ฮอร์โมนเทสโทสเตอโรนและหัวใจ: สิ่งที่การทดลอง TRAVERSE ที่มีชื่อเสียงได้สรุปผล

อัปเดตล่าสุด: ตุลาคม 31, 2026

• เวิร์ดเพรส
• ลิงค์อิน
• จดหมาย

For nearly a decade, one question hung over every conversation about testosterone therapy: does it damage the heart?

In 2015, on the strength of a few observational studies and one trial that was stopped early, the United States Food and Drug Administration required a cardiovascular warning on testosterone products. That warning did what warnings do. Doctors hesitated to prescribe. Men who genuinely needed treatment went without it. And a legitimate medical therapy acquired a reputation for danger that the evidence never really supported.

Then, in 2023, the results of the largest and most rigorous trial ever conducted on this question were published — and on the main question the answer was clear.

This article explains what that trial found, why the distinction between safe และ protective matters enormously, and — the part that is most often got wrong, including in an earlier version of this page — which of its adverse findings were statistically significant and which were not.

Before Anything Else: Symptoms That Need Same-Day Care

If you are taking testosterone, go to an emergency department the same day for chest pain or tightness, breathlessness at a level of exertion that never used to trouble you, pain or swelling in one calf, sharp chest pain that is worse on breathing in, a racing or irregular heartbeat, or any stroke symptom — face drooping, arm weakness, difficulty speaking — even if it settles within minutes. In Thailand, call 1669. The rest of this page explains why those particular symptoms are the ones listed.

Why Anyone Suspected a Heart Connection

The suspicion did not come from nowhere. Men with cardiovascular disease reliably tend to have lower testosterone levels than healthy men of the same age and build. Low testosterone has been linked to narrowed arteries, thicker artery walls, poorer function of the blood vessel lining, and higher markers of inflammation.

Very large population studies have refined this considerably. What emerged is not a simple straight line but a threshold effect: men whose testosterone sits in the ordinary low-normal range do not appear to face meaningfully higher risk, while men whose levels are genuinely and substantially low show higher rates of death from all causes and from cardiovascular disease specifically. It is severe deficiency that carries prognostic weight — not being slightly below average.

Here is the trap in all of this, and it is worth naming plainly: an association does not tell you which way the arrow points. Serious chronic illness suppresses testosterone production. So a man with heart disease may have low testosterone เพราะ he is unwell, rather than being unwell because his testosterone is low. Observational data alone cannot separate those two stories. Only a randomised trial can.

TRAVERSE: The Trial That Answered the Question

The TRAVERSE trial, published in the New England Journal of Medicine in 2023, was designed specifically to settle the safety question — and it was designed to be a hard test.

It randomised 5,246 men aged 45 to 80 who had confirmed low testosterone on repeat morning testing with genuine symptoms, และ who either already had cardiovascular disease or carried multiple risk factors for it. In other words, it deliberately selected the men most likely to be harmed if testosterone were harmful. Half received testosterone gel with doses adjusted to reach normal levels; half received an identical placebo gel. Neither the men nor their doctors knew which. Mean treatment lasted around 22 months and men were followed for a mean of 33 months.

The main question was straightforward: would more men on testosterone suffer a heart attack, a stroke, or death from cardiovascular causes?

They did not. Testosterone met the criterion for non-inferiority to placebo on that combined endpoint, and the rates in the two groups were essentially identical. This is the finding that matters most, and it is genuinely reassuring.

To appreciate how decisive it was, consider the scale: TRAVERSE alone recorded more cardiovascular events than every previous randomised testosterone trial in history put together. This was not another small study adding noise to a debate.

One caveat worth stating on the population: TRAVERSE studied men with an average testosterone well below the normal range and with real symptoms, treated to a normal level under supervision. It says nothing about men with normal testosterone taking it anyway, and nothing about supraphysiological doses.

The Distinction That Matters Most

Now for the part that gets misrepresented constantly, particularly by clinics and supplement sellers with something to gain.

TRAVERSE showed that testosterone therapy did not increase major cardiac events. It did not show that testosterone therapy protects the heart. Those are entirely different claims, and the trial was built to answer only the first one.

A safety trial asks: does this treatment cause harm? A superiority trial asks: does this treatment deliver benefit? They are designed differently and answer different questions. TRAVERSE was the former. Finding no increase in the feared harm is not the same as finding a benefit, and nobody should present it as such.

If someone tells you testosterone will protect your heart, they are going beyond what the evidence supports. If someone tells you it will wreck your heart, they are working from a warning that has since been overturned. The accurate position sits between them — and it is genuinely useful, because it means a man with real testosterone deficiency and real symptoms can be treated without living in fear of his heart.

