HEALTH Women's Health November 4, 2026 0 Comments

Estrogen or Testosterone? Unlock the Surprising Truth About Which Hormone Therapy Could Transform Your Body and Mind!

Ever felt like your body’s chemistry is hosting a chaotic party where estrogen and testosterone just can’t decide who’s the VIP? If you’re navigating the turbulent waves of perimenopause or menopause, you know exactly what I mean—hot flashes turning up the heat, restless nights stealing your Zzz’s, and mood swings that could rival the latest blockbuster plot twists. Now, here’s the kicker: menopausal hormone therapy (MHT) offers a lifeline, but when faced with the estrogen vs. testosterone debate—how do you pick your champion, or figure out if the tag team is the way to go? And with testosterone flashing headlines about heart health scares, should you be sounding alarms or sitting tight? Well, I dug deep and gathered insights straight from the experts’ playbook so you can make sense of the hormone hustle and reclaim your life with confidence. LEARN MORE

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If you’re in perimenopause or menopause you’re probably dealing with symptoms of your fluctuating hormones, such as hot flashes, insomnia, irritability and more. Menopausal hormone therapy (MHT) can help, but when it comes to estrogen vs. testosterone therapy, how do you know which one—or what combination—is right for you? And with testosterone making headlines for a potential link to heart health issues, should you be worried? We asked the experts to break down everything you need to know.

What is estrogen therapy?

Estrogen and testosterone are both hormones that play crucial roles in our bodies, and their levels can decrease as we age.

“Estrogen is one of the most important hormones in a woman’s body, and its role goes far beyond reproduction,” explains Anna Cabeca, DO, FACOG, triple-board certified ob-gyn, regenerative and integrative medicine physician. “It influences everything from temperature regulation, sleep, mood and cognitive function to bone health, vaginal tissue, skin elasticity and metabolic health.”

Dr. Cabeca adds that estrogen production also impacts how our bodies respond to insulin and distribute fat, which is why fluctuating levels during perimenopause and menopause can lead to changes in body composition and metabolism.

“Estrogen therapy is used primarily to relieve symptoms associated with declining estrogen levels, including hot flashes, night sweats and sleep disturbances,” adds Dr. Cabeca. She adds that estrogen therapy can help prevent bone loss and may even improve quality of life.

“For women who still have a uterus, systemic estrogen therapy is generally prescribed alongside a progestogen, such as progesterone, to protect the uterine lining,” continues Dr. Cabeca. “Women who have undergone a hysterectomy may be candidates for estrogen-only therapy.”

You deserve desire

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Have you ever considered hormone replacement therapy?

Who may be a good fit for estrogen therapy?

“Perimenopausal and menopausal women experiencing hot flashes or night sweats would be good candidates to consider starting systemic estrogen therapy, as it is FDA-approved to treat these symptoms,” explains Tiffany Bates, DO, co-founder and obstetrics and gynecology provider at Femwell Gynecology.

Dr. Bates says those who may want to avoid estrogen therapy, or at least have a detailed conversation with their doctor first, include women with:

Hormone-sensitive cancer or breast cancer history
Previous blood clots or known clotting disorder
Previous heart attack, stroke or established coronary heart disease
Unexplained vaginal bleeding
Suspected or known pregnancy
Significant liver disease

What is testosterone therapy?

“Testosterone is often labeled a male hormone, but women produce it too, primarily in the ovaries and adrenal glands,” explains Dr. Cabeca. “It plays a role in sexual desire and contributes to normal muscle, bone and metabolic physiology.”

One of the main benefits of testosterone therapy is treating persistent, distressing loss of sexual desire, also known as hypoactive sexual desire disorder or HSDD, which some women may experience after menopause, says Dr. Cabeca.

“While testosterone is sometimes discussed in connection with energy, mood, muscle strength and cognitive function, we don’t yet have sufficient evidence to recommend it specifically for those concerns,” says Dr. Cabeca.

Treatments that increase testosterone levels are prescribed off-label, as there’s currently no FDA-approved testosterone product designed for women in the United States, adds Dr. Cabeca. She says that’s why individualized dosing, monitoring throughout treatment and working with a knowledgeable doctor are all key.

Who may be a good fit for testosterone therapy?

If you’re already on (or seriously considering) testosterone therapy to deal with an issue such as loss of sexual desire, you may have come across news on testosterone therapy and heart health. Research presented at the 2026 annual meeting of The Menopause Society found an association between testosterone therapy use and a higher risk of cardiovascular disease. Researchers found that 3.8 percent of postmenopausal women using testosterone therapy experienced a cardiovascular event, compared to only 0.5 percent of nonusers.

Anytime new research comes out about medications we’re currently taking or considering taking, it can feel scary. But take a deep breath! Dr. Bates breaks down what these results mean. “This study showed that there was an association between the use of testosterone and cardiovascular events,” says Dr. Bates. “However, it did not show that the use of testosterone caused the events. Simply put, caution should be exercised when starting this therapy. If a woman is at high risk for cardiovascular disease, then perhaps alternative therapies would be better suited for her. However, in the absence of these risks, the benefits of the medication are promising and it is a reasonable option to explore in women experiencing hypoactive sexual desire disorder.”

As with any medication, your medical provider can help determine if it’s right for you. But Dr. Cabeca says postmenopausal women experiencing HSDD that causes significant distress and can’t be explained by relationship, psychological or medical factors may particularly benefit from testosterone therapy.

3 questions to ask your doctor about menopausal hormone therapy

It’s important to note that when it comes to menopausal hormone therapy, it’s not necessarily either-or. Many women can—and do—take both estrogen and testosterone therapy to manage their symptoms. If you’re considering MHT and not sure what to ask your doctor, Dr. Cabeca shares three important questions to get the ball rolling:

“Based on my symptoms, medical history and personal goals, am I a good candidate for estrogen, testosterone or both, and why?”
“What are the specific benefits, risks and uncertainties for me, and how will we monitor my response and long-term safety?”
“Which hormone formulation, dose and delivery method would be most appropriate for me? Are there FDA-approved, body-identical options, and how will we determine the lowest effective dose?”

The bottom line on estrogen vs. testosterone therapy

If hot flashes knock down your confidence during important moments in your life or your lack of sexual desire is taking a toll on your relationship, know that you don’t just have to live with the symptoms of perimenopause and menopause. If you’re a good fit, hormone therapies like estrogen and testosterone may help.

You deserve desire

HSDD is a recognized condition, and most women who have it have never been told. If what you’ve read here sounds familiar, answering a few questions can tell you whether this might be what you’re dealing with. Start the 60-second assessment

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.