Heart Health & Testosterone: What Men Over 40 Need To Know (and Why It's Not All Bad News)

Written by the UPGUYS Editorial Team

Published on July 09, 2025

For men in Canada considering testosterone replacement therapy (TRT), one of the most common concerns is heart health. 

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You've probably heard the warnings—claims that TRT could increase the risk of heart attacks, strokes, or blood clots. It's a topic that has caused hesitation for many men over 40 who might otherwise benefit from treatment. 

The truth? The relationship between testosterone and cardiovascular risk is far more nuanced than the headlines suggest. Recent studies have shown that when low testosterone is properly diagnosed, and TRT is medically supervised, the therapy is not only safe for the heart—it may even improve key risk factors like cholesterol, inflammation, and insulin resistance. 

This article unpacks the myths, the latest science, and how testosterone replacement therapy in Canada can support both hormonal health and cardiovascular well-being. 

Topics covered in this article: 

Where the Fear Started – Old Studies, FDA Warnings & Media Hype 

In the early 2010s, the testosterone-heart health debate kicked off with alarming headlines and some flawed studies that placed TRT under harsh scrutiny. The U.S. Food and Drug Administration (FDA) issued a safety communication in 2015 warning that testosterone products may carry an increased risk of heart attack and stroke, prompting changes to product labels to reflect these possible risks—even though some underlying data were inconclusive or poorly analyzed. 

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Much of the concern stemmed from studies like Vigen et al. (2013) and Finkle et al. (2014). In these studies, TRT appeared linked to higher cardiovascular events, but further scrutiny revealed serious methodological issues—such as missing control groups, skewed data, or errors in how events were counted. 

Media amplification of these results fueled widespread anxiety, even as the scientific community began to question the validity of those conclusions. 

Today, leading medical reviews—including those published in the Mayo Clinic Proceedings and stated by the Androgen Society—point out that these older studies are not reliable indicators of real-world heart risk from TRT, especially when correctly prescribed in men with clinically low testosterone. 

What the Latest Research Says – Meta‑analyses, New Trials & Health Canada 

Recent, high‑quality studies overwhelmingly support the conclusion that properly prescribed testosterone replacement therapy (TRT) does not increase cardiovascular risk—and may even offer benefits for heart health in men over 40. 

A 2024 meta‑analysis by Corona et al., which reviewed over 8,000 men across randomized controlled trials, reported no significant difference between TRT and placebo in major cardiovascular events—even when considering atrial fibrillation risk. Similarly, a large updated meta‑analysis published in the Journal of the American College of Cardiology found no increase in cardiovascular risk or mortality in hypogonadal men receiving TRT. 

The landmark TRAVERSE trial—a randomized study of more than 5,200 men (ages 45–80) with hypogonadism and cardiovascular risk factors—found TRT was non-inferior to placebo regarding heart attack, stroke, or cardiovascular death over a mean of 27 months of follow-up. A recent review of the TRAVERSE data similarly affirmed its cardiovascular safety stance. 

In Canada, the Canadian Urological Association guidelines emphasize that men with low testosterone are at an increased risk of heart disease if left untreated, and they affirm that individualized treatment under medical supervision remains an acceptable option for most men—even those with stable cardiovascular conditions. Health Canada also continues to require cardiovascular risk assessment and ongoing monitoring, but does not ban TRT, recognizing that properly managed therapy is generally safe. 

Key Takeaways: 

1. Meta-analyses and modern trials like TRAVERSE show no increased cardiovascular risk when TRT is medically supervised. 
2. Untreated low testosterone is itself linked to higher cardiovascular disease risk. 
3. Health Canada supports careful, monitored use of TRT in symptomatic men—even with heart disease—on a case-by-case basis. 

Altogether, the latest evidence offers reassurance: when testosterone replacement therapy is used correctly, it does not harm—and may even support—heart health in men over 40. 

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How Healthy Testosterone Supports the Heart 

Balanced testosterone levels play a surprisingly important role in supporting cardiovascular health—especially in men over 40. While past concerns focused on the risks of testosterone therapy, more recent research highlights how healthy testosterone can benefit heart function through several key mechanisms. 

Here's how optimized testosterone supports heart health: 

1. Improves cholesterol balance: Studies show that testosterone can reduce total cholesterol and LDL ("bad" cholesterol) while raising HDL ("good" cholesterol), helping to reduce plaque buildup in arteries. 
2. Enhances insulin sensitivity: Low testosterone is strongly associated with insulin resistance, a key factor in metabolic syndrome and type 2 diabetes. TRT has been shown to improve glucose regulation and reduce fasting blood sugar levels. 
3. Reduces systemic inflammation: Inflammation is a major driver of cardiovascular disease. Clinical data suggest that TRT may lower markers like C-reactive protein (CRP), helping to reduce overall inflammatory load on the heart and vessels. 

