Testosterone replacement therapy is safe for most men with heart problems who also have been diagnosed with a low testosterone disorder, clinical research has concluded. The trial found that testosterone replacement did not raise these patients’ incidence of heart attack, stroke, or heart-related death in a group of men with both heart problems and hypogonadism — a condition in which low testosterone levels have led to specific health problems.

“For men with heart disease or at risk for heart disease, taking testosterone — when given in appropriate doses and carefully monitored — did not increase the risk of heart-related events such as heart attack, stroke or death from heart-related causes,” said senior researcher Dr. Steven Nissen, chief academic officer of cardiovascular medicine with the Cleveland Clinic. “[But] there are some people I would not give it to,” Nissen continued. “Men that have had a history of atrial arrhythmias [heart rhythm problems] or any kind of clotting problems probably shouldn’t get it.”

Nissen and his colleagues recruited more than 5,200 men ages 45 to 80 with clinically diagnosed hypogonadism and either an existing heart problem or high risk of heart disease. The men all had two fasting blood tests which showed low testosterone, as well as one or more symptoms related to hypogonadism.

These symptoms included decreased libido, decreased spontaneous erections, fatigue or decreased energy, depressed mood, loss of body hair, or hot flashes.

The men were randomly assigned to take daily doses of either a testosterone gel or a placebo for nearly two years to see whether testosterone treatment affected their heart health. After about three years, researchers concluded that the number of major heart-related health events were about the same between the testosterone and placebo groups.

Heart attack, stroke, or heart-related death occurred in 182 patients in the testosterone group and 190 in the placebo group.