What men need to know about testosterone and heart health

Testosterone isn’t just about sex drive or gym performance. In fact, your heart might depend on it more than you think.

For decades, testosterone has been misunderstood, framed as a macho hormone tied to aggression or vanity. But behind the clichés lies something far more complex. Testosterone plays a vital role in nearly every system of the body, including the cardiovascular system. And for men, especially as they age, low testosterone may signal more than fatigue or low mood. 

Research suggests that testosterone levels and heart health are closely linked, with low levels associated with an increased risk of heart disease, type 2 diabetes, and even death. But whether testosterone is directly to blame, or simply a marker of other underlying health issues, is still being investigated.¹

What testosterone actually does

Testosterone is the main male sex hormone, produced in the testicles and controlled by signals from the brain. It helps regulate everything from sperm production and muscle growth to mood, energy, and bone density.²

In the bloodstream, most testosterone is bound to a protein called SHBG (sex hormone-binding globulin). Only a small amount (around 1–2%) circulates as “free testosterone,” which is the form that’s active and available to your body’s tissues, including the heart and blood vessels.²

Testosterone also gets converted into other hormones. One of them, dihydrotestosterone (DHT), is even more potent and affects things like hair growth and prostate health. Another, oestrogen, is made from testosterone in small amounts and plays a quiet but critical role in bone and cardiovascular health, even in men.²

The ageing male heart

After around age 40, testosterone levels begin to decline slowly but steadily. This is normal, but in some men, the drop becomes steep enough to trigger symptoms like low libido, fatigue, muscle loss, and irritability. That’s called testosterone deficiency (sometimes called hypogonadism).²

But recent studies suggest it’s not just about symptoms. Men with low testosterone are more likely to develop heart-related conditions like:¹

• Coronary artery disease: when the arteries that supply the heart become narrowed or blocked.

• Type 2 diabetes and metabolic syndrome: both of which are major risk factors for heart disease.

• Congestive heart failure: where the heart’s ability to pump blood is reduced.

In some studies, men with low testosterone levels were also more likely to die, particularly from cardiovascular causes. One large analysis showed that men over 70 with higher testosterone levels had a lower risk of heart problems and death compared to those with lower levels.¹ But this doesn’t prove testosterone protects the heart, it may simply reflect better overall health.

Why might low testosterone affect the heart?

Testosterone interacts with heart and blood vessel cells in complex ways. It helps relax blood vessels (making them wider), influences how the heart muscle contracts, and can impact how fat is stored and how the body handles blood sugar.²

When testosterone levels are low, the body may become more prone to:²

• Abdominal fat gain

• Insulin resistance (a key driver of type 2 diabetes)

• Higher cholesterol

• Increased inflammation

All of these factors can strain the heart over time, even if you don’t notice obvious symptoms.

And in men with existing heart problems, lower testosterone is often linked to worse outcomes. In fact, in one study of men with heart failure, those with low testosterone had a higher risk of dying than those with normal levels.¹

What should men do?

The best way to protect both your testosterone and your heart is by focusing on the basics:

• Stay active: Regular exercise supports healthy hormone levels and cardiovascular health.

• Eat well: A Mediterranean-style diet rich in vegetables, healthy fats, and lean protein can reduce both heart disease and testosterone decline.

• Avoid smoking and limit alcohol: Both are linked to lower testosterone and greater heart risk.

• Manage your weight: Excess body fat, especially around the belly, can lower testosterone and strain the heart.

• Get checked: If you’re experiencing symptoms of low testosterone or are concerned about your heart health, a simple blood test can offer some answers.

The numan take

Testosterone is a metabolic hormone with far-reaching effects, including on your heart. While we still have a lot to learn about exactly how testosterone interacts with cardiovascular health, what’s clear is that low levels are linked with worse outcomes, especially in older or unwell men. The smart move is to pay attention to the signs, addressing your lifestyle, and having open conversations with your doctor. That way, you can protect your heart - and the rest of you - for the long run.

References

1. Goodale T, Sadhu A, Petak S, Robbins R. Testosterone and the heart. Methodist DeBakey cardiovascular journal. 2017;13(2): 68–72.

2. Nassar GN, Leslie SW. Physiology, testosterone. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.