When testosterone levels are too low, men are more likely to develop risk factors like abdominal fat, elevated triglycerides, and high blood pressure—all of which put extra strain on the heart. For many men in Canada, testosterone replacement therapy (TRT) can help restore hormonal balance and offer protective effects when guided by a qualified healthcare provider. 

Who Should Be Cautious (and Who Shouldn't Panic) 

While testosterone replacement therapy (TRT) is generally safe for most men when medically supervised, it's not appropriate for everyone. Understanding who should proceed with caution—and who likely has little to worry about—is key to using TRT responsibly. 

Men who should be more cautious with TRT include: 

1. Those with recent heart events: Men who have had a heart attack or stroke within the past 6 months are typically advised to delay or avoid TRT until stabilized. 
2. Men with untreated sleep apnea: Low oxygen levels at night can strain the heart, and TRT may worsen symptoms if sleep apnea isn't addressed. 
3. Men with very high red blood cell counts: TRT can increase hematocrit levels, raising the risk of blood thickening and clot formation. 
4. Those with advanced prostate cancer or elevated PSA: Though not directly linked to prostate cancer, TRT may accelerate tumour growth if cancer is already present. 

However, for most men over 40 with stable cardiovascular conditions, mild hypertension, or controlled type 2 diabetes, recent evidence suggests TRT does not increase heart attack or stroke risk—and may even improve risk factors when used correctly. 

In Canada, clinicians typically assess cardiovascular and prostate health before starting therapy, then monitor regularly to keep treatment within a safe, therapeutic range. The key takeaway? TRT isn't off-limits for men with common age-related concerns—it just needs to be approached with the right context and care. 

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TRT and Heart Monitoring in Canada – What Responsible Care Looks Like 

In Canada, testosterone replacement therapy (TRT) is regulated and medically supervised to ensure safety—especially when it comes to cardiovascular health. Reputable clinics follow evidence-based protocols that prioritize ongoing monitoring and individualized treatment. 

Here's what responsible TRT care looks like in Canada: 

1. Pre-treatment screening: Before starting TRT, men undergo thorough blood work to assess testosterone levels, red blood cell count, PSA (prostate health), cholesterol, blood pressure, and markers of inflammation or metabolic risk. 
2. Baseline cardiovascular assessment: If a man has a history of heart disease, mild hypertension, or type 2 diabetes, his condition is reviewed to determine whether TRT is appropriate or needs to be delayed. 
3. Regular follow-ups: After starting therapy, blood work is repeated every 3 to 6 months to monitor testosterone levels and ensure safety. Doctors track changes in hematocrit, PSA, and lipid profiles to avoid complications. 
4. Dose adjustments: Treatment is tailored to keep testosterone levels within the physiological range—high enough to relieve symptoms, but not so high that it increases risk. 
5. Collaborative care: For men with heart conditions, many clinics coordinate with cardiologists or primary care physicians to ensure TRT is part of a safe, broader care plan. 

This type of structured, proactive care gives men over 40 in Canada confidence that they can pursue TRT without compromising heart health. When managed responsibly, TRT becomes a tool for restoring energy and vitality—not a cardiovascular gamble. 

How to Safely Balance Testosterone and Heart Health 

Testosterone replacement therapy (TRT) can be part of a heart-healthy life—when it's combined with smart habits, proper screening, and consistent medical follow-up. For men over 40 in Canada, the goal isn't just boosting testosterone—it's optimizing overall health while minimizing risks. 

Here's how to do it safely and effectively: 

1. Start with a complete health check: Before beginning TRT, get a full panel of blood work and discuss any history of cardiovascular issues, sleep apnea, or prostate conditions with your doctor. 
2. Follow the numbers: Regular monitoring of testosterone levels, cholesterol, hematocrit, blood pressure, and PSA ensures your treatment stays in the safe zone. 
3. Prioritize lifestyle: A heart-smart diet (low in processed carbs, rich in healthy fats), regular exercise (especially strength and cardio training), and quality sleep all enhance TRT's benefits and protect your heart. 
4. Watch for symptoms: Stay alert for changes like shortness of breath, swelling, high blood pressure, or chest discomfort—rare but important signs to report. 
5. Stay consistent with care: Don't skip follow-ups. TRT isn't a set-it-and-forget-it treatment—long-term success depends on collaboration with a knowledgeable provider. 

Balancing testosterone and heart health isn't about choosing one over the other. With proper screening and lifestyle support, TRT can be part of a strong, heart-smart plan for aging well. 

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Conclusion: You Don't Have to Choose Between Heart Health and Hormone Health 

For years, men over 40 have been told to be cautious—even fearful—about testosterone replacement therapy (TRT) and its effects on the heart. But today's research tells a different story. When low testosterone is properly diagnosed and treatment is medically supervised, TRT does not increase cardiovascular risk—and may actually help by improving key factors like cholesterol, blood sugar, and inflammation. 

In Canada, responsible TRT programs include full screenings, ongoing monitoring, and personalized care. That means you can restore energy, motivation, and quality of life without putting your heart at risk. You don't have to choose between feeling better and staying safe. With the right guidance, you can have both. 

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