Can Testosterone Cause Heart Problems?

We know that low Testosterone levels can cause cardiovascular problems, but can TRT cause Heart Problems? An in-depth look at studies and why TRT is healthy.


The first word that came to your mind when you read that was “man.” That’s because testosterone is a hormone that’s primarily found in men. It’s responsible for things like deepening voice, facial hair growth, and muscle mass.

Testosterone levels naturally decline with age. So, you may have noticed that your grandfather has a softer voice than your father, and your father has a softer voice than you.

We often tend to look at our anatomy in parts. For example, we have our heart, which is responsible for pumping blood around our body. Then we have our lungs, which help us to breathe. We even have a separate system for digesting food.

In reality, however, all of these systems are interconnected. What happens in one part of the body can impact other parts. Through very intricate and complex mechanisms, our bodies are constantly striving for balance, or homeostasis. Too much of one thing can throw the whole system off balance.

The same is true for testosterone. While it is important for male sexual function, too much testosterone can actually have negative effects on your cardiovascular health. The same can be said if there is too little testosterone.

So, how does an imbalance of testosterone levels affect your heart health? Let’s explore.

Key Takeaways

  • Low testosterone levels may have an impact on cardiovascular health
  • Two primary proteins in our blood, SHBG and albumin, allow testosterone to flow throughout the entire body
  • Testosterone levels have an enormous impact on your risk of developing heart disease and blood vessel disorders
  • The distinction between testosterone for enhancing performance and testosterone replacement therapy with testosterone is not the same

Testosterone and the Heart

The male hormone testosterone is the primary sex hormone responsible for the development of male characteristics. In general, we know that as men age, particularly after age 40, testosterone levels decline.

This can cause a number of changes and symptoms. Most commonly are decreased energy and low libido.

We also know that as men reach 40, their cardiovascular health also begins to decline. According to the Center for Disease Control (CDC), rates of obesity and high blood pressure start to increase for men in as low as age 35. Moreover, the CDC reports that the risk of heart disease begins to increase around age 45.

Given that testosterone levels decline with age and that cardiovascular health also declines with age, it’s not surprising that there might be a connection between the two.

From the Testes to the Heart

Testosterone typically exists in two forms within our bodies. The first form is “bound” testosterone, which is attached to a protein called sex hormone binding globulin (SHBG) or the protein albumin. The second form is “free” testosterone, which circulates in our blood, unbound to any protein, and available for our cells to use at any given time.

This is why testosterone is not only found in the testes, but also in other tissues such as our muscles, heart, and brain thanks to SHBG and albumin allowing it to move around the entire body.

Although there’s no evidence connecting normal testosterone levels in men and heart disease, there is evidence backing up the extreme cases of having high or low testosterone levels.

Low Testosterone Levels and the Heart

There has been some evidence that shows men with low testosterone levels are more susceptible to develop coronary artery disease. This is the condition where the arteries that supply blood to your heart muscle become narrowed or blocked. This can cause chest pain, a heart attack, or even death in some cases. [2]

Figure 1: While studies are not all conclusive, there are various that point to lower Testosterone having adverse effects on cardiovascular health

Some studies have also shown that low testosterone levels have been seen in older males that have cardiovascular health problems in which the heart can’t pump enough blood to meet the needs of the body. [3]

One study also showed that testosterone levels may have an impact on the health of your endothelium. [7] This is the thin layer of cells that line your arteries. A healthy endothelium allows your arteries to expand and contract when needed.

An unhealthy endothelium has been linked with the development of atherosclerosis, (the hardening and narrowing of your arteries) which can lead to an increased risk of heart attack or stroke.

High Testosterone Levels and the Heart

Athletes and body builders that use anabolic steroids and abuse them not only comes with a bevy of negative health consequences but also increased risk factors for cardiovascular problems. These include high blood pressure, heart attack, and stroke.

Figure 2: Steroid users that abuse Testosterone and other hormones do see an increase in heart failure

Anabolic steroids raise testosterone levels, which may contribute to elevated cholesterol levels, specifically the bad cholesterol, and the deterioration of good cholesterol.

A recent study investigated the effects of anabolic steroids on body builders and found that those who used them had a significant decrease in their high-density lipoprotein (HDL) cholesterol. HDL is the good kind of cholesterol that helps remove other forms from your blood. [4]

The good news is, the same study found that HDL levels returned to normal after they stopped the use of anabolic steroids.

Very high testosterone levels may also cause plaque to accumulate in the arteries, reduce blood flow, and decrease oxygen availability. This can also lead to an increased risk of a heart attack or stroke due to the accumulation of plaque.

Testosterone Replacement Therapy and the Heart

Surprisingly, men who receiving testosterone for testosterone replacement therapy do not have a higher risk of having a heart attack than men who don’t have low testosterone, according to studies.

In fact, some studies suggest that testosterone replacement therapy might actually improve heart health in men with low testosterone levels. [5]

One study found that testosterone replacement therapy improved blood flow to the heart muscle in older men with low testosterone levels. The study also found that there was no increased risk of a heart attack or stroke in men who were on testosterone therapy. [6]

The Final Say

When it comes to your heart, testosterone levels may be a factor, but it’s not the only one. Other things that can impact your heart health include your diet, exercise habits, and family history.

Despite emerging studies, there is still no clear evidence linking testosterone levels and heart disease. However, if you have low testosterone levels, you may be at a higher risk for developing heart problems.

The same can be said for those on anabolic steroids for bodybuilding. While testosterone levels may impact the health of your heart, it’s not the only factor. If you are concerned about your heart health, talk to your doctor about your options.

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Dunn JF, Nisula BC, Rodbard D. Transport of steroid hormones: binding of 21 endogenous steroids to both testosterone-binding globulin and corticosteroid-binding globulin in human plasma. J Clin Endocrinol Metab. 1981 Jul;53(1):58-68. doi: 10.1210/jcem-53-1-58. PMID: 7195404.

Zhao SP, Li XP. The association of low plasma testosterone level with coronary artery disease in Chinese men. Int J Cardiol. 1998 Jan 31;63(2):161-4. doi: 10.1016/s0167-5273(97)00295-7. PMID: 9510490.

Kloner RA, Carson C 3rd, Dobs A, Kopecky S, Mohler ER 3rd. Testosterone and Cardiovascular Disease. J Am Coll Cardiol. 2016 Feb 9;67(5):545-57. doi: 10.1016/j.jacc.2015.12.005. PMID: 26846952.

Li M, Rabkin SW (2018) Extremely Low HDL Cholesterol and Increased LDL Cholesterol Induced by the use of Anabolic Steroids in a Body Builder: A Case Study. Int J Sports Exerc Med 4:109.

Adverse cardiovascular events and mortality in men during testosterone treatment: an individual patient and aggregate data meta-analysis

Hudson, Jemma et al. The Lancet Healthy Longevity, Volume 3, Issue 6, e381 – e393

Hotta Y, Kataoka T, Kimura K. Testosterone Deficiency and Endothelial Dysfunction: Nitric Oxide, Asymmetric Dimethylarginine, and Endothelial Progenitor Cells. Sex Med Rev. 2019 Oct;7(4):661-668. doi: 10.1016/j.sxmr.2019.02.005. Epub 2019 Apr 12. PMID: 30987932.


Jimmy Diaz M.S.

Jimmy Diaz M.S. | Writer

Jimmy is a Clinical Scientist from Los Angeles with a background in Chemistry and Reproductive Clinical Science. He is an adrenaline junkie who loves water, winter and wind sports. He is dedicated to advancing the field of reproductive science and providing the best patient care while also exploring new experiences and challenging himself.

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