Impact of Testosterone Therapy: Cardiovascular Safety & Oral Innovation

Express Medical Experts
3 days ago
3 min read

Testosterone therapy has become a hot topic in recent years. This blog post explores the cardiovascular safety of testosterone therapy and highlights new oral formulations entering the market.

Understanding Testosterone Therapy

Testosterone therapy primarily treats men with hypogonadism, a condition where testosterone levels drop significantly. Symptoms can vary widely and often include fatigue, reduced sexual drive, and mood swings. While testosterone replacement can improve these issues, it also raises questions about its effects on the heart.

Research on cardiovascular safety related to testosterone therapy has produced a mixed bag of results. Some studies indicate that testosterone might support heart health by improving blood vessel function and reducing body fat. In fact, a study showed that men with higher testosterone levels had up to a 30% lower risk of cardiovascular conditions. Conversely, other research warns of potential dangers, like increased chances of blood clots and heart attacks. A notable 2015 study found that men over 65 using testosterone therapy experienced a significant spike in cardiovascular events, leading to the FDA warning about its use.

Testosterone and the Heart: Clearing the Air

Initial concerns regarding testosterone and heart health stemmed from observational studies with significant methodological issues, which grouped together diverse patient populations. Often, these studies failed to differentiate between men undergoing medically supervised therapy and those misusing anabolic steroids.

More recent, rigorously controlled studies present a different narrative:

Blood pressure typically remains stable in men undergoing physiologic TRT
The risk of clotting (including VTE) does not increase with therapy initiation—in fact, it might decrease over time
Testosterone seems to promote vascular health by enhancing nitric oxide availability, modulating the RAAS system, and reducing inflammatory clotting markers like fibrinogen and PAI-1

“The enduring narrative that testosterone causes hypertension or thrombosis is unsupported by current scientific literature.”

— Dr. Mark L. Gordon, MD

Neuroendocrinology and Integrative Physiology

Prostate Health: Looking Beyond Testosterone

Concerns about prostate cancer often halt therapy prematurely, but perspectives are changing.

A 2004 New England Journal of Medicine study found no link between higher testosterone levels and increased prostate cancer risk; low testosterone may be linked to more aggressive disease.

A 2011 Journal of Urology review similarly concluded that appropriately prescribed testosterone replacement does not increase prostate cancer risk and may benefit tissue integrity and symptom relief.

“Testosterone isn’t the problem. It’s how your body metabolizes it—especially into DHT and estradiol—that matters most.”

— Dr. Mitch Ghen

That’s why monitoring downstream metabolites is so important. Elevated DHT and unbalanced estradiol—not total testosterone itself—are more likely to be the culprits when prostate concerns arise.

The Role of Oral Innovation

Traditionally, testosterone therapy has been delivered via injections, patches, or gels. However, innovative oral formulations are emerging, offering a convenient alternative. These new oral medications aim to deliver the same benefits while potentially lowering risks associated with traditional methods.

One noteworthy example of an oral formulation is testosterone undecanoate. Clinical trials indicate it can be effectively absorbed through the lymphatic system, which avoids the liver and may reduce adverse cardiovascular effects. In one trial, about 70% of participants reported relief from low testosterone symptoms, demonstrating the therapeutic potential of this approach.

“Oral Testosterone Undecanoate brings testosterone therapy closer to biological reality. It preserves more natural signaling while delivering consistent symptom relief.”

— Dr. Andrew Sun

Monitoring: What to Test and When

One of the most common mistakes with oral TU? Fasting labs. Unlike injectables, this formulation needs to be taken with food—and lab timing matters.

“If labs look low but the patient feels great, always ask: Did they take their morning dose? Was it with enough fat? Timing matters more than most realize.”

— Dr. Andrew Sun

Dr. Sun recommends drawing labs 2–4 hours after dosing, ideally with a meal that includes some fat. This provides a more accurate picture of circulating hormone levels.

Key Panels:

Male Hormone Panel

Comprehensive Hormone Panel

These labs help you tailor dosing, catch metabolite imbalances, and ensure patient safety—especially in men at risk for cardiovascular or prostate complications.