A study reported in the July 13, 2023, issue of the New England Journal of Medicine found that men receiving testosterone HRT and a placebo group had a comparable incidence of major cardiovascular events during a 22-month period.¹

The randomized, double-blind trial included men between the ages of 45 and 80 years with low testosterone levels who had preexisting cardiovascular disease or had a high risk of the disease. A gel containing testosterone was applied daily by 2,596 men and 2,602 men received a placebo gel.

Cardiovascular events—which included nonfatal heart attacks and strokes as well as death from cardiovascular causes—impacted 7% of the men who received testosterone and 7.3% of the placebo group.

Deaths from cardiovascular causes were 16% lower and deaths from any cause were 2% lower among men who received testosterone compared to the placebo. Some of the other results were mixed, though: pulmonary embolism (blood clot in a lung) occurred among 0.9% of men who received testosterone and 0.5% of the placebo group, atrial fibrillation (a type of abnormal heart rhythm) occurred among 3.5% of the testosterone group and 2.4% of the placebo group, and acute kidney injury was observed among 2.3% and 1.5% of the testosterone and placebo groups, respectively.

The authors noted that a meta-analysis published in The Lancet Healthy Longevity failed to find an association between testosterone use and the risk of venous thromboembolism (blood clots in the veins), and that an association between testosterone therapy and a decrease in the incidence of atrial fibrillation was revealed by another study.

The findings may offer some comfort to men considering HRT who were concerned about a possible elevated risk of heart disease. “Controlled trials have shown that the use of testosterone in older men improves sexual function, increases volumetric and areal bone mineral density, corrects unexplained anemia, and moderately reduces depressive symptoms,” A. M. Lincoff and colleagues wrote.