New study shows combined estrogen-testosterone therapy boosts bone density: what it means for Canadian menopause patients

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

A study of 51 postmenopausal women, presented October 20, 2026, at the Annual Meeting of The Menopause Society in San Diego, found that adding testosterone to estrogen therapy produced significant increases in lumbar spine bone mineral density (T-scores), while estrogen therapy alone did not show significant gains at any measured site. For Canadian patients, the finding arrives in a regulatory grey zone: Health Canada has not approved any testosterone product specifically for use in women, meaning any prescribing here is off-label and varies considerably by province and prescriber.

Osteoporosis is not a minor footnote in Canadian women's health. Osteoporosis Canada estimates that one in three Canadian women over 50 will fracture a bone because of the condition. Women can lose 10 to 20 percent of their bone density in the first five to seven years after menopause, according to The Menopause Society, and that rapid loss drives up fracture risk at the spine and hip. Standard hormone therapy with estrogen (sold in Canada as estradiol products including Estrace tablets and the Estradot patch) has long been the hormonal tool for bone protection, but this new data suggests testosterone may add something estrogen alone does not.

What this means in Canada

Health Canada has approved testosterone products for men (AndroGel, Testim, Depo-Testosterone, among others), but none carry an indication for postmenopausal women. A compounded testosterone cream or gel, prepared by a licensed Canadian compounding pharmacy, is the most common route for women who are prescribed it off-label. This is legal under Health Canada's compounding framework, but it means there is no standardized product, no Health Canada-reviewed efficacy data for this population, and no provincial drug plan that routinely covers it. OHIP in Ontario, RAMQ in Quebec, MSP in British Columbia, and AHCIP in Alberta do not list a women's testosterone formulation on their formularies. Patients generally pay out of pocket.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has not issued a position statement specifically on testosterone therapy for bone health in postmenopausal women. The SOGC's 2021 menopause guidance acknowledged testosterone's role in treating hypoactive sexual desire disorder but stopped short of recommending it for skeletal indications. That position has not been updated to reflect this new data.

Canadian telehealth platforms that prescribe menopause hormones, including Cleo (a Canadian women's health platform), Felix, and Science and Humans (scienceandhumans.com), operate within the same off-label framework. A physician on any of these platforms can prescribe compounded testosterone, but coverage and pharmacy access differ by province. US-based platforms such as Midi Health and Winona do not serve Canadian patients.

What changed

The study, led by Sona Davis of the Keck School of Medicine at the University of Southern California, followed 51 women for an average of 4.1 years. Participants received estrogen therapy for a mean of 3.5 years and estrogen-plus-testosterone therapy for 3.1 years. Dual-energy X-ray absorptiometry (DEXA) scans measured bone mineral density at the lumbar spine, femoral neck, and hip at baseline, after at least one year of estrogen alone, and after at least one year of the combined regimen.

Estrogen alone did not produce statistically significant T-score increases at any site. The combined therapy significantly increased lumbar spine T-scores. T-scores at the femoral neck and hip remained stable across both periods, meaning the combination did not appear to worsen those sites but did not significantly improve them either.

The researchers concluded that testosterone may exert a synergistic effect with estrogen on trabecular bone, the spongy inner bone tissue that makes up most of the lumbar vertebrae. Dr. Stephanie Faubion, medical director of The Menopause Society, noted that while more research is needed, studies exploring options to protect women's bones during this period are important.

What Canadian patients should know

If you are postmenopausal and concerned about bone density, the first step is a DEXA scan. In most provinces, a DEXA scan is covered when ordered by a physician for patients who meet clinical criteria, including postmenopausal women with risk factors. Ask your family doctor or gynaecologist whether you qualify.

If you are already on estrogen therapy and your bone density is not improving as expected, this study gives you a reasonable basis to ask your prescriber about testosterone. Bring the study citation (The Menopause Society, October 2026 Annual Meeting) to the conversation. Your prescriber can refer you to an endocrinologist or menopause specialist if they are not comfortable prescribing off-label testosterone.

Compounded testosterone for women in Canada typically costs between CAD $40 and $100 per month depending on the formulation and pharmacy. That cost is not covered by most provincial drug plans, though some private insurance plans may reimburse it under a drug benefit with a physician's letter of medical necessity.

Weight-bearing exercise, resistance training, adequate calcium (1,200 mg daily for women over 50, per Osteoporosis Canada), and vitamin D (800 to 2,000 IU daily depending on individual assessment) remain the non-hormonal backbone of bone protection and are not replaced by any hormone therapy.

Limitations and open questions

The study is small. Fifty-one participants followed for just over four years is not enough to draw firm conclusions about fracture prevention, long-term safety, or optimal testosterone dosing. The study was observational, not a randomized controlled trial, which means confounding factors cannot be ruled out.

The lumbar spine result is promising, but the absence of significant improvement at the femoral neck and hip matters. Hip fractures carry the highest mortality and disability burden in older women, and a therapy that protects the spine but not the hip would have limited clinical reach.

Health Canada has not reviewed testosterone for this indication. Until a manufacturer submits a New Drug Submission for a women's testosterone product, or until Health Canada issues guidance on off-label use in this context, prescribing will remain inconsistent across Canada. The SOGC has not yet weighed in on this specific finding. Canadian patients should not interpret this single conference presentation as a green light for self-directed testosterone use.

Larger randomized trials with fracture outcomes as primary endpoints are needed before any clinical society, including The Menopause Society, is likely to issue a formal recommendation.

---

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

Editorial note

Hormone Journal articles are written by our editorial team and reviewed against published clinical guidelines, with a focus on Canadian patient access. We do not promote specific clinics or providers.