From the Guidelines
An EKG is not routinely required before starting testosterone therapy in most patients, but it should be considered for those with known cardiovascular disease, multiple risk factors, or those over 40-50 years of age. For healthy individuals without cardiovascular risk factors or pre-existing heart conditions, baseline EKG screening is generally unnecessary, as supported by the American College of Physicians' evidence report 1. However, testosterone therapy can potentially affect cardiovascular health by increasing red blood cell production (erythrocytosis), altering lipid profiles, and in some cases exacerbating underlying cardiac conditions.
During testosterone treatment, regular monitoring should include blood pressure checks, lipid panels, complete blood counts, and symptom assessment, as suggested by the evaluation and management of testosterone deficiency guideline 1. If cardiovascular symptoms develop during treatment, such as chest pain, shortness of breath, or palpitations, an EKG should be performed promptly. The decision to obtain a baseline EKG should be individualized based on the patient's overall risk profile rather than applied universally to all patients starting testosterone. It is also important to note that testosterone therapy should not be commenced for a period of three to six months in patients with a history of cardiovascular events, as recommended by the AUA guideline 1.
Key considerations for determining the need for a baseline EKG include:
- Known cardiovascular disease
- Multiple risk factors (such as hypertension, diabetes, hyperlipidemia, smoking, or family history of early cardiac events)
- Age over 40-50 years
- History of cardiovascular events
- Presence of symptoms suggestive of cardiovascular disease. In patients with existing, stable ASCVD and/or a remote history of a myocardial infarction, or a cerebrovascular accident, testosterone therapy with close monitoring may be considered after a three to six month waiting period from the most recent cardiac event, as per the AUA guideline 1.
From the Research
EKG Check Prior to Testosterone Therapy
- There is no direct evidence in the provided studies that specifically addresses the necessity of checking an EKG on a patient prior to starting them on testosterone therapy.
- However, several studies suggest that testosterone replacement therapy (TRT) may be associated with adverse cardiovascular events, particularly in older patients and those susceptible to cardiovascular diseases 2, 3.
- Low testosterone levels have been linked to an increased risk of cardiovascular disease, as well as adverse lipid profiles and incident dyslipidemia 4, 5.
- While the provided studies do not directly recommend EKG checks prior to testosterone therapy, they do highlight the importance of considering cardiovascular health when prescribing testosterone 2, 3.
- Other studies suggest that complete blood count (CBC) components, such as white blood cell count and platelet count, may be useful markers for predicting cardiovascular and metabolic diseases 6.