Danish national registries gave researchers an observational view of women ages 50 to 69 across nearly two decades, and the findings reinforce a principle bioidentical providers already teach. Oral estrogen was associated with higher rates of venous thromboembolism at any dose or duration. Oral estradiol above 1 mg daily, used longer than a year, also tracked with higher rates of ischemic stroke and myocardial infarction, and the risk rose with time on therapy. Transdermal therapy showed no increase in thrombotic events. The one exception was myocardial infarction with transdermal combined cyclic therapy, and the authors based that estimate on sparse data. The French ESTHER study supplies the progestogen piece: micronized progesterone showed no significant association with venous thromboembolism, while norpregnane derivatives carried higher risk. For clinicians, the takeaway is clear: route, dose and progestogen belong at the center of every prescribing decision.

Berggreen J, Pourhadi N, Wood-Kurland H, Løkkegaard E, Torp-Pedersen C, Meaidi A. Contemporary menopausal hormone therapy and thrombotic disease: nationwide nested case-control study. BMJ. 2026 Sep 23;394:e100688. doi:10.1136/bmj-2026-100688. PMID: 42778212.

Canonico M, Oger E, Plu-Bureau G, Conard J, Meyer G, Lévesque H, Trillot N, Barrellier MT, Wahl D, Emmerich J, Scarabin PY. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation. 2007 Feb 20;115(7):840-845. doi:10.1161/CIRCULATIONAHA.106.642280. PMID: 17309934.

Beyond Libido: Testosterone Is a Core Hormone in Women’s Physiology

Testosterone is the most abundant biologically active sex steroid in women, yet it remains underrecognized. This narrative review draws on literature from 1974 through 2025. It describes testosterone arising from ovarian, adrenal, neural and peripheral pathways, and it persists after menopause. Physiologic levels contribute to bone maintenance, muscle mass, metabolic balance, endothelial function, cognition, mood and sexual function. Emerging evidence points to roles in neuroprotection, immune modulation and pelvic floor integrity, though the strength of evidence varies by domain. Levels shift with age, reproductive status and hormonal milieu,which complicates interpretation of a single serum value. The authors call for standardized assessment and further research. For providers, the message is to treat testosterone in women as whole-body physiology rather than a libido question alone.

Hernandez BS, Covarrubias A, Perez-Grego PG, Coady PJ, Walia A, Casperson K, Newson L, Lyon G, Khera M. Beyond libido: the multifaceted role of testosterone in women. Sex Med Rev. 2026 Sep 30;14(4):qeag072. doi:10.1093/sxmrev/qeag072. PMID: 42867946.