Heart and lungs

Low testosterone in women ‘link to heart risk’

Older women with low levels of the sex hormone testosterone were more likely to have a build-up of fatty tissue blocking their arteries, which could lead to heart disease, the Daily Mail reported. 

Under the headline "Testosterone could protect older women from heart disease", the newspaper suggested that more post-menopausal women should be prescribed testosterone patches on the NHS "because higher levels of the hormone may protect against cardiovascular disease".

The researchers found lower levels of some of the sex hormones in women with atherosclerosis compared with women with mild or no atherosclerosis.

Where did the story come from?

The story was based on a study conducted by Dr Erik Debing and colleagues in the Department of Vascular Surgery at the Free University of Brussels in Belgium. This study was published in the peer-reviewed journal European Journal of Endocrinology.

What kind of scientific study was this?

This was a case-control study investigating whether levels of sex hormones in postmenopausal women are associated with presence of heart disease (atherosclerosis).

The study compared 56 women who were referred for an operation to remove build-up of fatty tissue (atherosclerosis) in the artery with 56 age-matched women with mild (less than 10%) or no atherosclerosis. Ultrasound imaging was used to determine whether the arteries were affected by atherosclerosis. The researchers measured the women’s levels of sex hormones and recorded the presence of other known cardiovascular risk factors (for example, smoking, diabetes and high blood pressure). They then performed mathematical analysis to determine if any of these factors were related to hormone levels.

What were the results of the study?

The researchers found lower levels of some of the sex hormones in women with atherosclerosis compared with women with mild or no atherosclerosis.

What interpretations did the researchers draw from these results?

The researchers concluded that low hormone (testosterone, androstenedione) levels are associated with atherosclerosis in postmenopausal women, and that a normal or higher level of naturally occurring testosterone may have a role in protecting these women from developing atherosclerosis.

What does the NHS Knowledge Service make of this study?

This was a reasonably well-conducted study, which showed that postmenopausal women with atherosclerosis have low levels of testosterone and androstenedione levels. The authors acknowledge limitations that can be identified in the study.

  • There were small numbers of highly selected people in the study, which means that results may not apply to all postmenopausal women. The results from larger studies are generally more reliable than from smaller ones.
  • Not all hormone levels were measured directly; for some of the hormones, calculations were used to determine the levels in the blood - the authors cite research indicating that these calculations are likely to be reliable. 
  • Although the authors adjusted statistically for differences between the women with atherosclerosis and those chosen as controls, the women with atherosclerosis were less healthy generally than the control group (for example they were more than four times as likely to be smokers). The differences in overall health may explain part of the difference in hormone levels that the study found.
  • This study is limited to the effect of naturally occurring testosterone, so it is not possible to conclude whether testosterone supplements for postmenopausal women with low testosterone levels will reduce their risk of developing atherosclerosis.

Sir Muir Gray adds…

Until more research is available, women should not seek testosterone patches.

NHS Attribution