What is the correlation between testosterone supplements and the risk of myocardial infarction (heart attack) and hypertension (elevated blood pressure)?

From the Guidelines

Testosterone supplements may increase the risk of heart attacks and worsen hypertension in some individuals, particularly those with pre-existing cardiovascular conditions, and therefore, men should be cautious when considering testosterone therapy. The potential risks associated with testosterone-replacement therapy, including cardiovascular disease, lipid alterations, and erythrocytosis, should be carefully weighed against the benefits of treatment 1. According to a study published in the Annals of Internal Medicine, the pooled risk for adverse cardiovascular outcomes did not differ significantly between testosterone and placebo groups, but the incidence of cardiovascular events was 2.3% in the testosterone group compared to 1.5% in the placebo group 1.

Key Considerations

• Testosterone therapy can cause fluid retention, which may elevate blood pressure and increase the workload on the heart.
• Testosterone may also increase red blood cell production, making blood thicker and potentially raising the risk of clots that could lead to heart attacks.
• Additionally, testosterone may adversely affect cholesterol levels by decreasing HDL (good) cholesterol.
• Before starting testosterone supplementation, patients should undergo cardiovascular risk assessment, including blood pressure measurement, lipid profile, and assessment of heart disease risk factors.
• During treatment, regular monitoring of blood pressure, hematocrit levels, and cardiovascular symptoms is essential.

Recommendations

• Men with pre-existing cardiovascular conditions, including high blood pressure, should be particularly cautious when considering testosterone therapy.
• The benefits of testosterone therapy should always be weighed against the potential cardiovascular risks through discussion with a healthcare provider.
• For men who need testosterone therapy but have hypertension, proper blood pressure management with appropriate medications and lifestyle modifications should be implemented concurrently.
• The risk appears higher in older men and those using higher doses, and therefore, dose and age should be carefully considered when prescribing testosterone therapy 1.

From the FDA Drug Label

Some postmarketing studies have shown an increased risk of myocardial infarction and stroke associated with use of testosterone replacement therapy. Edema with or without congestive heart failure (CHF) may be a complication in patients with preexisting cardiac, renal, or hepatic disease. The correlation between testosterone supplements and heart attack risk and elevated blood pressure hypertension is that some postmarketing studies have shown an increased risk of myocardial infarction associated with use of testosterone replacement therapy. Additionally, edema with or without congestive heart failure (CHF) may be a complication in patients with preexisting cardiac disease. Key points:

• Increased risk of myocardial infarction
• Potential for edema with or without CHF in patients with preexisting cardiac disease 2

From the Research

Testosterone Supplements and Heart Attack Risk

• The correlation between testosterone supplements and heart attack risk is still a topic of debate, with some studies suggesting a potential increased risk, while others indicate no significant association 3, 4.
• A study published in 2017 found that long-term testosterone therapy improved cardiometabolic function and reduced the risk of cardiovascular disease in men with hypogonadism 5.
• Another study published in 2023 found that testosterone therapy provides significant health benefits and reduces the risk of cardiovascular disease, with longer durations of therapy associated with greater health benefits 6.

Elevated Blood Pressure and Hypertension

• Low testosterone levels have been associated with cardiovascular disease, including elevated blood pressure and hypertension 7.
• Testosterone replacement therapy has been shown to improve vascular health and reduce cardiovascular mortality, with no apparent harm when given in the physiological range 6.
• However, older patients and those susceptible to cardiovascular diseases may still be at risk with testosterone prescriptions, and careful monitoring is recommended 4, 7.

Key Findings

• Testosterone therapy has been found to reduce the incidence of major adverse cardiovascular events, including nonfatal strokes and myocardial infarctions 5.
• The current scientific and clinical evidence demonstrates a strong relationship between low circulating testosterone levels and the risk of cardiovascular disease 6.
• Testosterone replacement therapy is deemed safe in men with hypogonadism when given in the physiological range, with significant health benefits and reduced cardiovascular risk 6.