Testosterone Replacement Therapy and Heart Health

Testosterone Replacement Therapy and Heart Disease

Testosterone replacement therapy is a medical treatment addressing low testosterone levels in men. As with many other medical treatments, TRT is associated with potential benefits and certain risks. TRT safety depends upon factors like patients’ current health status, previous medical history, type, and the dose of testosterone used. 

TRT is safe if administered appropriately under the supervision of a medical specialist. However, there are certain risks and myths associated with TRT. Previous studies reported the likelihood of increased blood clots, sleep apnea, infertility, heart diseases, and prostate issues.  

How does TRT Work?

Testosterone replacement therapy is prescribed to patients with hypogonadism or low circulating testosterone levels. According to American Urological Association, If testosterone levels decrease below 300 ng/dL, a person becomes eligible for TRT.  

The symptoms of decreased testosterone levels include:

  • Fatigue
  • Breast growth
  • Sexual dysfunction
  • Low libido
  • Unexplained weight gain
  • Difficulty sleep
  • Low libido and low sperm count
  • Loss of pubic hair 
  • Shrinking testicular size
  • Hot flashes

Why do Testosterone Levels decrease?

The body increases testosterone production as you age. But after age 30, testosterone production starts decreasing 1-2% each year. 

  • Testes produce less testosterone as you age.
  • Decreased testosterone levels cause the hypothalamus to produce less GnRH (gonadotropin-releasing hormone)
  • Low levels of GnRH cause the pituitary to decrease Luteinizing hormone (LH) production.  
  • Lowered LH levels ultimately lead to decreased production of testosterone. 

Medical Uses Of TRT:

TRT is performed to treat the hypogonadism condition. Hypogonadism can be primary or secondary. 

Primary Hypogonadism:

This is a condition of low circulating testosterone levels caused by any issue in the gonads. The brain signals the gonads to produce testosterone, but the gonads cannot.

Secondary Hypogonadism:

Low levels of testosterone are caused by any reason other than gonads. Any abnormality usually causes secondary hypogonadism in the pituitary or hypothalamus. 

TRT is the exogenous supply of testosterone that isn’t produced by the gonads. Medically it has the following benefits:

  • Improves sexual function
  • Increases the level of other hormones like prolactin which interact with testosterone. 
  • Improves sperm count and fertility.

TRT is also helpful for other medical conditions like undescended testes, sex organ surgeries, and genetic or autoimmune disorders. 

Non-medical Uses:

Apart from medical conditions, TRT has the following uses:

  • Boosts energy and agility 
  • Helps lose undesired weight
  • Boosts sexual drive 
  • Improves endurance for athletic activities
  • Helps gain lean muscle mass for bodybuilding

A study shows that TRT helps gain muscle strength in middle-aged and older males.


TRT and Risk of Heart Disease:

Testosterone plays a vital role in maintaining cardiovascular health. Human testosterone levels begin to decrease after age 40, which increases cardiovascular diseases and mortality4

TRT has been debated in the medical community because of its potential benefits and possible side effects. Multiple studies confirm that TRT is entirely safe and does not cause cardiovascular diseases. 

Some previous studies depicting potential risks associated with TRT are given below. However, recent studies rule out the finding of old studies.   

A large-scale study published in the Journal of American Association in 2013 showed that people who underwent testosterone therapy had cardiovascular issues 30% more than those who didn’t. Later, this study was criticized because the methodology and the analytics were not up to the mark. The criticism over the methodology and the subsequent research in TRT showed that this study was flawed. 

Another study by Finkle, W. D. et al. in 2014 stated that there was a marked increase in non-fatal myocardial infarction in patients after testosterone replacement therapy. The study showed that exogenous testosterone administration increased thrombotic and clotting factors, predisposing a person to myocardial infarction and high blood pressure. The methodology and the findings of this study were also highly criticized.   

Studies Confirm That TRT Is Completely Safe:

A large observational study in European Heart Journal in 2015 was carried out on more than 83,000 people with low testosterone levels who underwent TRT. The results show no increase in stroke, myocardial infarction, heart attack, or high blood pressure5

Another study published in JAMA in 2017 reveals that testosterone replacement therapy is safe and does not lead to stroke or other cardiovascular events. This study focuses on the fact that unless there is a prior history of underlying heart disease, TRT is safe and does not lead to cardiovascular anomalies; instead, it is associated with a decrease in all-cause mortality6.

Testosterone replacement therapy is beneficial to heart health. TRT improves endothelial function and arterial stiffness7. A clinical trial-based study manifests that TRT decreases the chances of cardiovascular diseases. 

Benefits of TRT: 

Although TRT is used to treat medical conditions, it has excellent effects on the body8

Improved Bone Density:

Low testosterone levels are associated with osteoporosis. TRT helps prevent bone loss and increases bone density. 

Increased Libido:

Testosterone is a key hormone associated with sexual function. Low testosterone levels are associated with decreased sex drive. 

Increased Energy and Agility:

Testosterone helps boost energy and vitality. A lack of testosterone may lead to lethargy and dullness. TRT recovers deficient testosterone levels and gives new life to the body. 

Improved Cognition:

Testosterone has a direct effect on intellectual and cognitive function. TRT increases concentration and improves memory and cognition. 

Mood Regulation: 

Testosterone has a key role in mood regulation. TRT helps get rid of anxiety, depression, and stress. 

Bottom Line:

Testosterone replacement therapy has dozens of benefits for the human body. Testosterone improves heart health through increased high-density lipids, reduced cholesterol, reduced blood pressure, and improved insulin sensitivity. TRT was thought to be associated with heart disease, and many studies backed this up. But recent advancements in the research carried out to check the effects of TRT on heart health showed that it is a completely safe procedure and does not cause heart disease. TRT not only provides physical benefits but also cures mood and mental issues.   

Although TRT is safe, consulting a medical professional for better advice is better. 


1. American Urological Association. Accessed February 19, 2023.

2. McBride JA, Carson CC, Coward RM. Testosterone deficiency in the aging male. Ther Adv Urol. 2016;8(1):47. doi:10.1177/1756287215612961

3. Skinner JW, Otzel DM, Bowser A, et al. Muscular responses to testosterone replacement vary by administration route: a systematic review and meta‐analysis. J Cachexia Sarcopenia Muscle. 2018;9(3):465. doi:10.1002/JCSM.12291

4. Kloner RA, Carson C, Dobs A, Kopecky S, Mohler ER. Testosterone and Cardiovascular Disease. J Am Coll Cardiol. 2016;67(5):545-557. doi:10.1016/J.JACC.2015.12.005

5. Desroches B, Kohn TP, Welliver C, Pastuszak AW. Testosterone therapy in the new era of Food and Drug Administration oversight. Transl Androl Urol. 2016;5(2):207. doi:10.21037/TAU.2016.03.13

6. Sharma R, Oni OA, Gupta K, et al. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J. 2015;36(40):2706-2715. doi:10.1093/EURHEARTJ/EHV346

7. Hackett G, Kirby M, Edwards D, et al. British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice. J Sex Med. 2017;14(12):1504-1523. doi:10.1016/J.JSXM.2017.10.067

8. Barbonetti A, D’Andrea S, Francavilla S. Testosterone replacement therapy. Andrology. 2020;8(6):1551-1566. doi:10.1111/ANDR.12774