A recent publication on the complications of subcutaneous hormone-pellet therapy, looking at a large cohort of patients over 7 years, demonstrated long-term safety. There is growing evidence to support the use of physiologic doses of testosterone for sexual function, osteoporosis prevention, brain protection, and breast protection. By taking steps to monitor the heart and manage risk factors, TRT can be made safer for those who need it. The risk depends on personal health, the form and dose of TRT, and how the body responds. Eating a healthy diet, staying active, avoiding smoking, and managing stress can support heart health while taking TRT. There are steps that can help reduce the risk of side effects. This may include blood tests, blood pressure checks, and heart monitoring.
Furthermore, sex hormones may also directly bind to potassium channels or the auxiliary subunits to modulate the activities of potassium channel blockers and potassium channel openers. Conversely, in a cross-sectional study by Fitzgerald et al. (18) which compared trained cyclists to recreational cyclists, the former group had higher levels of serum testosterone than the latter. In fact, testosterone increases during low-intensity training periods in comparison to high-intensity training periods. Finally, the amount of active serum testosterone is heavily reliant on the concentrations of sex hormone-binding globulin (SHBG) and albumin, thus being subject to fluctuations in those proteins. The main male sex hormone is testosterone, but females also produce a small amount of this hormone. These steroid hormones are known to exert their multiple physiological effects by binding to cytosolic or membrane receptors (6). In contrast, females are at increased risk for Torsade de pointes (TdP), both in congenital and acquired Long QT Syndrome (LQTS) (5).
This genetically-determined disease is characterized by the appearance of a coved-type ST segment elevation in the right precordial ECG leads, and puts the patients at significant risk for SCD in the absence of an underlying structural heart disease (61). As mentioned previously, estrogen, progesterone and testosterone have varying effects on these currents, which could explain the gender differences (7). Female sex is known to be an independent risk factor, as females have 10–20 ms longer QTc intervals. Likewise, testosterone replacement was shown to exert cardioprotective effects in orchiectomized rats (48). In fact, there are reports of increased (29), decreased (32), or indifferent calcium currents (ICa) in females as compared to males (27).
Testosterone can affect how the heart responds to signals from the nervous system. Some patients report palpitations or fluttering sensations in the chest while taking testosterone. An irregular heartbeat, also called an arrhythmia, is another heart condition that can be affected by TRT. Blood pressure should be checked regularly, and TRT may need to be adjusted or paused if blood pressure becomes too high. People with high blood pressure should be carefully monitored when using TRT.
However, they did notice that men with a history of heart disease were more likely to experience changes in heart rate after starting TRT. The effect was more noticeable in men who received large doses or infrequent injections, which caused hormone levels to rise and fall sharply. This research found that some men experienced spikes in heart rate shortly after receiving their injections. This suggests that while heart rate changes may occur, they are not common in all users. However, the researchers also tracked heart-related side effects.
Sometimes, these effects are temporary and improve as the body adjusts to TRT. Not every fast heartbeat or related symptom means something is wrong. Shortness of breath, along with a rapid heartbeat, may suggest that the heart is working harder than usual. In some cases, TRT may also raise the risk of sleep apnea, a condition that affects breathing during sleep. Some people find it harder to fall asleep or stay asleep through the night. Some men describe it as being more aware of their heartbeat, even when resting.
Monitoring helps identify early signs of unwanted effects and allows for safe adjustments to the therapy plan. Because of this, doctors often monitor heart health during treatment, especially during the first few months. Overall, current research does not show strong or consistent evidence that TRT causes dangerous heart rate changes in most patients. The authors concluded that more long-term studies are needed to fully understand how TRT affects the heart over time. It also noted that heart rate changes, when reported, were usually mild and temporary. While this does not happen in every patient, it may explain why some people feel jittery or experience palpitations after starting therapy.
The Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy ResponSE in Hypogonadal Men (TRAVERSE) study is an ongoing clinical trial designed to measure the time to major adverse cardiovascular events in hypogonadal men, aged 45 to 80 years, with increased risk or evidence of CVD.36 The study commenced in May 2018 and is expected to be completed in June 2022, with 6000 planned participants randomized to receive topical testosterone or placebo.36 This clinical trial will play an important role in determining the safety of TRT in hypogonadal men. Thus, although many studies have found inverse associations between endogenous testosterone levels and cardiovascular risk and mortality, conflicting results and heterogeneous study populations have prevented firm conclusions from being drawn. An increased risk of premature cardiovascular events in men initially led to the belief that testosterone had detrimental effects on cardiovascular health. These visits allow the healthcare provider to track hormone levels, heart rate, blood pressure, and symptoms. Some studies suggest that low testosterone levels are linked to a higher risk of heart failure. Reports of increased heart rate in people using TRT do exist, but it is not one of the most common side effects. A small number of men in the testosterone group experienced increased heart rates and blood pressure.
Also, oral testosterone passes through the liver, which processes the hormone before it reaches the bloodstream. After taking a dose, testosterone can enter the blood quickly, leading to a short-term rise in levels. For those with heart issues or sensitivity to changes in hormones, these ups and downs may be uncomfortable. This happens because testosterone may stimulate the nervous system, increase metabolism, and raise blood pressure slightly.