Does Testosterone Therapy Cause Heart Attacks?
No. The largest, most rigorous clinical trial ever conducted on testosterone therapy — the TRAVERSE Trial (Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men) — found that testosterone replacement therapy does not increase the risk of heart attack, stroke, or cardiovascular death when prescribed to men with confirmed low testosterone.
Published in the New England Journal of Medicine (June 2023), TRAVERSE followed 5,246 men aged 45–80 with hypogonadism for an average of nearly 2 years. The primary endpoint — a composite of major adverse cardiovascular events (MACE) including non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death — showed no statistically significant difference between the testosterone group and the placebo group.
Key Findings of the TRAVERSE Trial
- 5,246 men enrolled, ages 45–80, all with pre-existing cardiovascular disease or high risk
- Randomized to either testosterone gel or placebo gel for an average of 22 months
- Primary endpoint (MACE): 7.0% in the testosterone group vs 7.3% in placebo — no significant difference
- Testosterone was non-inferior to placebo for cardiovascular safety
- TRT did show benefits: improved sexual function, mood, bone density, and muscle mass
Why Did People Think TRT Caused Heart Attacks?
The fear traces back to a few flawed studies (see our full breakdown: Is Hormone Replacement Therapy Dangerous?) from 2013–2014 that received widespread media coverage:
- A 2013 retrospective study by Vigen et al. published in JAMA claimed a higher rate of cardiovascular events in men receiving TRT. This study was later corrected by JAMA after major methodological errors were identified — the original conclusion was wrong.
- A 2014 study by Finkle et al. suggested increased heart attack risk in the 90 days after starting TRT. This was an observational study, not a randomized controlled trial, and could not establish causation.
- The FDA issued a safety communication in 2014, leading to the requirement for TRAVERSE — which ultimately cleared testosterone of excess cardiovascular risk.
The FDA Position (Updated February 2025)
Based on TRAVERSE results, in February 2025 the FDA updated its testosterone product labeling. The FDA now requires labeling to state that testosterone therapy was not shown to increase the risk of major adverse cardiovascular events in men with hypogonadism. This was a landmark reversal of the 2014 caution — a direct result of TRAVERSE data.
European Expert Panel Confirms Safety (2026)
In January 2026, a position statement by the European Expert Panel for Testosterone Research published in Andrology reviewed TRAVERSE and all subsequent data. Their conclusion: testosterone therapy, when used as indicated for confirmed hypogonadism, is cardiovascularly safe and the benefits outweigh theoretical risks for the vast majority of patients.
Who Might Still Have Risk?
While TRT is safe for the vast majority of men with hypogonadism, TRT is not for everyone. Men with:
- Uncontrolled heart failure (NYHA Class III or IV)
- Recent myocardial infarction or stroke (within 3–6 months)
- Severe untreated sleep apnea
- Polycythemia (hematocrit >54%) without therapeutic phlebotomy
…should be evaluated by a physician before initiating TRT. This is why legitimate telehealth clinics like Viking Alternative Medicine require comprehensive lab work and a physician consultation before prescribing — safety first.
The Bottom Line: TRT and Heart Health
The question “does testosterone cause heart attacks?” has been answered by the TRAVERSE trial with a clear no — when TRT is prescribed at physiologic doses to men who are actually hypogonadal, it does not increase cardiovascular risk. The old studies that scared people were flawed. The best evidence we have today shows TRT is cardiovascularly safe.
At Viking Alternative Medicine, every patient receives physician-supervised care with complete lab monitoring — including hematocrit, PSA, estradiol, and comprehensive metabolic panels — to ensure TRT is both effective and safe. Serving men and women in almost every state. See also: Does Hormone Therapy Stop Aging?
Sources
- Lincoff AM, et al. “Cardiovascular Safety of Testosterone-Replacement Therapy.” New England Journal of Medicine 2023; 389:107–117. DOI: 10.1056/NEJMoa2215025
- Zitzmann M, et al. “Cardiovascular safety of testosterone therapy — Insights from the TRAVERSE trial and beyond.” Andrology 2026; 14:294–302. DOI: 10.1111/andr.13770
- Nissen SE, et al. “Long Term Cardiovascular Safety of Testosterone Therapy.” Nature Reviews Endocrinology 2025. PMID: 39211666
- FDA Testosterone Product Labeling Update, February 2025
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult a licensed physician before starting any hormone therapy.
Recent Comments