Are you a man over 40 who is feeling tired, gaining weight, or having less interest in sex? These could be signs of low testosterone, a condition that can impact more than just your energy and sex drive.

Research suggests a potential link between low testosterone and heart disease, raising questions about whether addressing this issue could improve heart health.

What Is Low Testosterone?

Testosterone is a sex hormone that plays an important role in various bodily functions. According to the American Urological Association, as men age, it’s natural for testosterone levels to decline. However, when levels drop significantly, it can lead to a condition called hypogonadism. This is also known as low testosterone or “low T.” Symptoms can include:

• Reduced sex drive
• Erectile dysfunction (also an early warning sign of heart disease)
• Decreased muscle mass
• Increased body fat (particularly in the belly)
• Low energy
• Mood changes
• Reduced bone density

If you’re experiencing these symptoms, talk with your healthcare provider. They can measure your testosterone levels to determine if you have low T.

The Link Between Low T and Heart Disease

Research has shown a complex relationship between testosterone levels and cardiovascular health. Cardiovascular health is the overall well-being of the heart and blood vessels, ensuring they function properly to support the body. Low T has been associated with several risk factors for heart disease:

• Increased body fat, especially abdominal fat
• Decreased muscle mass
• Higher cholesterol levels
• Insulin resistance
• Metabolic syndrome
• Inflammation

If untreated, these factors can lead to many other cardiovascular problems, including high blood pressure and atherosclerosis (a buildup of plaque in blood vessels).

Testosterone Replacement Therapy — A Potential Solution?

Given the potential link between low testosterone and heart disease, you might wonder if testosterone replacement therapy (TRT) could improve heart health. The answer isn’t straightforward, as studies have shown mixed results.

Research on TRT and Heart Health

A landmark study published in 2023 in the New England Journal of Medicine involved over 5,200 men aged 45 to 80 with low testosterone levels and major heart problems. This study found that TRT did not increase the risk of heart attack or stroke when compared to a placebo. However, men taking testosterone had slightly higher rates of irregular heartbeat, kidney problems, and blood clots in the lungs.

Another review of 30 trials published in Progress in Cardiovascular Diseases supported these findings. The study, which included 11,502 patients, concluded that TRT does not increase cardiovascular disease risk or mortality for men with low T.

It’s important to note that the above research suggests that TRT is not necessarily bad for heart health. This does not mean it is beneficial. However, a review of the literature on TRT over 25 years found the risk of cardiovascular events among men receiving TRT was reduced by 18 percent compared to those who received a placebo.

Other Potential Benefits of TRT

Besides potentially improving heart health, TRT can offer some additional benefits. According to the American Urological Association, TRT may improve erectile dysfunction and increase sex drive. TRT can also help boost mood by reducing symptoms of depression. Physical health benefits may include stronger bones, increased muscle mass, and improved anemia. However, not all potential benefits are backed by clear evidence. Researchers are still unsure if TRT helps improve memory, concentration, or overall cognitive skills. It's also unclear if TRT significantly boosts energy levels, reduces fatigue, or improves cholesterol and blood sugar levels.

The Endocrine Society generally does not recommend TRT for all men aged 65 or older who have low testosterone. Instead, treatment decisions should be personalized, carefully weighing potential risks and benefits.

Potential Risks of TRT

While some studies have shown TRT to be generally safe for heart health, there are risks as well. If you have a heart condition and receive TRT, you might be at an increased risk for:

• Pulmonary embolism — This is a blood clot in your lung that can be fatal.
• Atrial fibrillation — This is a type of irregular heartbeat.
• Acute kidney injury — Your kidneys filter your blood to help your heart pump smoothly.

It’s important to note that these risks were observed in specific subgroups. Therefore, they may not apply to everyone considering TRT. Consult with your healthcare provider for their recommendations about TRT. When doing so, make sure they are aware of any other underlying health concerns you have.

Should You Consider TRT for Heart Health?

Thinking about starting TRT? Here are some factors to consider:

1. Symptoms and testosterone levels — TRT is typically recommended for men with low testosterone levels and symptoms of hypogonadism, according to Cleveland Clinic.
2. Overall health — Your healthcare provider will consider your complete health profile, including preexisting conditions or risk factors.
3. Age — If you’re between the ages of 45 and 64, your doctor may recommend TRT. If you’re outside of that age range, you will need to consider risks and benefits with your physician.
4. Treatment goals — Discuss your specific health concerns and goals with your healthcare provider. These should help you figure out if TRT is right for you.
5. Monitoring — If you start TRT, regular follow-ups are essential. Follow-ups can help your doctor monitor your response to TRT and screen for any potential side effects.

Again, consult with your healthcare provider before making your final decision about TRT. Your doctor should help you come up with the best plan that’s right for you.

Alternative Approaches to Boosting Testosterone and Heart Health

If you’re concerned about low testosterone and heart health, there are several lifestyle changes you can make that may help:

• Exercise regularly — Aerobic exercise and strength training can boost testosterone levels and improve heart health.
• Maintain a healthy weight — Obesity is associated with lower testosterone levels and increased cardiovascular risk.
• Eat a balanced diet — Focus on whole foods, lean proteins, and healthy fats.
• Manage stress — Chronic stress can lower testosterone levels and negatively impact heart health.
• Get enough sleep — Poor sleep is associated with lower testosterone and increased cardiovascular risk. Try to get at least seven hours of sleep per night.
• Limit alcohol consumption — Drinking too much alcohol can lower testosterone levels and harm heart health. It also makes sleep more difficult.

Making some of these lifestyle changes can benefit your overall health. They may also improve your testosterone levels and cardiovascular function.

Talk to Others Who Understand

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 62,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Do you live with low T? Have you considered TRT? Share your experience in the comments below, or start a conversation by posting on your Activities page.