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The Effect of TRT on Your Heart

The Effect of TRT on Your Heart (Testosterone Replacement Therapy)

The Effect of TRT on Your Heart (Testosterone Replacement Therapy)

Some studies attribute gender distinctions in cardiovascular disease risk to differences in sex hormone concentrations between men and women.

In premenopausal women, investigators think that endogenous estrogens confer a protective effect on the vasculature by delaying the onset of cardiovascular disease (for example, what many call the female advantage).

In contrast, a more androgenic (male-like) sex hormone pattern in premenopausal women, for example, those with polycystic ovary syndrome and in postmenopausal women, has been associated with increased cardiovascular risk.

Thus, studies have speculated that higher testosterone concentrations in men may explain some of their higher age-adjusted cardiovascular event rates compared with women.

A general question: is testosterone beneficial or harmful to your cardiovascular health?

Bioavailable testosterone concentrations progressively decline in older men at a rate of about two percent yearly. This age-related decline is the “andropause” or “male menopause.”

In epidemiological studies, low endogenous testosterone concentration has to do with cardiovascular risk in men. Low testosterone concentration, on the other hand, correlates with many adverse cardiometabolic effects, such as inflammation, dyslipidemia, insulin resistance, and atherosclerosis.

Men have used testosterone replacement therapy (TRT) to increase libido, improve dysfunction, and increase energy levels, mood, and muscle strength. However, several observational and clinical trial studies suggest a possible increased cardiovascular risk of testosterone replacement therapy when administered to older men.

In addition, Mendelian randomization studies indicate that higher genetically predicted testosterone concentrations correlate with an increased risk of heart failure in men.

In 2014, the FDA (United States Food and Drug Administration) warned against using testosterone replacement therapy for aging-related low testosterone because of possible increased cardiovascular risks. Instead, the FDA recommended reserving this type of therapy for symptomatic hypogonadism.

Nevertheless, the data remain inconclusive, and many men with hypogonadism who might have benefited from testosterone replacement therapy avoided this potentially helpful treatment.


If you are a man and know how a man’s body functions, you know what testosterone (the male sex hormone) is and how it contributes to the person you are. This hormone, among other products of the endocrine system, is responsible for building muscle mass and bone, deepening your voice, and giving you the fuel for sexual performance.

So, testosterone plays a role in anything that shapes your masculinity, such as strength, authority, and assertiveness.


As vital as endogenous testosterone is, our bodies gradually lose some of this hormone over time, resulting in the need for therapy to bring this essential substance back to normal levels. This moment is where testosterone therapy or TRT (testosterone replacement therapy) enters the picture.

Simply put, testosterone therapy is a treatment alternative that emphasizes the stabilization of testosterone levels in the human body, especially in those older individuals whose organs cannot generate sufficient hormones.

However, the heart and testosterone have long had an intricate, interconnected relationship. For example, individuals with cardiovascular disease frequently have testosterone deficiency. Conversely, those with low testosterone levels are more susceptible to heart-related conditions.

This complexity problematizes further because testosterone has a wide range of median values. For example, a healthy man may have between 270 and 1070 nanograms of testosterone per deciliter (ng/dL). Hence, scientists have not been able to establish the exact connection between heart disease and testosterone.


Researchers have conducted various studies to untie the knot between testosterone and heart disease.

According to some studies, testosterone affects many aspects of heart health. A deficiency in this active hormone results in poor cardiovascular outcomes. Specifically, low testosterone relates to coronary artery disease, congestive heart failure, and metabolic syndrome.

However, having too much of this hormone will not make you healthier just because having too little results in poor cardiovascular health. Many testosterone supplements carry a warning on the FDA-mandated box label that they may increase the risk of heart attack and stroke. The FDA has also restricted testosterone prescription to individuals with testosterone deficiency due to pituitary or testicular disease.

In consequence, whether increasing the “male hormone” through testosterone replacement therapy may cause heart disease, so far, remains unresolved.

