Key result
Transdermal testosterone fails to improve peak oxygen uptake in postmenopausal stage B heart failure.
Why the study?
Asymptomatic postmenopausal women with stage B heart failure often have reduced exercise capacity, and the effects of exogenous testosterone on this capacity were unclear.
Does transdermal testosterone improve peak oxygen uptake in postmenopausal women with stage B heart failure and reduced exercise capacity?
RCT (n=38)
Double-blind
Randomly allocated crossover
No
Does transdermal testosterone improve peak oxygen uptake in postmenopausal women with stage B heart failure and reduced exercise capacity?
Effect estimate: β -0.05 (95% CI -0.74 to 0.65)
p-value: p=0.897
Transdermal testosterone therapy does not improve exercise capacity, cardiac structure, or quality of life in postmenopausal women with stage B heart failure.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In 2025, there is no justification for treating postmenopausal women or premenopausal women with testosterone to prevent muscle loss, to prevent bone muscle fracture, to prevent heart disease, to treat depression or cognitive decline, and I would also add in fatigue, because the psychological general wellbeing questionnaires also include a domain of vitality. It is not the silver bullet; it is not the missing hormone. Women are not missing out if they're not getting testosterone.”
“Despite this preponderance of scientific evidence and recommendations, the myths about testosterone die hard, including that it improves women's muscle function, endurance, and well-being.”
“we're also looking at the effects of testosterone on bone in women under the age of 55, and on cardiac function and heart failure outcomes in postmenopausal women. And we're also doing a big study of testosterone and muscle function, power, performance, and mass in postmenopausal women. We're trying to better understand what role testosterone has in women beyond sexual function.”
May warrant further trials in stage B HF; leaves open effects on exercise capacity in asymptomatic women.
Objective Asymptomatic individuals with stage B heart failure (HF) often have reduced exercise capacity. As exogenous testosterone may have favorable skeletal muscle and vasculature effects, this study investigated whether transdermal testosterone improves exercise capacity in women with stage B HF.Method In this single-center, double-blind, randomized, placebo-controlled crossover trial involving women aged ≥55 years with stage B HF (defined as cardiac remodeling and/or diastolic dysfunction) and reduced exercise capacity (<100% age-predicted peak oxygen uptake V˙O2peak]), participants were randomly allocated to transdermal testosterone 5 mg/day or identical placebo for 4 months with cross-over after a 4-week washout. The primary outcome was change in V˙O2peak. Secondary outcomes included changes to cardiac structure and function assessed by echocardiography and cardiac magnetic resonance imaging, and subjective quality of life.Results Thirty-eight participants (median age 72 years, range 60–80 years; median body mass index 33.2 kg/m2 [P25–P75 28.7–35.9 kg/m2]) completed the study. Testosterone treatment increased circulating serum testosterone concentrations and was well tolerated, with no adverse treatment-related events. Testosterone treatment had no significant effect on V˙O2peak (β = –0.05, 95% confidence interval = –0.74, 0.65, p = 0.897), cardiac structure or indices of cardiac function, or quality of life.Conclusion Transdermal testosterone treatment did not improve exercise capacity in postmenopausal women with stage B HF.
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Grant et al. (2026) conducted an RCT in Stage B heart failure (n=38). Transdermal testosterone vs. Identical placebo was evaluated on Change in V˙O2peak (β -0.05, 95% CI -0.74 to 0.65, p=0.897). Transdermal testosterone treatment did not significantly improve peak oxygen uptake (β = -0.05; 95% CI -0.74 to 0.65; P=0.897) in postmenopausal women with stage B heart failure.
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