Testosterone and Heart Health: An Updated View

Short answer: the cardiovascular safety picture for TRT has become substantially clearer in recent years. The 2023 TRAVERSE trial, the largest randomised study to date, did not find a significant increase in major cardiovascular events with appropriately-prescribed TRT. Current guidelines reflect this updated picture.

Where the concern came from

Early observational studies in the 2010s suggested a possible association between TRT and cardiovascular events. The studies had methodological limitations but produced understandable caution and influenced regulatory language and guidelines for several years.

What changed

The TRAVERSE trial, published in NEJM in 2023, randomly assigned over 5,000 men with hypogonadism and existing cardiovascular risk to TRT or placebo over an average of three years. The result: no significant increase in major adverse cardiovascular events (heart attack, stroke, cardiovascular death) with TRT compared with placebo.

This trial significantly updated the evidence base. The Endocrine Society and AUA guidelines have been revised post-TRAVERSE to reflect that TRT, when appropriately prescribed and monitored, does not appear to substantially increase cardiovascular risk for most men.

What this doesn't mean

• TRT is not contraindicated in men with cardiovascular risk factors when otherwise appropriate
• TRT is not recommended for men who've had a recent (within 6 months) heart attack or stroke
• Cardiovascular monitoring remains part of standard TRT care
• Lipid management, blood pressure, weight, and other cardiovascular risk factors still matter

Practical takeaway

For men with confirmed hypogonadism and significant symptoms, TRT is a reasonable consideration even with cardiovascular risk factors, with appropriate medical assessment. The old blanket framing of "avoid TRT in anyone with heart issues" has softened in light of better evidence.

Speak to a doctor on Noah

If you're weighing TRT against cardiovascular concerns, book a confidential consultation with a Singapore-licensed doctor on Noah.