From the Guidelines
Low testosterone levels are not directly associated with an increased risk of palpitations, according to the most recent and highest quality study available 1. The relationship between low testosterone levels and palpitations is complex and not fully understood. However, the American College of Physicians' evidence report on the efficacy and safety of testosterone treatment in men found that the incidence of cardiovascular events, including palpitations, was low and did not differ significantly between the testosterone and placebo groups 1. Some key points to consider:
- The study found that the pooled risk for adverse cardiovascular outcomes did not differ between groups, with a Peto OR of 1.22 [CI, 0.66 to 2.23] and low-certainty evidence 1.
- The incidence of cardiovascular events was 2.3% in the testosterone group, compared with 1.5% in the placebo group, although this difference was not statistically significant 1.
- The study notes that most trials excluded men with advanced heart failure or a recent history of myocardial infarction or stroke, and none were designed to adequately assess cardiovascular risk of testosterone therapy 1. In terms of management, if palpitations are suspected to be related to testosterone levels, consultation with a healthcare provider is recommended to evaluate testosterone levels and cardiac function. Lifestyle modifications, such as reducing caffeine and stress, and ensuring proper hydration and regular exercise, may also be beneficial in managing palpitations. However, the current evidence does not support a direct link between low testosterone levels and an increased risk of palpitations 1.
From the Research
Relationship between Low Testosterone Levels and Palpitations
The relationship between low testosterone levels and palpitations (irregular heart rhythms) is not directly addressed in the provided studies. However, some studies discuss the effects of testosterone replacement therapy on cardiovascular health, which may be relevant to the topic.
- The study by 2 discusses the association between serum levels of endogenous testosterone and cardiovascular disease, but does not specifically mention palpitations.
- The study by 3 found that testosterone-replacement therapy was noninferior to placebo with respect to the incidence of major adverse cardiac events, but noted a higher incidence of atrial fibrillation in the testosterone group.
- The study by 4 found no difference in the risk of cardiovascular events, including myocardial infarction and stroke, between men with hypogonadism who received testosterone replacement therapy and those who did not.
Cardiovascular Effects of Testosterone Replacement Therapy
The studies suggest that testosterone replacement therapy may have some effects on cardiovascular health, including:
- Increased risk of atrial fibrillation, as noted in the study by 3
- No difference in the risk of major adverse cardiac events, as noted in the study by 3
- No difference in the risk of cardiovascular events, including myocardial infarction and stroke, as noted in the study by 4
Limitations of the Studies
The studies have some limitations, including:
- The study by 3 was a randomized controlled trial, but the follow-up period was relatively short (mean 33.0 months)
- The study by 4 was a retrospective cohort study, which may be subject to biases and limitations
- None of the studies specifically addressed the relationship between low testosterone levels and palpitations.