Testosterone Replacement Therapy and Stroke

Elderly Man Talking To Doctor About Test Results

Tom Werner / Getty Images

Testosterone replacement therapy for men is used for a number of reasons, most commonly for testosterone deficiency. Symptoms of testosterone insufficiency combined with low testosterone levels may indicate a need for testosterone hormonal replacement therapy. This can affect men who are in their 20s, 30s, 40s, and beyond. Symptoms of low testosterone include weakness, fatigue, depression, low sex drive, erectile dysfunction, and infertility. However, these problems can be caused by low testosterone levels or by other medical conditions.

Sometimes, children and adolescents who are taking puberty-blocking hormones as a part of gender reassignment are also given testosterone to promote sexual maturation.

Testosterone hormonal therapy can be useful for some men, but it also has been associated with strokes and you might have even seen commercials on television advertising lawsuits for those who have suffered from a stroke while taking testosterone.

So, what do you need to know about testosterone and strokes so that you can get the therapy you need and stay safe?


Hormones are complex steroids naturally produced by the body. A man’s testosterone production and required levels of testosterone vary throughout the years, as does his testosterone level. The body’s natural production of biological hormones, including testosterone, may decline for a number of reasons, including aging, illness, and medications. Replacement of deficient hormones may generate a complex physiological effect, essentially elevating the body's hormone levels but also altering the body's usual feedback processes, which can increase or decrease the body’s regular hormone production.

A number of large scientific research studies over the years have examined testosterone replacement and its relationship to stroke.

Increasing the Risk of Stroke

A recent article published in the Journal of the American Medical Association reported the results of a large Veterans Affairs study involving over 8000 men. The men in this research study who received testosterone therapy experienced an overall worse stroke rate one year, two years and three years after the study began when compared with controls who did not receive testosterone therapy.

Testosterone may increase blood pressure and may also increase the risk of blood clot formation, both of which are known to cause a stroke.

Decreasing the Risk of Stroke

Given the findings of the Veterans Affairs research study, another more recent article was published in the Mayo Clinic Proceedings, reviewing data from a large number of reports that assessed testosterone therapy in relation to stroke. The authors of the Mayo Clinic Proceedings article stated that the majority of research studies pointed to a beneficial effect of testosterone on cardiovascular disease, which is a leading cause of stroke.

What Should You Do?

Commercials marketing testosterone therapy and commercials advertising lawsuits for men who have suffered from a stroke while taking testosterone therapy seem to contradict each other. The science itself can appear inconsistent regarding the risks and benefits of testosterone therapy. With all of these contradictory findings, what is a patient to do?

Testosterone therapy is not something to be viewed casually; it does require a prescription and must be administered under a doctor’s supervision. Symptoms of testosterone deficiency may be red flags signifying serious medical problems. Your doctors will carefully evaluate your symptoms, your physical examination, and your hormone levels before prescribing any type of hormonal treatment.

Both very low levels of testosterone and very high levels of testosterone are associated with numerous health risks, including stroke. Correction of low testosterone levels is recommended for some men. But, often, hormonal therapy needs to be adjusted over time so it is vital to follow up with your doctors if you begin taking testosterone replacement therapy because your dose may need to be regularly reevaluated and possibly modified.

The data on testosterone replacement therapy and stroke risk is indeed contradictory, the FDA is convinced enough that there is such risk that, recently, the agency directed pharmaceutical companies to change the labeling on their testosterone products to point out a possible increased risk of heart attack and stroke. The labeling changes are still under development and have not yet been put into place, but they are on the way.

Testosterone Abuse

Some hormone replacements, such as testosterone and erythropoietin, are susceptible to abuse and may result in adverse consequences if they are used or abused when they aren’t medically necessary.

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  • Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels, Vigen R, O'Donnell CI, Barón AE, Grunwald GK, Maddox TM, Bradley SM, Barqawi A, Woning G, Wierman ME, Plomondon ME, Rumsfeld JS, Ho PM, JAMA, November 2013

  • Testosterone therapy and cardiovascular risk: advances and controversies, Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM, Mayo Clinic Proceedings, February 2015