Combined Estrogen and Testosterone Therapy for Bone Health

Testosterone Addition Linked to Higher Lumbar Spine Density

Adding testosterone to standard estrogen regimens raised lumbar spine bone mineral density in postmenopausal women followed over four years. Researchers presented the data at the 2026 Annual Meeting of The Menopause Society in San Diego. The investigation evaluated combined estrogen and testosterone therapy for bone health across multiple skeletal sites.

Lead author Sona Davis from the Keck School of Medicine of the University of Southern California (USC) tracked 51 women for an average of 4.1 years. Each participant underwent Dual-Energy X-ray Absorptiometry (DEXA) scans at baseline, after at least one year of estrogen alone, and after at least one year of combined therapy.

Spine Density Responded while Hip Scores Remained Stable

Estrogen therapy alone failed to generate measurable gains in T-scores at any monitored anatomical site in this cohort. The participants took estrogen alone for an average duration of 3.5 years before transitioning to the combined regimen.

The introduction of combined estrogen and testosterone therapy for bone health altered those results at the spine. The addition of testosterone for an average of 3.1 years raised lumbar spine T-scores, while femoral neck and total hip scores remained stable across both treatment phases.

Why Trabecular Bone Responds Differently to Hormones

Researchers suggested testosterone exerts a synergistic effect with estrogen specifically on trabecular bone tissue. The lumbar spine contains a high proportion of trabecular bone, which turns over more rapidly than cortical bone found in the hip.

Women frequently lose 10% to 20% of their total bone mineral density during the first five to seven years after menopause. Rapid mineral loss raises the clinical risk of osteopenia and osteoporosis, which increase vulnerability to debilitating fractures.

Study Limitations Require Caution in Clinical Interpretation

The small sample size of 51 women means these findings cannot establish definitive treatment guidelines. The presentation reflects observational data from a single academic center rather than a randomized controlled trial.

Dr. Stephanie Faubion, medical director of The Menopause Society, noted that while protecting bone mass remains an urgent goal, larger trials must establish safety and efficacy before clinicians adopt testosterone for skeletal protection.

Discussing Combined Estrogen and Testosterone Therapy with a Physician

Standard bone preservation relies on weight-bearing exercise, adequate daily intake of calcium and vitamin D, and approved medications. Testosterone therapy remains unapproved by the Food and Drug Administration (FDA) for female bone preservation.

Patients managing postmenopausal bone loss can discuss combined estrogen and testosterone therapy for bone health with a qualified endocrinologist to review approved interventions.