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Understanding the link between testosterone levels and atrial fibrillation risks in older men


Recent research has highlighted a potential health concern for older men: high testosterone levels may be associated with an increased risk of atrial fibrillation (AFib), a common heart condition that can lead to stroke. This finding is significant as it extends beyond those with cardiovascular disease risk factors to include healthy men over 70 with no prior heart disease.

Key insights from the study

The study, published in The Lancet, followed 4,570 men aged 70 and above who were part of the ASPREE clinical trial. These participants had no history of cardiovascular disease or other life-threatening illnesses. Over an average of three to five years, researchers discovered that men who developed AFib had higher initial average testosterone levels compared to those who did not. Specifically, men with the highest testosterone levels faced a greater risk of AFib.

Implications for older men and testosterone management

While the study does not establish causation, it suggests that maintaining testosterone levels within a mid-range could potentially lower the risk of developing AFib. This new evidence supports the findings of the TRAVERSE study, which indicated a similar relationship between testosterone levels and AFib risk.

Experts advise that clinicians should consider the potential risk of AFib when assessing testosterone levels in older men. Additionally, for those considering testosterone replacement therapy (TRT), it is crucial to weigh the benefits against the risks and make decisions with a comprehensive assessment of the patient’s total risk for atrial fibrillation.

Lingering questions and future research

Despite the study’s insights, there are limitations, including the lack of regular timing for sample collection and the absence of measurements for other sex hormones that could influence AFib risk. Further research is needed to understand the mechanisms behind testosterone’s impact on heart health.

For men undergoing TRT, it is important to monitor for new symptoms, such as acne, excessive body hair, aggressive behaviors, headaches, high blood pressure, and increased appetite, and report them to a health care provider.


As the population ages and the prevalence of AFib is expected to rise, understanding the relationship between testosterone and heart health becomes increasingly important. Older men and their health care providers should remain vigilant about the potential risks associated with high testosterone levels and consider all factors when evaluating hormone therapy options.