The Adverse Findings — and Which Ones Reached Significance

This section has been substantially corrected. An earlier version of this page listed pulmonary embolism, atrial fibrillation and fractures together under the heading of risks that are real, described the pulmonary embolism signal as real, and built a treatment recommendation on it. That was wrong in both directions at once, and the distinction matters enough to set out properly.

Statistically significant: thickened blood

Erythrocytosis was the clearest adverse effect in the trial, and it was absent from the earlier version of this page altogether. Testosterone raises the red cell count, and it did so in TRAVERSE far more often than placebo — a difference of a wholly different order from the other signals discussed below.

This is not an abstract laboratory finding. It is the single commonest reason a dose is reduced, a preparation is changed, or treatment is paused, and it is why haematocrit is checked before starting and regularly afterwards for as long as you remain on treatment. A man managing his own testosterone without monitoring is neglecting the one adverse effect that the largest trial in the field demonstrated convincingly.

Statistically significant: fractures

The earlier version called this simply unexpected and unexplained. It deserves stronger language than that. The TRAVERSE fracture subtrial found a statistically significant increase of roughly 43% in clinical fractures on testosterone — around 3.5% of men versus 2.5% on placebo, with the curves separating within the first few months of treatment. Ribs, wrist and ankle were the commonest sites.

It is genuinely counterintuitive, because testosterone improves bone density on a scan, and the mechanism is not settled. But bone density and broken bones turned out not to be the same endpoint. The practical conclusion is firm: testosterone should not be prescribed to protect bone, and a man with osteoporosis needs treatment aimed at bone specifically.

Numerically higher, but not statistically significant

Atrial fibrillation, pulmonary embolism and acute kidney injury each occurred somewhat more often in the testosterone group than in the placebo group. None of these differences reached statistical significance in the trial.

That phrasing is deliberate, and the earlier version of this page did not use it. Saying a signal was real, when the trial could not distinguish it from chance, converts an uncertainty into a fact. It is the same error, in the opposite direction, as brushing off the fracture finding.

What follows from that? Not dismissal. These are serious events, the numbers moved the same way, and a trial of this size not reaching significance is not proof of no effect. It is reasonable to raise a previous blood clot, a clotting disorder or a known arrhythmia before starting, and to weigh it in the decision. It is also reasonable to know the emergency symptoms at the top of this page. What is ไม่ reasonable is to describe these as established harms of testosterone, or to refuse treatment to a man who needs it on the strength of them.

Where Testosterone Does and Does Not Help the Cardiovascular System

Diabetes prevention — a claim this page previously overstated

The earlier version of this article called testosterone’s effect on diabetes prevention the most striking finding in the entire field, and led with it. That was too strong, and it has been rewritten.

The encouraging study is the Australian T4DM trial: men with abdominal obesity and impaired glucose tolerance, all of them enrolled in a structured lifestyle programme, were less likely to develop type 2 diabetes over two years if they also received testosterone.

The problem is what happened when the question was asked again in a larger trial without that lifestyle programme attached. The prespecified TRAVERSE diabetes substudy found no significant difference in progression from prediabetes to diabetes, and no difference in glucose or HbA1c. The American Diabetes Association does not recommend testosterone for diabetes prevention.

The honest reading is that testosterone is not a treatment for diabetes and not a substitute for weight loss. If there is an effect at all, it appears alongside real lifestyle change rather than instead of it. That is also the position taken in ฮอร์โมนเพศชายต่ำ: หลักฐานที่สนับสนุนอย่างแท้จริง and in why your doctor recommends the gym before the pharmacy.

Body composition and metabolic markers

Testosterone therapy reliably increases muscle mass and reduces fat, including the visceral fat around the organs that is most strongly tied to cardiovascular risk. Pooled trials in men with diabetes or metabolic syndrome show improvements in blood sugar control, insulin sensitivity and cholesterol profile. These are modest changes rather than transformations, but they move in the right direction — and none of them has been shown to translate into fewer heart attacks.

Blood vessels and chest pain

Testosterone acts directly on blood vessels as a dilator, relaxing the muscle in vessel walls and improving blood flow, including through the coronary arteries.

The most intriguing demonstration comes from a small randomised study in men with stable angina, now twenty-five years old, in which men given testosterone could exercise noticeably longer before their hearts showed signs of strain. The men who improved most were those whose testosterone had been lowest to begin with — the pattern you would expect if you are correcting a genuine deficiency rather than adding surplus hormone. It is a mechanistic finding from a small trial, and it has not translated into any demonstrated reduction in cardiac events.

การอักเสบ

Testosterone reduces several inflammatory signalling molecules and increases an anti-inflammatory one. Laboratory work has also shown it helps immune cells clear cholesterol — a mechanism directly relevant to how arteries fur up. Whether this translates into fewer heart attacks over decades has never been tested, and it would take a very long trial to find out.

