Unnecessary Testosterone Use Doubles Risk of Serious Cardiovascular Events and Death

A comprehensive study involving over 350,000 men has revealed that individuals using testosterone without a medical indication face nearly double the risk of severe cardiovascular events, including heart attack, stroke, cardiac arrest, and death, compared to those receiving the hormone for genuine clinical needs like hypogonadism. The research, published in eBioMedicine, tracked participants for up to ten years and found that the risk of mortality from any cause almost doubled for men taking testosterone without a diagnosed deficiency. Testosterone replacement is medically indicated for hypogonadism, a condition characterized by insufficient hormone production due to testicular or pituitary gland issues. When prescribed for confirmed hypogonadism with symptoms, testosterone therapy is considered safe, as evidenced by recent trials like TRAVERSE which found no increased cardiovascular risk in treated men with hypogonadism and high cardiac risk.

The study specifically targeted men using testosterone without a diagnosed need, who constitute approximately one-third of all users. Out of 358,957 men aged 30-75 using testosterone, 35.4% had no record of hypogonadism, including altered test results or justifying symptoms. To ensure a fair comparison, researchers employed statistical matching to pair participants with similar characteristics, forming over 113,000 pairs, totaling more than 227,000 men. The group using testosterone without indication experienced a 51% higher risk of major cardiovascular events, nearly doubled mortality, and increased instances of ischemic stroke, cardiac arrest, and heart failure. These associations persisted across various racial and ethnic groups.

Physicians and experts explain that supra-physiological levels of testosterone, often achieved through unnecessary use, can lead to increased red blood cell production, making blood more viscous and prone to clotting, thereby increasing the risk of heart attack and stroke. This hormonal excess also triggers inflammation, damaging blood vessel walls and accelerating plaque buildup. Furthermore, it can cause heart muscle thickening, leading to heart failure, and elevate blood pressure. The study also noted that discontinuing testosterone use without medical necessity can be complicated, as the body may suppress its own production, potentially leading to testicular atrophy and dependence on external applications. The trend of non-indicated testosterone use is fueled by its popularity in bodybuilding and among gym-goers, social media pressures linking hormone levels to virility, and a contemporary lifestyle that may contribute to declining natural testosterone levels.