Cardiovascular risk from TRT? What It Means for Metabolic Health

For many years there have been concerns about the safety of testosterone replacement in men from a cardiovascular standpoint. The TRAVERSE trial-the largest randomized study on testosterone therapy to date-has reshaped our understanding of TRT’s safety and efficacy, particularly for men with metabolic concerns. Here’s how these findings apply to clinical practice and why supervised care remains critical.

Key Safety Outcomes: No Cardiovascular Excess Risk

The TRAVERSE trial followed over 5,200 men with low testosterone and preexisting cardiovascular risks for an average of 33 months. The results were clear:

• No increase in major cardiovascular events (e.g., heart attacks, strokes) compared to placebo.

• Prostate safety confirmed: No difference in prostate cancer rates or urinary symptoms.

• Caveats: Small increases in atrial fibrillation (3.5% vs. 2.4%) and acute kidney injury (2.3% vs. 1.5%) were noted, though absolute risks remained low.

These findings led the FDA to revise its warnings in 2025, removing cardiovascular risk language from testosterone product labels.

Metabolic and Functional Benefits

Beyond safety, TRT demonstrated measurable benefits for metabolic health and quality of life:

• Body composition: Increased lean mass (+1.7 kg) and reduced fat mass (−1.3 kg).

• Diabetes risk: A 22.5% relative reduction in progression from prediabetes to diabetes in a subset analysis.

• Sexual health: Improved erectile function and libido.

• Mood and vitality: Significant gains in energy levels and well-being.

  
  

Why Supervision Matters

While TRAVERSE is reassuring, it also highlights the importance of medical oversight:

1. Lab Monitoring:

   • Testosterone levels must be checked regularly to avoid supraphysiologic dosing.

   • Hematocrit, PSA, and kidney function require ongoing assessment.

2. Individualized Care:

   • Men with prior blood clots or arrhythmias need cautious evaluation due to slight risk elevations.

   • Treatment goals should address symptoms, not just lab values.

3. Long-Term Data Gaps:

   • Open communication between you and your doctor with expertise and experience about benefits vs. risks is essential.

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Our Approach at Mission Metabolic Health

At Mission Metabolic Health, TRT is never a one-size-fits-all solution. We emphasize:

• Baseline testing and repeat testing to confirm true low testosterone and hypogonadism and rule out contraindications.

• Lifestyle integration: Combining TRT with nutrition, exercise, and sleep optimization for metabolic optimization.

• Ongoing partnership: Regular follow-ups to adjust dosing and address concerns proactively.

The TRAVERSE trial confirms that TRT can be safely used in men with metabolic and cardiovascular risks-when managed correctly. If you’re considering TRT, let’s discuss how to personalize a plan that aligns with your health goals. Schedule your appointment at Mission Metabolic Health, we will look at your total health when investigating your testosterone. Lets get you living leaner, longer and better!

1. Lincoff AM, et al. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med. 2023. doi: [PubMed link].

2. PMC (2024). TRAVERSE trial analysis on diabetes progression and undertreatment.

3. Grand Rounds in Urology (2025). FDA label changes post-TRAVERSE.

Always consult a physician before starting or adjusting TRT. Individual results may vary.