Who Actually Benefits

The men who gain from testosterone therapy are those with genuinely low levels confirmed on more than one properly taken morning blood test, together with real symptoms — low libido, erectile difficulty, persistent fatigue, low mood, loss of muscle. The lower the starting level, the clearer the benefit tends to be.

Current expert reviews describe the realistic gains as improved libido and sexual function, better erections, correction of anaemia, and modest improvements in mood, energy and physical function. That is a worthwhile list. It is not a promise of rejuvenation.

Men whose testosterone is normal will not get these benefits, because there is nothing to correct — but they will still carry the risks. This is the central problem with clinics that prescribe testosterone on the basis of vague tiredness without proper testing.

One area still uncertain is heart failure. Testosterone deficiency is common in men with heart failure and tracks with severity, and some small studies showed improved exercise capacity. Pooled analyses have been less convincing. Current advice is to avoid testosterone in severe heart failure and in the months immediately following a heart attack.

One cost of treatment sits outside the cardiovascular question entirely and must be raised before the first dose rather than after it: testosterone given from outside suppresses sperm production, frequently to zero. If you may want children, say so — clomiphene citrate, hCG or an aromatase inhibitor can raise testosterone while preserving fertility.

Two related questions come up so often in clinic that I have written about them separately: whether testosterone is dangerous for the prostate — the evidence there has shifted just as dramatically — and whether erectile dysfunction medications themselves affect the heart, which I reviewed last week.

สรุปประเด็นสำคัญ

The decade-long fear that testosterone therapy causes heart attacks and strokes has been tested properly and did not survive. In men with genuine testosterone deficiency — including men who already have heart disease — treatment did not increase major cardiac events in the largest trial ever conducted.

That is meaningful. It means a man with real deficiency and real symptoms can be treated on the merits, rather than being refused out of a fear that turned out to be unfounded.

But safe is not the same as protective, and the trial also found things that get quietly dropped from the summary: a significant rise in red cell count that requires lifelong monitoring, and a significant rise in fractures. I would rather be clear about all of it than let a patient believe a hormone is doing work that it is not. Testosterone is not a heart medication. It helps indirectly — through muscle, fat, blood sugar and blood vessels — and most convincingly when it sits alongside the things that genuinely protect hearts: managing blood pressure, cholesterol and blood sugar, not smoking, moving regularly, and sleeping properly.

Used properly, in the right man, with the right monitoring, testosterone therapy is a legitimate and valuable treatment. See how การรักษาด้วยการทดแทนฮอร์โมนเทสโทสเตอโรน is structured in practice, including the testing and monitoring that should accompany it, and how it relates to erectile dysfunction treatment.

If you have symptoms of low testosterone — reduced libido, erectile difficulty, persistent fatigue, or loss of muscle — please have it assessed properly with appropriate blood tests rather than self-treating. Dr. Soarawee Weerasopone offers specialist consultations in men’s health and testosterone therapy at โรงพยาบาลกรุงเทพ สำนักงานใหญ่, and at Samitivej Sriracha Hospital in Chonburi on 088-022-1445.

บริการ Bangkok Hospital Telemedicine พร้อมให้บริการสำหรับผู้ป่วยที่ไม่สามารถมาพบแพทย์ด้วยตนเองได้ รวมถึงผู้ป่วยชาวต่างชาติ — กรุณานัดหมายล่วงหน้าทางอีเมลถึงแผนกศัลยกรรมระบบทางเดินปัสสาวะที่ bhquro@bdms.co.th. A video consultation is useful for reviewing symptoms, previous results and your clotting and cardiac history before deciding what to test; testosterone therapy itself is started and monitored in person, because it depends on blood tests. Samitivej Sriracha is in-person only. Enquiries about cost are answered by the hospital rather than through this website.

Frequently Asked Questions About Testosterone and Heart Health

Does testosterone therapy cause heart attacks?

No. The TRAVERSE trial randomised 5,246 men aged 45 to 80 with confirmed low testosterone who either already had cardiovascular disease or carried multiple risk factors. Over a mean follow-up of 33 months, rates of heart attack, stroke and cardiovascular death were essentially identical between testosterone and placebo, meeting the criterion for non-inferiority. This trial recorded more cardiovascular events than all previous randomised testosterone trials combined.

Does testosterone therapy protect the heart?

This has not been shown, and the distinction matters. TRAVERSE was designed as a safety trial asking whether testosterone causes harm, not a superiority trial asking whether it delivers cardiovascular benefit. Finding no increase in the feared harm is not evidence of protection. Testosterone does improve several cardiovascular risk factors indirectly, including body composition, blood sugar control and blood vessel function, but no trial has shown it prevents heart attacks or cardiovascular deaths.

