Is Testosterone Therapy Safe for Men?

For men with properly diagnosed low testosterone, testosterone replacement therapy has a strong safety profile when it is correctly prescribed and monitored. The largest cardiovascular study to date, the TRAVERSE trial of more than 5,200 men, found that testosterone did not increase major cardiac events, and in 2026 the FDA removed its longstanding cardiovascular black box warning. Safety comes down to the right diagnosis, the right candidate, and ongoing monitoring, which is exactly why physician oversight matters.

In my more than 20 years managing hormone replacement for men, I have watched this question move from fear to evidence. For years men were told testosterone might be dangerous for the heart. The research has now caught up, and it tells a clearer and more reassuring story, as long as the therapy is done properly.

Here is what the evidence actually shows. A 2025 New England Journal of Medicine review concluded that in men with confirmed low testosterone, therapy does not increase the risk of major cardiac events, prostate cancer, or urinary symptoms. The TRAVERSE trial in 2023, the first large trial built specifically to answer the cardiovascular question, found testosterone was noninferior to placebo for major cardiac events in over 5,200 men, nearly half of them 65 or older and more than half with existing heart disease. A 2024 Androgen Society position paper reviewed TRAVERSE alongside additional trials, observational studies, and meta-analyses and concluded the evidence now shows testosterone is not associated with increased heart attack, stroke, or cardiovascular death.

That does not mean there is nothing to watch. The same trials show a few signals that call for monitoring rather than fear:

Established benefits	What we monitor
Improved libido and sexual function	Red blood cell count (the most common effect, tracked with routine bloodwork)
Correction of anemia	A small increase in blood clot risk, so we use caution in men with a prior clot
Improved mood, energy, and bone health	PSA and prostate health, checked before and during therapy
No increased heart attack, stroke, or prostate cancer risk in trials	Keeping levels in a healthy mid-normal range rather than pushing them high

Here is what this research actually means in practice. Testosterone is safe for the right man, diagnosed correctly and monitored consistently. Proper diagnosis means confirming genuinely low levels with morning bloodwork, not treating a single borderline number. Monitoring means checking red blood cell count and prostate health on a schedule and keeping your levels in a healthy range instead of chasing a high one. This is the part that separates real hormone medicine from a quick prescription, and it is why a physician managing your care is not a luxury but the reason it stays safe.

I will also be straight about what the research does not yet fully answer. Men at high risk, such as those with active prostate cancer or a recent heart attack, were excluded from these trials, so therapy is not right for everyone. And when low testosterone is driven by weight and metabolic issues, the levels can often recover with weight loss, including with GLP-1 medications, so sometimes the smarter first move is to fix the metabolism before starting testosterone at all. That is a conversation worth having before anyone hands you a prescription.

The right next step is simple. Testosterone therapy should start with two early-morning lab draws to confirm the diagnosis, followed by a plan built around your health and monitored over time. If you are wondering whether it is right and safe for you specifically, that is exactly what a consult is for.

To Health and Wellness, Dr. Ty Tallman