Longevity & Aging · Metabolic & Cardiometabolic
testosterone therapy does not increase cardiovascular risk
In plain terms: Is testosterone therapy safe for your heart?
Part of: 💊 Testosterone therapy (TRT)
Mostly reassuring, not fully settled. The big 2023 TRAVERSE trial found no increase in major cardiac events (heart attack, stroke, cardiac death) — putting an old scare to rest — but it did find more atrial fibrillation and blood clots in the lungs. So: probably safe for major events in the right patients, with a real, unresolved signal for irregular heartbeat and clots.
📅 Last reviewed: 2026-07-14 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
How the studies fall
What the evidence shows
TRT's cardiovascular safety is reassuring on the biggest question but not fully settled. The large TRAVERSE randomized trial (2023) found testosterone was non-inferior to placebo for major cardiac events (heart attack, stroke, CV death) — strong evidence against the earlier scare — and several meta-analyses agree.
The evidence (21)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| La Vignera S et al 2026 · study_type: RCT | RCT | supports | moderate | In CKD patients with hypogonadism, cardiovascular safety data from large trials indicate noninferiority to placebo for major adverse cardiac events, though vigilance for atrial fibrillation and acute kidney injury is warranted. |
| Garcia-Becerra CA et al. 2026 · Int J Impot Res | meta-analysis | supports | high | Meta 41 RCTs (n=11,161): TTh not associated with increased MACE (OR 0.83, 95% CI 0.52-1.32, ns) - supports short-to-mid-term cardiovascular safety (authors note long-term data still needed). |
| Lincoff AM et al. 2023 · N Engl J Med | RCT | mixed | high | TRAVERSE (n=5246): non-inferior to placebo for MACE (HR 0.96) BUT higher atrial fibrillation, acute kidney injury, and pulmonary embolism in TRT group. |
| Xu L et al. 2013 · BMC Med | meta-analysis | contradicts | moderate | Meta 27 RCTs: increased CV-event risk overall (OR 1.54); non-industry trials OR 2.06 vs industry OR 0.89. |
| Basaria S et al. 2012 · J Androl | RCT | contradicts | moderate | TOM trial substudy: trial halted early for excess CV events; greater free-T rise associated with events. |
| Merlino L et al 2026 · study_type: observational | observational | supports | moderate | In 1,545 propensity-matched pairs of men with CKD and hypogonadism followed a median 3.7 years, TRT was associated with lower all-cause mortality (HR 0.78, 0.63-0.98) and no significant differences in cardiovascular outcomes, prostate cance |
| Vigen R et al. 2013 · JAMA | observational | contradicts | moderate | Retrospective cohort (n=8709): TT associated with increased death/MI/stroke (25.7% vs 19.9% at 3y). |
| Alexander GC et al. 2017 · Am J Med | meta-analysis | mixed | low | SR/meta 39 RCTs + 10 observational: no significant increase in MI/stroke/mortality, but evidence rated very low quality. |
| Munro V et al 2026 · study_type: observational | observational | supports | moderate | In 408 men with pituitary disease followed a median 8.1 years, multivariable analysis found no significant difference in MACE between TRT-treated secondary hypogonadism, untreated secondary hypogonadism, and no-hypogonadism groups; untreate |
| Higa S et al 2026 · study_type: animal | animal | contradicts | low | In nitric-oxide-synthase-knockout mice with reduced NO production (modeling elderly men), long-term testosterone treatment worsened survival, increased myocardial infarction incidence, impaired arterial relaxation, and worsened cardiovascul |
| Vo TT et al 2026 · study_type: observational | observational | supports | moderate | Using three complementary quasi-experimental designs in a US insurance database, exogenous testosterone (vs glaucoma-treatment active comparator) showed no difference in risk of the composite endpoint of MI, ischemic stroke, and sudden card |
| Kerniss H et al 2026 · study_type: observational | observational | contradicts | high | In 358,957 men, TT initiated without evidence of hypogonadism (35.4%) had higher MACE than TT initiated with evidence of hypogonadism (16.53% vs 11.83%; HR 1.51, 1.45-1.56) and higher all-cause mortality, ischaemic stroke, cardiac arrest, a |
| Cannarella R et al. 2023 · J Clin Med | meta-analysis | supports | moderate | Meta (14 RCTs + observational): no increased arterial/venous thrombosis, stroke, MI, or mortality in RCTs. |
| Morbey EJ et al 2026 · study_type: mechanism | observational | contradicts | moderate | Mendelian randomization in 425,097 UK Biobank men found higher genetically predicted circulating testosterone conferred higher coronary artery disease risk (OR 1.17, 1.07-1.27), likely mediated by blood pressure, while observational analysi |
| Ayele HT et al. 2021 · Drug Saf | meta-analysis | mixed | moderate | Meta 13 RCTs (n=5050): TRT not associated with VTE (RR 1.03) but wide CIs cannot rule out risk. |
| Finkle WD et al. 2014 · PLoS One | observational | contradicts | moderate | Self-controlled cohort (n=55,593): post-prescription MI rate ratio 1.36 overall; 2.19 in men >=65. |
| Glueck CJ et al. 2017 · Clin Appl Thromb Hemost | observational | mixed | low | Case-control: VTE peaks ~3 months post-initiation, concentrated in men with underlying thrombophilia (unmasks Factor V Leiden/high Lp(a)). |
| Traish AM et al 2026 · study_type: RCT | RCT | supports | moderate | Reviewing MEDLINE literature on TTh and atrial fibrillation in hypogonadal men, the majority of studies (including trial data) found T deficiency associated with greater AF incidence and that TTh does not increase AF incidence, though no tr |
| Sood A et al. 2023 · J Urol | meta-analysis | supports | high | Meta 26 RCTs (n=10,941): no significant differences in all-cause/CV mortality, MI, stroke, CHF, AF, PE, or VTE. |
| Haddad RM et al. 2007 · Mayo Clin Proc | meta-analysis | tested-null | moderate | Meta 30 RCTs: any-CV-event OR 1.82 (95% CI 0.78-4.23, ns); weakly reassuring. |
| Tienforti D et al 2026 · study_type: RCT | RCT | mixed | high | Synthesizing TRAVERSE, TRT showed non-inferiority for MACE in older hypogonadal men (HR 0.96, 0.78-1.17), but non-MACE signals for atrial fibrillation (3.1% vs 2.4%), pulmonary embolism (2.0% vs 1.5%), and acute kidney injury (2.3% vs 1.5%) |
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