Many researchers have requested large-scale testing to uncover the possible correlation between heart disease and testosterone fully. That said, more evidence indicates that the therapy does not increase cardiovascular risk more than the other way around.


Testosterone has various effects, both good and bad, on cardiovascular physiology.

Some beneficial effects of testosterone, such as coronary vasodilation and increased coronary blood flow, improved vascular reactivity, increased muscle mass, decreased visceral and total body fat mass, and normalization of blood glucose, can potentially reduce cardiovascular risk.

However, other adverse effects of testosterone, such as increased red blood cell volume (hematocrit), decreased HDL cholesterol (high-density lipoprotein – good cholesterol), and sodium and water retention, could increase cardiovascular risk.

The FDA’s warning about the potential risk of heart disease and the aforementioned adverse effects of testosterone has caused concern in testosterone prescriptions and a subsequent drop in testosterone sales in the United States.

The European Medicines Agency, on the other hand, confirmed that there is currently no reliable evidence that TRT (testosterone replacement therapy) increases the risk of heart disease.

After considering all available findings, the study concluded that short and medium-term use of TRT (testosterone replacement therapy) does not increase the risks of heart disease. However, further investigations still have to evaluate whether long-term use of TRT may damage the heart.

Conclusively, taking TRT within an adequate duration does not affect the heart. But how long must the treatment last to be risk-free?


According to similar studies, testosterone treatment for twelve months in older men correlates with a more significant increase in the volume of noncalcified coronary artery plaque associated with cardiovascular events. However, there were no discernible signs of such risks within the first nine and a half months after initiation of TRT.

Hence, a period shorter than one year should be the safe duration of TRT to prevent heart disease.

Therefore, men with low testosterone levels at risk for heart disease may take short or medium-term TRT lasting less than twelve months. Even so, individuals with heart health problems should receive counseling before treatment to ensure the safety and tolerability of the treatment.

Consult your physician to determine the optimal duration of TRT, which is risk-free, efficient, and sustainable for you.


Testosterone Replacement Therapy can be a superior treatment option that increases the overall sense of well-being among those suffering from low testosterone levels without causing a risk of heart disease when you take it properly.

TRT may be even more beneficial if implemented with a healthy lifestyle, like physical activity and healthy eating.

A lifestyle modification will increase testosterone levels and reduce the risk of heart disease, as cardiovascular problems frequently relate to a lack of physical activity and a high-fat diet. Therefore, begin TRT and a balanced exercise regimen to regain a good quality of life, live better and get back to being your younger self.


Our Modern Heart and Vascular Institute staff provides functional medicine to optimize health and performance. In addition, we offer personalized, scientifically advanced treatments to create a new state of human development.

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Modern Heart and Vascular Institute plans to deliver you with information but does not attempt to substitute the medical advice of your physician or healthcare provider. Consult your physician or healthcare provider for guidance or recommendations on a specific medical condition.

It is our priority to maintain you well all year! Visit any Modern Heart and Vascular Institute sites for high-quality prior care near your home. Call us today at 832-644-8930 to schedule your appointment.

At Modern Heart and Vascular Institute, we will be honored to answer your questions about circumstances that could impact your heart. Our specialized cardiologists may help you handle, foresee, anticipate, and treat all the characteristics of your cardiovascular condition.

We are Modern Heart and Vascular Institute, a diagnostic and preventative medicine cardiology practice. For more information, contact us.

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Modern Heart and Vascular, a preventive cardiology medical practice, has several offices around Houston. We have locations in Humble, Cleveland, The Woodlands, Katy, and Livingston.

We are Modern Heart and Vascular Institute, a diagnostic and preventative medicine cardiology practice.

Every heart has a story… What’s yours?

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At the Modern Heart and Vascular Institute, we offer state-of-the-art cardiovascular care with innovative diagnostic tools and compassionate patient care. Our priority at Modern Heart and Vascular Institute is prevention. We help patients lead healthier lives by avoiding unnecessary procedures and surgeries.

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This article does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. If you need cardiovascular care, please call us at 832-644-8930.

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