Testosterone & Your Heart

Testosterone is in the news lately in the US, mostly due to the country’s Secretary of Defense wanting to increase the effectiveness of soldiers.

You can read about it here, for example: Pete Hegseth wants a testosterone-fueled military. The science doesn’t back the macho fantasy

However, here in the real world, testosterone will not turn people into the Incredible Hulk, but rather is a hormone that mediates a lot of things in the body, and people generally function best with correct hormone levels.

• For most women, that’s 0.2–1.9nmol/L
• For most men, that’s 8.7–38nmol/L

We’ve written about both before, for example:

• For women: Is It Worth Taking Testosterone In Menopause?
• For men: Topping Up Testosterone?

So, what’s this about the heart?

Too much of a good thing

Researchers (Dr. Hatim Kerniss et al.) analyzed data from 227,108 men aged 30–75 who were prescribed testosterone, matching 113,554 men with hypogonadism to an equal number without hypogonadism.

Those who were prescribed testosterone despite having no evidence of hypogonadism had a 51% higher risk of major adverse cardiovascular events than men with hypogonadism who were receiving testosterone.

Further, testosterone users without hypogonadism had a 90% higher risk of death from any cause compared with those who had hypogonadism.

Testosterone-using men without hypogonadism also had higher risks of ischemic stroke, heart attack, cardiac arrest, heart failure, and pulmonary embolism.

All this means that before getting a testosterone prescription, it is important to:

• Assess current testosterone levels (i.e. is the man actually suffering from hypogonadism?)
• Assess current cardiovascular risk (i.e. if cardiovascular risk is high, then what’s more important?)

…and then make an informed decision from there.

You can read this study in full, here: Off-label testosterone therapy is associated with higher long-term cardiovascular risk in men

Since then, another study, this time by Dr. Anand Reddy Maligireddy et al., found that atrial fibrillation (AF) risk may be higher at both low and high testosterone levels, with the lowest risk appearing to occur in the mid-physiological range.

In other words, this is the sort of thing we meant up top when we said “people generally function best with correct hormone levels”.

More is not always better!

And in fact, if wondering whether it’s better to err high or err low, then in this case, it’s worth noting that:

• evidence for increased AF risk was more consistent at higher testosterone levels than evidence at the low end
• older men in the highest two testosterone groups had nearly twice the AF risk of those in the middle group

You can read this paper in full, here: Association of testosterone and testosterone replacement therapy with atrial fibrillation: an updated review

Want to learn more?

For more on managing T-levels and related considerations, consider:

• DHT Blockers: What Actually Works?
• Too Much Or Too Little Testosterone?
• Tribulus Terrestris For Testosterone?
• What Menopause Does To The Heart
• Testosterone levels decline with age, not menopause, despite what you’ve heard

Take care!