If you are trying to work out whether testosterone could help your bones after menopause, the short answer is this: a small new study saw spine bone density scores rise when estrogen was combined with testosterone, but the 2019 global expert consensus found the available data did not support a bone density effect at 12 months. Here is what each finding means for you, and where the research still falls short.
What the new small study found
According to The Menopause Society press release, the study followed 51 women for an average of 4.1 years. The women received estrogen therapy for a mean of 3.5 years and estrogen plus testosterone for 3.1 years. Bone density was measured with DEXA scans at baseline, after at least one year of estrogen alone, and after at least one year of estrogen plus testosterone. The lead author is Sona Davis of the Keck School of Medicine of the University of Southern California.
Estrogen alone did not produce significant increases in T-scores at any location. Estrogen plus testosterone significantly increased lumbar spine T-scores. The femoral neck and hip T-scores stayed stable across both treatment periods.
The study measured T-scores on DEXA scans. It did not measure fractures. The release describes it as a meeting presentation and does not cite a published full paper. It also does not report the size of the spine change, the testosterone dose, the product or route, or whether the women were randomized.
Why the spine result and the hip result mean different things
The researchers concluded that testosterone may have a synergistic effect with estrogen on trabecular bone, especially at the spine. That is a statement about where the effect may act. It is not a fracture result.
The spine and hip matter for a specific reason. The NIAMS guide to bone mineral density test numbers explains that the weak bones that tend to break most often are the hip and spine, so DXA usually measures those two sites. A rise at the spine is a change at a relevant site. In this study, though, the hip did not change.
A T-score also compares your bone with a healthy young adult. It is a measurement, not a count of breaks. The NIAMS guide says the risk of broken bones increases by 1.5 to 2 times with each 1-point drop in the T-score. A higher T-score at the spine is therefore not the same as a known drop in fracture risk.
A 2021 two-year randomized trial in men aged 50 and older reported that testosterone increased areal bone density at both the lumbar spine and the total hip, predominantly via effects on cortical bone, with minor effects on trabecular architecture. The authors said implications for fracture risk reduction require further study. That trial was in men, so it does not transfer directly to women after menopause.
What the 2019 expert consensus says about bone
The 2019 global consensus position statement on testosterone therapy for women, endorsed by societies including the International Menopause Society, The Endocrine Society and the European Menopause and Andropause Society, says: “The available data do not support an effect of testosterone treatment on bone mineral density at the spine, total hip, or femoral neck at 12 months.”
The same statement says: “The only evidence-based indication for testosterone for women is for HSDD.” HSDD means hypoactive sexual desire disorder. It also calls for adequately powered randomized trials that measure both bone density and fracture risk. The 2026 study was published as a meeting presentation after that statement, so the consensus did not have it.
Side effects and what is still unknown
The 2019 consensus describes the side effects it found in women. The table below sets out its wording.
| Concern | What the 2019 consensus says |
|---|---|
| Acne and body or facial hair | Mild increases in some women |
| Hair loss, enlarged clitoris, voice change | Not associated with testosterone in the statement |
| Oral testosterone and cholesterol | Associated with adverse lipid profiles; not recommended |
| Non-oral testosterone and cholesterol | No significant adverse lipid effects in the short term at physiologic doses |
| Deep venous thrombosis (blood clots in deep veins) | A nonsignificant trend was seen; the role of concurrent estrogen cannot be excluded |
| Breast cancer | Short-term transdermal testosterone does not appear to affect risk; long-term data are insufficient |
| Heart attack or death | Limited data preclude assessing |
| Long-term use | “The safety of long-term testosterone therapy has not been established.” |
| Compounded, pellet and injected forms | Compounded testosterone is not recommended for HSDD unless an authorized equivalent is unavailable; pellets and injections producing supraphysiologic concentrations are not recommended |
The statement notes that the trials excluded women at high cardiometabolic risk and were of relatively short duration. It advises blood level checks at baseline, at 3 to 6 weeks, and about every 6 months. At the time, it says, no female testosterone product was approved by a national regulator.
How bone density is measured and what the numbers mean
A bone mineral density test measures calcium and other minerals in your bone. The NIAMS guide explains that bones with more minerals are denser, and tend to be stronger and less likely to break. The most common test is the DXA, also written DEXA. It uses radiation to measure how much calcium and other minerals are in a specific area of bone, usually the hip and spine.
- A T-score of -1 or higher is considered healthy.
- A T-score from -1 to -2.5 means osteopenia, a less severe form of low bone density.
- A T-score of -2.5 or lower means you might have osteoporosis.
Women after menopause receive a T-score. Premenopausal women and men under 50 receive a Z-score, which compares them with people of their age, sex and ethnicity. The NIAMS guide says the U.S. Preventive Services Task Force recommends bone density testing for women over 65, and for women under 65 who have gone through menopause and are at increased risk of an osteoporosis-related fracture. Any diagnosis or treatment decision is based on the scan result along with your age and other fracture risk factors.
Why bone density drops after menopause
The Menopause Society release says women can lose 10% to 20% of bone density in the first five to seven years after menopause. The NIAMS guide notes that bones can become less dense as we age. When too much bone is lost, osteoporosis can develop, which makes bones weak and brittle and raises the risk of fractures.
Other options the research points to
The Menopause Society release lists weight-bearing and resistance exercise, adequate calcium and vitamin D, and hormone therapy as methods it calls proven to help protect bone health. It says standard estrogen therapy significantly lowers the risk of spine and hip fractures. Our vitamin d and bone health guide covers the vitamin D side in more detail.
The FDA consumer update on hormone replacement therapies says the approved hormone therapies for hot flashes, night sweats and related symptoms “may reduce chances of getting osteoporosis.” The 2022 hormone therapy position statement from The North American Menopause Society, now The Menopause Society, says the benefit-risk ratio is favorable for women younger than 60, or within 10 years of menopause onset, with no contraindications, for treating bothersome vasomotor symptoms and preventing bone loss. It says treatment should be individualized and periodically reevaluated.
Our joint, muscle and bone care section gathers related topics in one place.
Questions to bring to a clinician
- Which of my scores matters most for my fracture risk, given my age and other risk factors?
- Would a repeat DXA scan show whether my spine or hip bone density is changing over time?
- Is any hormone therapy I take already part of my bone plan?
- If testosterone were considered, what form would be used, how often would my blood levels be checked, and what would count as a response?
- What would happen if I did not notice a response after six months?
- Which side effects, including effects on cholesterol, blood clots and breast health, apply to my situation?
- Is any testosterone product approved for women where I live?
Where this leaves you
The research so far shows one small study with a spine T-score rise, a stable hip, and no fracture data. The 2019 global consensus statement said the available data do not support a bone density effect at 12 months, and it names HSDD as the only evidence-based indication for testosterone in women. Long-term safety has not been established. Bring your own DXA results, including both spine and hip T-scores, into that conversation.
By BackToHealthTroy.com Editorial Team
This article is for general information purposes only and does not constitute medical advice. Consult your doctor or qualified healthcare provider before making changes to your health routine.