, this is not me telling you to go off this hormone or never consider taking it. If testosterone is treating HSDD for you, that’s a legitimate use, and the right move is a conversation with your doctor, not a panicked trip to the trash can. Bring this study to that conversation.

But if you’re using testosterone because you heard on social media that it would fix everything menopause throws at you, ask the four questions. Ask for labs. And be honest about whether it’s actually doing anything.

Mine wasn’t. So I’m done.

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