Weighing the Evidence on Links Between Testosterone and Heart Attack, Stroke, and Mortality
As men age, declining testosterone levels can drain energy, sap sex drive, and dampen mood. Testosterone replacement therapy (TRT) offers invigorating relief for many.
But given testosterone’s effects on the heart and circulatory system, some men also worry: Could TRT increase my risk of a heart attack or stroke?
New research provides reassuring answers for most men. When used properly to treat low testosterone, TRT does not substantially raise cardiovascular risk and may even provide heart-protective benefits.
This article reviews the latest evidence on testosterone and heart health to help you make an informed decision about TRT.
What is Testosterone Replacement Therapy?
Testosterone replacement therapy involves administering testosterone to treat low testosterone levels in men. Some common administration methods include:
| Method | Description |
| Injections | Testosterone injections are given intramuscularly or subcutaneously, usually weekly or every 2-4 weeks. This method provides stable testosterone levels. |
| Gels & Creams | Testosterone gels or creams are applied topically to the skin daily. Testosterone is absorbed into the bloodstream through the skin. |
| Patches | Testosterone patches are applied to the skin and replaced every 1-3 days. The testosterone diffuses slowly into the bloodstream. |
| Pellets | Testosterone pellets are implanted under the skin every 3-6 months to release testosterone slowly over time. |
| Oral | Testosterone can be taken as pills or tablets but may impact the liver. Injections or skin delivery methods are more commonly used. |
TRT can provide benefits like improved libido, sexual function, muscle mass, bone density, energy, and mood in men with low testosterone.
But testosterone also impacts the cardiovascular system, so it’s important to weigh potential heart-related risks.
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Testosterone Therapy and Heart Attack and Stroke Risks
Some earlier studies raised concerns that testosterone therapy could increase cardiovascular risk. But more recent research indicates TRT does not significantly raise heart attack or stroke risk when used appropriately to treat hypogonadism (clinically low testosterone).
A 2021 study in JAMA Network followed over 37,000 men with low testosterone starting TRT. It found TRT did not increase heart attack, stroke, or death risk during the first year of treatment compared to untreated men.
Similarly, A 2023 study found men taking testosterone therapy did not have an increased risk of heart attack or stroke over 1 year if they were at risk of these conditions.
Based on current evidence, major health organizations state TRT does not markedly raise cardiovascular risk when used properly to treat hypogonadism. However, there are some exceptions:
- Men with pre-existing heart conditions may need extra monitoring/precautions with TRT.
- The FDA advises cardiovascular risks may be higher shortly after starting TRT and stabilize over time.
- Abuse or overtreatment with testosterone likely does increase adverse heart effects.
While TRT seems relatively safe for most men’s hearts, more research on long-term cardiovascular effects is still needed. You should discuss your individual risk factors with one of Physician’s Rejuvenation Center’s experts before starting therapy.
How Does Testosterone Affect Heart Health?
Testosterone acts on androgen receptors throughout the body and can impact the heart and circulatory system through several mechanisms:
| Mechanism | Description |
| Regulates red blood cell production | Testosterone helps produce red blood cells which carry oxygen. Low testosterone may reduce red blood cells. |
| Impacts cholesterol levels | Testosterone tends to lower “bad” LDL cholesterol and increase “good” HDL cholesterol. |
| Acts as a vasodilator | Testosterone relaxes blood vessels and improves blood flow, which may benefit heart health. |
| Impacts body composition | Testosterone increases muscle and reduces fat, potentially improving metabolic factors. |
| Has anti-inflammatory effects | Testosterone has anti-inflammatory effects that may protect blood vessels. Low testosterone is linked to vascular inflammation. |
Via these mechanisms, maintaining healthy testosterone levels as men age could provide cardiovascular benefits. However, too much testosterone or abuse can negatively impact the heart.
The effects follow an “inverted U” shape where both low and excessive testosterone can be problematic. TRT aims to restore normal levels.
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Other Testosterone Therapy Heart Risks and Safety Precautions
While TRT does not appear to substantially raise heart attack or stroke risk, it may impact the heart through other mechanisms:
Sleep Apnea
Some research indicates testosterone therapy could exacerbate sleep apnea in men with risk factors like obesity or older age. Sleep apnea stresses the cardiovascular system. If sleep apnea or other breathing problems develop with TRT, therapy may need to be adjusted.
Polycythemia
Testosterone stimulates red blood cell production, and excessively high hemoglobin or hematocrit levels (polycythemia) may result. This thickens the blood and increases clotting risk. Hemoglobin and hematocrit should be monitored with TRT.
Congestive Heart Failure
Men with severe heart failure are usually excluded from testosterone studies, so effects in these patients are less clear. TRT may cause fluid retention, so caution is advised in men with heart failure.
Benign Prostatic Hyperplasia
Testosterone can enlarge the prostate. This may exacerbate urinary symptoms in men with enlarged prostates.
To minimize cardiac risks, doctors recommend:
- Evaluating men for pre-existing heart conditions and risk factors before prescribing TRT
- Starting with conservative testosterone dosing and slowly titrating based on lab tests
- Monitoring for side effects like polycythemia, congestion, and sleep apnea
- Encouraging lifestyle changes like weight management, healthy diet, and exercise
With proper precautions, testosterone therapy appears relatively safe for most men’s cardiovascular health when clinically indicated. But careful consideration of individual risk factors is important.
Can Testosterone Therapy Improve Heart Health?
While TRT does not significantly raise heart risks in most men, emerging research suggests it may provide cardiovascular benefits beyond improving sexual function:
- Multiple studies associate low testosterone levels in men with higher rates of heart disease, heart failure, and cardiovascular death. Restoring testosterone to normal ranges may provide protection.
- Small studies show TRT can improve chest pain symptoms in men with angina, potentially by dilating blood vessels.
- TRT has been shown to reduce inflammatory markers like C-reactive protein and improve blood vessel function. Chronic inflammation and impaired blood flow contribute to heart disease.
- By building muscle mass, reducing fat, and improving cholesterol, testosterone therapy can positively impact metabolic risk factors.
- Testosterone replacement may benefit men with heart failure by improving exercise capacity and heart function on testing.
- Research indicates men receiving TRT after a heart attack had increased survival rates. Testosterone deficiency may impair recovery.
While more research is still needed, these findings suggest testosterone therapy holds promise for improving cardiovascular health in deficient men.
TRT should not be prescribed solely for heart protection until more data confirms benefits outweigh the risks. But when used appropriately for hypogonadism, it may provide added heart health advantages.
The Bottom Line: Testosterone and Heart Disease
Current research suggests testosterone replacement therapy does not substantially increase cardiovascular risk when used to treat testosterone deficiency in men. While those with pre-existing heart conditions need extra precaution, TRT appears relatively safe for most men.
In fact, maintaining healthy testosterone levels seems to correlate with improved heart health. TRT shows potential benefits like reduced inflammation, better cholesterol levels, improved exercise capacity, and increased survival after a heart attack when testosterone is low.
However, more research is still needed on the cardiovascular effects of long-term testosterone therapy. Men interested in TRT should discuss risk factors and benefits with an expert.
The physicians at Rejuvenation Centers are hormone therapy experts who can help determine if TRT is right for you based on extensive lab testing and evaluating heart health.
Call us at (561) 783-5153 today to schedule a consultation. Our goal is to help men feel their best while optimizing both hormonal and cardiovascular wellbeing.