For most men, testosterone therapy poses no added cardiac risks. In some cases, it can even improve heart health.

Testosterone is one of several sex hormones that play an important role in our physical and mental health. Almost everyone produces testosterone, but levels of this hormone are typically much higher in males than females, especially after puberty.

Males who have low testosterone levels can choose to have testosterone replacement therapy to bring their levels back to optimal levels. Transmasculine people can also use testosterone therapy, or masculinizing therapy, as part of their gender affirming care.

Here’s what the research says on the relationship between testosterone and heart attacks, including whether testosterone therapy increases or decreases the risk of heart-related conditions.

Testosterone is most well known for its role in sexual development, affecting everything from sex drive to sperm production to muscle formation and more.

Testosterone also plays an important role in the cardiovascular system, directly affecting the cells and function of the heart. Because of this, research suggests that low testosterone levels are associated with an increased risk of cardiovascular disease, especially in males.

An early study from 2009 found that males with lower testosterone levels had an increased risk of stroke or transient ischemic attack.

A 2011 research review found an association between low testosterone levels in men and cardiovascular death.

A more recent study from 2021 explored the relationship between oxidative stress, inflammation, endothelial dysfunction, and low testosterone levels. Results suggest that men with low testosterone showed greater vascular aging, which was associated with higher levels of oxidative stress and inflammation.

However, the effects of low testosterone may not be exclusive to just males.

In a study from 2022, researchers found that low testosterone in women may be associated with an increased risk of having a cardiovascular event like a heart attack or stroke.

Language matters

You’ll notice that the language used to share stats and other data points is pretty binary, fluctuating between “male” and “men.”

Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.

Note that most of the studies and surveys referenced in this article didn’t report data on or include participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

Learn more about transgender representation in clinical trials here.

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Research from 2021 suggests that testosterone therapy can improve heart-related conditions in men with low testosterone levels. However, most studies on testosterone therapy actually focus on whether this therapy increases the risk of heart-related conditions.

In a 2022 research anaylsis, researchers investigated cardiovascular events and deaths in men with hypogonadism undergoing testosterone therapy. The researchers found no evidence that testosterone therapy increased the risk of cardiovascular conditions.

An earlier review from 2019 also explored the effects of gender affirming hormone therapy on cardiovascular disease risk — including stroke and blood clots — in transgender adults.

According to the research, testosterone therapy does appear to have an effect on blood pressure and lipid levels in transgender men. But the researchers found no consistent evidence showing an increase in cardiovascular disease risk in trans men taking testosterone.

Can testosterone steroids cause heart problems?

Anabolic steroids, also known as anabolic-androgenic steroids (AASs), are a synthetic form of testosterone. While there are some medical uses of anabolic steroids, people typically use these steroids for other purposes, such as to increase strength and muscle mass.

However, illicit use of anabolic steroids has been associated with an increased risk of health complications, including cardiovascular events.

In a 2020 study, researchers explored the effects of anabolic steroids on cardiovascular outcomes. They found that some of the potential complications of anabolic steroid use included:

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Millions of people use testosterone replacement therapy, either to treat low testosterone or as a form of gender affirming care.

To date, there’s been no strong evidence to suggest that testosterone replacement therapy can increase the risk of heart-related complications.

With that said, health experts recommend against taking testosterone therapy if you:

If you have other cardiovascular risk factors, such as diabetes, you may also want to discuss the risks and benefits of testosterone therapy before moving forward with treatment.

Decades of research have shown that low testosterone levels are linked with an increased risk of cardiovascular disease, including heart attack and stroke.

Testosterone therapy can help normalize testosterone levels, while possibly reducing the risk of heart-related conditions. For most cisgender and transmasculine men undergoing testosterone therapy, there doesn’t appear to be any increased risk of cardiovascular events.

If you’re interested in taking testosterone therapy, whether for low testosterone or as gender affirming hormone therapy, reach out to a doctor for more information. Together, you can weigh the risks and benefits to decide if this treatment is right for you.