Is Testosterone Bad for Your Heart?

Are replacement-level dosages of T going to mess with your ticker? Here’s what you probably don’t know.

“Testosterone gives you big muscles and hefty erections, but it won’t matter because your heart will stop.”

That’s what people say. Are they right?

The Bad Study

A couple of years ago, the FDA became worried about testosterone. Most of their worries stemmed from a single study that appeared in the journal PLOS One.

The authors of the study examined a large healthcare database for guys who’d been on testosterone replacement therapy for 90 days. Younger men with a history of heart disease who started TRT had a two to three-fold increase in the risk of myocardial infarction. Guys over 65 who started TRT had a two-fold increase in the risk of myocardial infarction, regardless of their cardiovascular history.

The study had several problems, though:

  • The study didn’t consider levels of testosterone before treatment or after treatment. Therefore, we have no idea if the men had low testosterone in the first place, or if in fact they were being grossly overdosed.
  • The study didn’t monitor estrogen levels or red blood cell levels. If high estrogen levels aren’t addressed by medication and high red blood cell counts aren’t adjusted by changes in dosing, heart problems are possible.
  • The study’s entire control group was on a drug that prevents heart attacks, making the comparison between them and the testosterone group ludicrous.

So let’s throw that study aside, preferably over a bridge and into a raging river.

The Better Meta-Study

About a month before that study was published, The Journal of the American Heart Association published a meta-study that compiled the results of over 100 studies on testosterone and heart health. They found, unequivocally, that higher levels of testosterone were essential to heart health.

In fact, the journal reported that low T was associated with a higher rate of mortality in general, along with higher rates of cardiovascular mortality, obesity, and diabetes.

The list of possible conditions associated with low testosterone was downright scary:

  • Higher risk of cardiovascular disease
  • Narrowing of carotid arteries
  • Abnormal EKG
  • More frequent congestive heart failure
  • Increased incidence of angina
  • Increased body mass index
  • Type II diabetes
  • Metabolic syndrome
  • Insulin resistance
  • Increased belly fat
  • Higher death rate from all causes, including cardiac mortality

So what it comes down to is that you have one ill-conceived study portraying testosterone in a bad light, compared to at least 100 others proving that low levels of testosterone are bad, very bad, for your health.

And One More Study…

Let’s look at one more study, just to put your mind at ease. Three years ago, researchers at the Intermountain Medical Center Heart Institute recruited 755 heart patients between the ages of 58 and 78 who also tested low in testosterone.

The men were divided into three groups, two of which received testosterone replacement therapy in the form of gel or an injectable, and one group that served as the placebo group.

After one year:

  • 64 patients who weren’t on testosterone replacement therapy suffered a major cardiovascular event (stroke, heart attack, or death).
  • Only 12 patients on medium doses of testosterone experienced a major cardiovascular event.
  • And only 9 patients on high doses of testosterone experienced a major cardiovascular event.

In other words, non-testosterone patients were 80% more likely to suffer an adverse event.

The same trends continued 3 years later. One hundred twenty-five of the untreated men experienced stroke, heart attack, or death, as compared to 38 of the medium-dose testosterone replacement patients and only 22 of the high-dose testosterone replacement patients.

Clearly, normal or even slightly higher than normal testosterone levels are good for the heart and cardiovascular health in general.


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I’ve seen some evidence (studies) that seem to suggest that the DHT from Testosterone is responsible for much of the damage to the heart (in a high testosterone environment), not the testosterone itself. Estrogen is a protective hormone, and AI use has been shown to worsen outcomes for the heart. Basically, if using exogenous T in high amounts (including “sports TRT”), artificially reducing DHT, and letting E2 be elevated is the ticket for heart health.

Wondering if you had any thoughts on this?