Testosterone Replacement Therapy and Heart Attacks
Testosterone Replacement Therapy and Heart Attacks – is it true that TRT increases the risk of heart attacks and strokes?
‘Testosterone’ is a topic that carries a lot of stigma.
Many people associate it with massive, vein covered bodybuilders who abuse steroids.
These huge men look like they are about to have a heart attack or stroke at any minute.
On top of this, with occasional news reports on bodybuilders who abuse steroids and die young from heart issues, you can see why people might think that testosterone increases the risk of cardiovascular issues.
Thankfully, the reality is that testosterone replacement therapy is unlikely to increase your risk of cardiovascular problems if managed well by an experienced professional!
In this article we will look at the research, discuss what increases your risk of heart attacks and strokes, and consider how a well designed TRT program can actually reduce your risk of heart attacks and strokes.
It tells us a lot about new treatments and their safety.
It can help us to understand risks and make decisions about certain treatments.
Unfortunately it is frequently conducted either with poor methodology or inappropriate study designs.
This can lead to medical communities making assumptions based on the results of a poorly designed study with inaccurate findings.
Often the results, which are heralded as medical truths, turn out to be much less credible than originally suspected.
Later research doesn’t show the same results, or can even contradict previous studies when different factors are taken into account.
Unfortunately, one early study can often become ingrained in the medical community – particularly if they fit with ‘common wisdom’ or stereotypes.
This appears to be what has happened with testosterone replacement therapy and heart attacks research.
The association between testosterone replacement therapy and hearts attacks & strokes spread, after one or two studies in the early 2000s appeared to indicate a link to an increased risk of heart attacks or strokes.
The medical community pounced on these studies as a way to vilify TRT, whilst there was a mounting stigma around testosterone.
New research has come out since, indicating that low testosterone is what increases your risk of heart attacks, strokes and other cardiovascular events. Unfortunately, these studies get less press.
Even today, it remains a commonly held belief by many doctors as well as amongst the wider population, that TRT is linked to heart attacks.
As more and more research is completed on this issue it becomes more and more evident that previous research is likely to be incorrect.
A 2014 study reported that testosterone therapy might increase the risk of a heart attack in men aged 65 and older…however, more recent studies show no increase in cardiovascular disease in men taking testosterone therapy.
A study by Muraleedharan et al. (2013) even shows a lower risk of death in men receiving testosterone therapy compared with those not receiving therapy.
Sharma et al., (2013) looked at 83,000 men suffering from low testosterone. They found that those treated with TRT to normalise testosterone levels saw a significantly reduced rate of cardiovascular events including heart attacks and strokes.
A recent study (2017) in the JAMA journal which looked at over 44,000 men suffering with androgen deficiency and showed a 33% lower risk of cardiovascular events in men who supplemented with TRT compared to those who didn’t.
That is a huge difference in a large sample size of men. And it’s not just one or two studies; these results are stacking up and are bourne out in several other recent papers.
Another study ‘found that TRT was not linked with any increased risk for MI (HR=0.84 [95% CI=0.69~1.02]).
In contrast, men at greater risk for heart problems who underwent TRT actually had a lower rate of heart attacks than similar men who did not receive this treatment.”
How does testosterone replacement therapy reduce these risks?
Additionally, men with low testosterone appear to be at higher risk of these conditions.
Low endogenous (naturally produced) testosterone levels have been shown to be associated with higher rates of all-cause and cardiovascular-related deaths in men.
Testosterone replacement therapy has been shown to increase exercise tolerance without increasing left ventricular ejection fraction (linked to growth of the left side of the heart which can lead to cardiac complications).
It has also been shown to improve the homeostatic model of insulin resistance and hemoglobin A1c in diabetics as well as lowering the BMI of obese patients.
Clearly TRT has a myriad of positive effects on male health beyond improving muscle, sexual function and mood.
Update and latest research
A new study by Loo et al. 2019 looking at 15,000 men aged 45-69 found that there was a 21% increased risk of cardiovascular events in the first 2 years of treatment.
After this time the risk reduced back to normal.
They also found that all men on TRT had a lower overall chance of dying of all causes over the period of the study.
So TRT may increase your risk of a heart in the first two years, but you are less likely to die overall, at least for the 22 years that this study covered!
There is some new evidence that Testosterone Replacement Therapy and heart attacks / strokes are linked. However, this is most likely in men who do not stick to safe doses and may be related to men who first start TRT. After the first two years, this risk reduces dramatically, and these men are less likely to die over the same period of time.
Most recent studies suggest that TRT improves several factors that increase life span and general health.
As long as you are aware of the potential risks involved and stick to safe treatment provided by a specialist, TRT should help you to live a longer, happier life.
Dr Chris Airey
This article has been medically reviewed for accuracy by Dr Airey on 23rd June 2020.
Dr Chris Airey is a fully registered UK doctor with the GMC (General Medical Council) Reference No: 7490533.
He trained at the University Hospital Southampton and graduated as a Doctor with a joint Bachelor of Medicine and a Bachelor of Surgery, plus a Masters in Medical Science, completing his research project in the Medical Neurosciences Department.
He is undertaking a Master of Science course in Endocrinology and is a member of the European Society for Sexual Medicine, and the Androgen Society.
He has personal experience with taking Testosterone Replacement Therapy and is a pioneer in UK treatment protocols for Testosterone Deficiency Syndrome.