Hormone replacement therapy (HRT) increases the risk of developing breast, ovarian and endometrial cancers. Equilin and equilenin are the major components of the widely prescribed drug used for HRT. 4-hydroxyequilenin (4-OHEN), a major metabolite of equilin and equilenin, promotes 4-OHEN-modified dC, dA, and dG DNA adducts. These DNA adducts were detected in breast tumor and adjacent normal tissues of several patients receiving HRT. We have recently found that 4-OHENdC DNA adduct is a highly miscoding lesion generating C → T transitions and C → G transversions. To explore the mutagenic potential of another major 4-OHEN-dA adduct, site-specifically modified oligodeoxynucleotides containing a single diastereoisomer of 4-OHEN-dA (Pk-1, Pk-2, and Pk-3) were prepared by post-synthetic method and used as DNA templates for primer extension reactions catalyzed by human DNA polymerase (pol) η and κ that are highly expressed in the reproductive organs. Primer extension catalyzed by pol η or κ occurred rapidly on the unmodified template to form fully extended products. With the major 4-OHEN-dA-modified templates (Pk-2 and Pk-3), primer extension was retarded prior to the lesion and opposite the lesion; a fraction of the primers was extended past the lesion. Steady-state kinetic studies with pol η and κ indicated that dTMP, the correct base, was preferentially incorporated opposite the 4-OHEN-dA lesion. In addition, pol η and κ bypassed the lesion by incorporating dAMP and dCMP, respectively, opposite the lesion and extended past the lesion. The relative bypass frequency past 4-OHEN-dA lesion with pol η was at least two orders of magnitude higher than that observed with pol κ. The bypass frequency past Pk-2 was more efficient than that past Pk-3. Thus, 4-OHEN-dA is a miscoding lesion generating A → T transversions and A → G transitions. The miscoding frequency and specificity of 4-OHEN-dA varied depending on the stereoisomer of 4-OHEN-dA adduct and DNA polymerase used.