Testosterone added to hormone replacement therapy may protect postmenopausal women’s bone density better than estrogen alone, according to findings presented at the 2026 Annual Meeting of The Menopause Society in San Diego this October, ScienceAlert reported.
The medical community has long framed testosterone strictly as a male sex hormone. But the ovaries also produce this overlooked androgen naturally. As estrogen levels plummet following menopause, bones weaken and lose mass rapidly. Emerging clinical data now suggests that pairing testosterone with traditional estrogen therapy yields a synergistic skeletal benefit, particularly for the spine.
Trial Compares Estrogen Alone with Estrogen Plus Testosterone
For decades, clinicians relied primarily on estrogen replacement therapy to increase bone mineral density and reduce fractures in both the hip and the spine. While estrogen helps stabilize bone mass, it does not always actively rebuild it across every skeletal site. A small trial analyzing 51 postmenopausal participants treated at a private hospital evaluated this limitation.
Every participant in the trial underwent two distinct treatment regimens, each lasting at least a year: one utilizing estrogen alone, and another combining estrogen with testosterone. Dual-energy X-ray absorptiometry scans measured their bone mineral density at baseline and after one year on each therapy. The results demonstrated that estrogen alone kept bone density stable without significant increases at the lumbar spine, femoral neck, or hip. However, the combination of estrogen and testosterone measurably increased bone density scores in the lumbar spine.
These findings suggest that testosterone may exert a synergistic effect with estrogen on trabecular bone, particularly at the spine, and may offer enhanced skeletal benefit beyond estrogen alone,
lead author Sona Davis from the University of Southern California noted in the conference abstract.
Studies Link Testosterone Levels to Improved Bone Density
This clinical presentation builds upon mounting epidemiological evidence pointing toward the skeletal role of female androgens. A 2022 population-based study examining females aged 40 to 60 in the United States established a positive association between endogenous testosterone levels and bone mineral density in the lumbar spine. Similarly, a 2023 trial demonstrated that testosterone therapy, administered alone or alongside low-dose estrogen, improved bone density in both the spine and the hip.
Despite these promising radiographic improvements, clinical researchers emphasize a critical distinction. It remains entirely unclear whether the observed gains in spinal density are clinically sufficient to reduce actual fracture risk, which serves as the ultimate diagnostic benchmark of success in osteoporosis treatment.
| Therapy Type | Target Skeletal Site | Observed Effect on Bone Density |
|---|---|---|
| Estrogen Alone | Lumbar Spine, Femoral Neck, Hip | Maintained stability without significant increases |
| Estrogen + Testosterone | Lumbar Spine | Measurably increased bone mineral density scores |
Larger, long-term longitudinal studies are necessary to track fracture rates rather than mere density shifts. Researchers at Monash University in Australia initiated trials in 2023 to investigate whether adding testosterone to hormone replacement therapy prevents bone loss and restores sexual function in women experiencing early menopause.
Healthcare Professionals Must Evaluate Hormone Replacement Therapy Risks
Hormone replacement therapy carries complex physiological risks and benefits that require careful evaluation by qualified healthcare professionals.
References
- The Menopause Society. Annual Meeting Abstracts and Clinical Presentations. San Diego, California, October 2026.
