Testosterone replacement therapy (TRT) can be safe for men aged 65 with heart conditions when it is carefully prescribed and monitored by healthcare professionals. Recent large clinical trials and meta-analyses have shown that TRT, when used to treat men with clinically confirmed low testosterone levels and symptoms of deficiency, does not increase the risk of major cardiovascular events compared to placebo. In fact, TRT may improve certain cardiovascular and metabolic parameters in appropriately selected patients.
Men over 65 often experience a natural decline in testosterone levels, which can contribute to symptoms like fatigue, reduced muscle mass, decreased libido, and worsening metabolic health. For those with heart conditions, the question of TRT safety is especially important because testosterone affects the cardiovascular system in complex ways. However, landmark studies such as the TRAVERSE trial, which included thousands of men with hypogonadism and cardiovascular risk factors, found no increase in heart attacks, strokes, or cardiovascular deaths in men receiving testosterone therapy compared to those receiving placebo. This has led to the removal of previous FDA cardiovascular warnings on testosterone products, marking a significant shift in the understanding of TRT safety.
The key to safe TRT use in men with heart conditions at 65 is *proper patient selection and ongoing monitoring*. Treatment should only be started if a man has both symptoms consistent with testosterone deficiency and confirmed low testosterone levels on repeated morning blood tests (typically below 300 ng/dL). Men with active prostate or breast cancer, elevated prostate-specific antigen (PSA), or uncontrolled heart failure are generally not candidates for TRT.
When prescribed correctly, TRT may offer several cardiovascular and metabolic benefits. It has been shown to improve endothelial function (the health of blood vessel linings), increase arterial compliance (flexibility of arteries), and reduce systemic inflammation, all of which can contribute to better heart health. TRT also tends to lower waist circumference, body mass index, and markers of metabolic syndrome, potentially reducing the risk of diabetes and improving insulin sensitivity. These effects can be particularly valuable in older men who often face multiple metabolic and cardiovascular challenges.
However, TRT is not without risks. It can increase red blood cell count, which may raise the risk of blood clots if not monitored. Some men may experience mild increases in blood pressure, so cardiovascular parameters must be regularly checked during therapy. Different forms of testosterone delivery—such as topical gels, injections, or patches—carry varying risk profiles, with topical applications generally providing more stable hormone levels and potentially safer cardiovascular outcomes.
For men with existing heart conditions, the decision to start TRT should involve a thorough evaluation by a healthcare provider experienced in hormone therapy and cardiovascular medicine. This evaluation includes a detailed medical history, physical examination, hormone level testing, and cancer screening. Once therapy begins, regular follow-ups are essential to monitor testosterone levels, hematocrit (red blood cell concentration), blood pressure, lipid profiles, and prostate health.
In addition to cardiovascular safety, TRT can improve quality of life by increasing energy, muscle strength, bone density, sexual function, and mood in men with low testosterone. These benefits often outweigh the manageable risks when therapy is individualized and carefully supervised.
In summary, testosterone therapy at age 65 with heart conditions can be safe and beneficial if prescribed for men with confirmed testosterone deficiency, without contraindications, and with close medical monitoring. The evolving evidence supports TRT as a valuable treatment option that may also contribute to improved cardiovascular and metabolic health in this population.
