Does Testosterone Affect Heart Health?

Understanding Testosterone and Heart Health

Testosterone is primarily produced in the testes and plays a significant role in the development and maintenance of male characteristics. It is also involved in the regulation of various physiological processes, including cardiovascular function. While testosterone is essential for overall well-being, some studies have suggested a possible association between high testosterone levels and an increased risk of heart conditions such as blood clots, heart failure, and myocardial infarction. 

Ultimately however the results are very mixed, with a multitude of meta analysis showing that higher rates of testosterone levels actually lower risk of heart issues, making this topic a little tricky.

It should be noted that TRT has however been deemed safe, with terms of theraputic doses of external testosterone that are close to natural human ranges seeming to reduce heart risk according to the FDA study, rather than increasing it. [1] On top of that several large meta analysis showed low testosterone increased heart risk. [2] And several meta analysis have found no link between elevated testosterone and heart issues [3]. 

The Role of Testosterone in Heart Disease

Research conducted by Professor Mary Schooling and her team at the City University of New York's Graduate School of Public Health & Health Policy and the University of Hong Kong has shed light on the potential link between testosterone and heart disease. Using a technique called mendelian randomisation, they analyzed genetic variants that predict testosterone levels and their associations with cardiovascular conditions. The study involved nearly 400,000 men and women and revealed a higher risk of blood clots and heart failure in men with elevated endogenous testosterone levels. [4]

Limited Impact on Women

While the findings in men were significant, the impact of testosterone on cardiovascular health in women appeared to be less pronounced. Further research is needed to understand the gender-specific effects of testosterone on heart conditions fully.

Testosterone Replacement Therapy and Cardiovascular Risk

Testosterone replacement therapy (TRT) is a treatment option for individuals with low testosterone levels. However, concerns have been raised about the potential cardiovascular risks associated with TRT. To evaluate the long-term effects of TRT on heart health, extensive research, including large-scale placebo-controlled randomized clinical trials, is necessary. A review by the U.S. Food and Drug Administration (FDA) identified only four studies suggesting an increased cardio vascular risk with TRT, whereas more than 100 studies reported reduced heart risk with higher testosterone concentrations. [1]

Association Between Low Testosterone and Cardiovascular Risk

Several studies have highlighted the association between low testosterone levels and an increased risk of cardiovascular disease. Low serum testosterone concentrations have been linked to higher mortality rates and elevated cardiovascular risks. These findings suggest that testosterone replacement therapy may have potential benefits in improving cardiovascular health. This is likely due to increased body fat percentages, stress and other heart stressors that are common issues caused by low testosterone levels. [2]

Misleading Studies on Testosterone and Cardiovascular Risk

Despite the existing evidence supporting the potential benefits of TRT on cardiovascular health, a few observational studies have reported increased cardiovascular risks in men receiving testosterone prescriptions. However, these studies have been subject to criticism due to methodological limitations and inadequate control groups. 

Potential Cardiovascular Benefits of TRT

Contrary to the misleading studies, numerous studies have reported reduced cardiovascular risks and improved metabolic profiles in men receiving testosterone therapy. Higher endogenous testosterone concentrations have been associated with reduced cardiovascular risk factors and improved overall mortality rates. Furthermore, a meta-analysis of placebo-controlled studies found no evidence of increased cardiovascular risk with TRT and indicated improved metabolic profiles.

Expert Consensus on Testosterone Therapy

An international expert consensus highlighted the lack of credible evidence supporting an increased cardiovascular risk associated with testosterone therapy. On the contrary, the consensus suggested a potential cardiovascular benefit of testosterone therapy in men. The consensus concluded that there is substantial evidence indicating that testosterone therapy does not increase cardiovascular risk and may offer cardiovascular benefits.


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