Introduction: TRT and Your Heart, What You’re Not Hearing Enough About
Author: Joe Miller, Founder of 1st Optimal
Testosterone replacement therapy (TRT) is one of the most talked-about and controversial treatments for aging men. While it promises energy, libido, and muscle gains, many wonder: “Is it safe for my heart?”
A landmark 2017 JAMA study from the Testosterone Trials (TTrials) revealed compelling, and concerning, data on how TRT may increase noncalcified coronary artery plaque. This early-stage marker of atherosclerosis isn’t visible on standard tests but may be a warning sign of future cardiovascular disease.
With celebrities like Joe Rogan, Dave Asprey, and Mark Wahlberg publicly embracing hormone optimization, the conversation around TRT has exploded, but are men fully aware of the cardiovascular implications?
Testosterone and the Heart: A Complex Relationship
What Testosterone Does for Your Body:
- Boosts energy and libido
- Improves muscle mass and fat distribution
- Enhances mood and cognitive function
But its effect on the heart and arteries? Less clear.
Two Opposing Theories:
- Low testosterone = higher heart risk
- Observational data shows men with low T levels have more heart attacks, strokes, and metabolic syndrome
- TRT may accelerate plaque
- Artificially increasing T levels could increase arterial inflammation and plaque formation
🔍 The JAMA 2017 Trials Study: What It Found
Study Design:
- Participants: 170 men, age 65+
- Duration: 12 months
- Treatment: Daily testosterone gel vs. placebo
- Goal: Measure noncalcified coronary plaque volume using coronary CT angiography (CCTA)
Results:
1. 📈 Significant Increase in Plaque Volume
- TRT group had a 41 mm³ increase in noncalcified plaque
- Placebo group showed no significant change
2. 🚫 No Major Cardiac Events During Study
- No heart attacks, strokes, or cardiovascular deaths in either group
- Indicates short-term safety, but long-term impact remains uncertain
“This study raises red flags about TRT and heart health, but it doesn’t prove harm outright.”, Dr. Matt Budoff, lead researcher
🤔 What Does This Mean for Men Considering TRT?
1. Plaque Doesn’t Equal a Heart Attack, But It’s a Warning
Plaque buildup, especially the noncalcified kind, is a precursor to heart disease. While no adverse events occurred during the 12-month trial, plaque progression could increase long-term cardiovascular risk.
2. Bigger, Longer Trials Are Needed
We need 5–10 year data to understand:
- Whether TRT-related plaque leads to events
- Who’s most at risk (genetics, inflammation, lifestyle)
A 2021 Mayo Clinic Proceedings review emphasized that testosterone’s cardiovascular risks depend heavily on baseline health and medical oversight.
Celebrities & Public Figures Weigh In
- Joe Rogan regularly discusses TRT and heart health on his podcast, often advocating for full-body diagnostics before starting treatment
- Dave Asprey emphasizes cardiovascular monitoring in his biohacking protocols for TRT users
- Mark Wahlberg is vocal about hormone support, including the need for responsible, physician-supervised therapy
These voices have driven mass interest, but with that interest must come responsibility.
Risk Management: The 1st Optimal Way
If you’re considering TRT, you MUST pair it with cardiovascular screening:
- Coronary CT Angiography (CCTA)
- High-sensitivity CRP, ApoB, LDL-P
- Calcium scoring
- Inflammatory and endothelial markers
At 1st Optimal, we never prescribe TRT without:
- Comprehensive labs
- Cardiovascular health screening
- Physician evaluation and symptom scoring
Is TRT Still Worth It?
For many men: Yes, but with caveats. TRT can improve:
- Fatigue and mood
- Bone density
- Muscle mass and recovery
- Sexual function
But these benefits must be weighed against:
- Your personal and family history of heart disease
- Inflammation and lipid markers
- Plaque presence (even without symptoms)
Final Thoughts: Optimize, But Don’t Gamble
TRT isn’t inherently dangerous. But it isn’t risk-free either. The JAMA study teaches us this:
Hormone optimization without cardiovascular insight is a gamble.
That’s why our model at 1st Optimal is built on precision, lab data, and root-cause care, not quick fixes.
✅ Take Control of Your Hormones and Heart Health
At 1st Optimal, we specialize in lab-based, physician-guided care for men navigating hormone decline, fatigue, and longevity goals. If you’re considering testosterone therapy or want to assess your cardiovascular profile before starting:
👉 Book your complimentary consultation today.
Your health deserves more than a prescription, it deserves precision.
🔗 Resources:
- JAMA 2017 Study – Testosterone and Coronary Plaque
- Mayo Clinic Proceedings – TRT and Cardiovascular Risk
- NIH: Testosterone Trials Summary
- Harvard Health: Risks of TRT
- Cleveland Clinic: Heart Screening Tests
