The Link Between Testosterone and Cardiovascular Health
The relationship between testosterone and cardiovascular health is a growing area of research that continues to evolve. Once thought to raise heart disease risk, testosterone is now being reevaluated as a key factor in supporting metabolic and vascular health—especially in aging men and women. Studies suggest that maintaining healthy testosterone levels may positively influence cholesterol, insulin sensitivity, and overall heart function.
What Is Testosterone and Why Does It Matter?
Testosterone is a vital hormone in both men and women. Beyond its role in sexual health, it regulates muscle mass, fat distribution, mood, and metabolism. In men, levels typically begin to decline around age 30, decreasing by 1–3% per year (Feldman et al., 2002). Women also experience a gradual decline, particularly after menopause.
Low testosterone, often referred to as hypogonadism, has been linked to fatigue, reduced muscle tone, poor concentration, and changes in body composition—all of which can indirectly influence heart health.
How Testosterone Affects Cholesterol and Heart Health
One of the most well-established benefits of healthy testosterone levels is their effect on cholesterol balance. Research shows that as testosterone levels rise, LDL (“bad”) cholesterol tends to decrease, while HDL (“good”) cholesterol may increase or remain stable. Lower LDL levels are associated with improved cardiovascular outcomes and reduced arterial plaque buildup (Kloner et al., 2016).
In addition, optimal testosterone levels may:
Improve vascular function by supporting nitric oxide production, which helps arteries relax and improves blood flow.
Support red blood cell production, enhancing oxygen delivery throughout the body.
Reduce visceral fat accumulation, a major risk factor for heart disease and insulin resistance.
These combined effects suggest that maintaining adequate testosterone may play a protective role in heart health.
Testosterone, Insulin Resistance, and Metabolic Health
Low testosterone levels have been strongly associated with insulin resistance, a condition in which the body’s cells do not respond properly to insulin, leading to elevated blood sugar levels. Over time, this can progress to metabolic syndrome or type 2 diabetes, both of which raise cardiovascular risk.
According to Rao et al. (2013), testosterone helps regulate glucose metabolism by stimulating glucose uptake and energy utilization in muscle tissue. In other words, testosterone encourages the body to use sugar efficiently, reducing strain on the pancreas and stabilizing blood sugar levels. Ongoing research suggests that testosterone replacement therapy (TRT) in hypogonadal men may improve insulin sensitivity and reduce inflammation.
The Aging Connection: Declining Testosterone and Cardiovascular Risk
As testosterone naturally declines with age, men and women may experience a gradual shift toward higher fat mass, lower lean muscle, and changes in lipid metabolism. These shifts contribute to elevated cardiovascular risk over time. Studies show that men with the lowest testosterone levels are more likely to develop hypertension, obesity, and coronary artery disease.
Addressing low testosterone through lifestyle, nutrition, and medical evaluation may therefore help support both metabolic and cardiovascular resilience as we age.
When to Get Tested
If you notice symptoms such as fatigue, low libido, brain fog, mood changes, or decreased exercise tolerance, it may be time to test your hormone levels. A simple blood test can assess total and free testosterone levels, along with related markers such as lipid profile, fasting glucose, and hemoglobin A1C to evaluate your metabolic health.
Consulting a hormone specialist ensures that results are interpreted in context—taking into account your age, overall health, and individual risk factors.
Conclusion
The evidence linking testosterone and cardiovascular health continues to grow, emphasizing the importance of balanced hormone levels for heart and metabolic wellness. While testosterone is not a cure-all, maintaining optimal levels may help improve cholesterol balance, reduce insulin resistance, and support long-term vascular function.
If you’re concerned about symptoms of low testosterone, consider scheduling an evaluation with a qualified provider. They can help determine whether hormone optimization, lifestyle modifications, or further testing is right for you.
References
Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2002;87:589-598
Kloner R, Carson C, Dobs A, et al. Testosterone and Cardiovascular Disease. J Am Coll Cardiol. 2016 Feb, 67 (5) 545–557. https://doi.org/10.1016/j.jacc.2015.12.005
Rao, P. M., Kelly, D. M., & Jones, T. H. (2013). Testosterone and insulin resistance in the metabolic syndrome and T2DM in men. Nature Reviews Endocrinology, 9(8). https://doi.org/10.1038/nrendo.2013.122
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