Which adverse findings in TRAVERSE were statistically significant?

Two. ภาวะเม็ดเลือดแดงมากเกิน — a rise in red cell count — was by far the clearest, occurring several times more often on testosterone than on placebo, and it is why haematocrit is monitored for as long as treatment continues. Clinical fractures also rose significantly, by roughly 43%, in the fracture subtrial. Atrial fibrillation, pulmonary embolism and acute kidney injury were each numerically higher on testosterone but did not reach statistical significance. An earlier version of this page presented those three as established risks and did not mention erythrocytosis at all; both errors have been corrected.

Should a previous blood clot stop me having testosterone?

Not automatically. The pulmonary embolism signal in TRAVERSE was numerically higher but not statistically significant, so it does not support a blanket prohibition. It is still worth raising a previous clot, a known clotting disorder or an arrhythmia before starting, so it can be weighed in the decision — and worth knowing the emergency symptoms: breathlessness, pain or swelling in one calf, or sharp chest pain worse on breathing in mean same-day assessment.

Can testosterone help prevent type 2 diabetes?

Not on current evidence. The Australian T4DM trial found a benefit, but every participant in it was also enrolled in a structured lifestyle programme. The prespecified TRAVERSE diabetes substudy, without that programme, found no significant difference in progression from prediabetes to diabetes and no difference in glucose or HbA1c, and the American Diabetes Association does not recommend testosterone for diabetes prevention. Testosterone is not a treatment for diabetes and not a substitute for weight loss.

Who should actually receive testosterone therapy?

Men with genuinely low testosterone confirmed on more than one properly taken morning blood test, combined with real symptoms such as reduced libido, erectile difficulty, persistent fatigue, low mood or loss of muscle mass. Benefits are clearest in men whose levels are substantially low rather than borderline. Men with normal testosterone will not gain these benefits because there is nothing to correct, yet they still carry the risks. Anyone who may want children should raise fertility first, since testosterone suppresses sperm production.

Can I discuss testosterone therapy by video consultation?

Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients, and is arranged in advance by email to the Urology department at bhquro@bdms.co.th. A video consultation is useful for reviewing symptoms, previous results and clotting and cardiac history before deciding what to test. Testosterone therapy itself is started and monitored in person, because it depends on blood tests. Samitivej Sriracha Hospital is in-person only.

เอกสารอ้างอิง

1. ลินโคฟ AM, บาซิน S, เฟลวาริส P, et al. ความปลอดภัยด้านหัวใจและหลอดเลือดจากการใช้ฮอร์โมนทดแทนเทสโทสเตอโรน. N Engl J Med. 2023;389(2):107–117. PubMed
2. ซินเดอร์ พีเจ, บาวเออร์ ดีซี, เอลเลนเบิร์ก เอสเอส, และคณะ. การรักษาด้วยฮอร์โมนเพศชายและภาวะกระดูกหักในผู้ชายที่มีภาวะฮอร์โมนเพศชายต่ำ. N Engl J Med. 2024;390(3):203–211. PubMed
3. Bhasin S, Lincoff AM, Nissen SE, et al. ผลของฮอร์โมนเทสโทสเทอโรนต่อการลุกลามจากภาวะก่อนเป็นเบาหวานเป็นเบาหวานชนิดที่ 2 ในผู้ชายที่มีภาวะฮีโพแอนโดรมินี: ผลการศึกษาเชิงสังเกตในงานทดลองทางคลินิก TRAVERSE. JAMA Intern Med. 2024;184(4):353–362. PubMed
4. Bhasin S, Snyder PJ. Testosterone treatment in middle-aged and older men with hypogonadism. N Engl J Med. 2025;393(6):581–591. NEJM
5. Morgentaler A, Dhindsa S, Dobs AS, et al. Androgen Society position paper on cardiovascular risk with testosterone therapy. Mayo Clin Proc. 2024;99(11):1785–1801. PubMed
6. Wittert G, Bracken K, Robledo KP, et al. Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM): a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial. Lancet Diabetes Endocrinol. 2021;9(1):32–45. PubMed
7. Yeap BB, Marriott RJ, Dwivedi G, et al. Associations of testosterone and related hormones with all-cause and cardiovascular mortality and incident cardiovascular disease in men: individual participant data meta-analyses. Ann Intern Med. 2024;177(6):768–781. PubMed
8. Kloner RA, Carson C, Dobs A, Kopecky S, Mohler ER. Testosterone and cardiovascular disease. J Am Coll Cardiol. 2016;67(5):545–557. PubMed
9. English KM, Steeds RP, Jones TH, Diver MJ, Channer KS. Low-dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina: a randomized, double-blind, placebo-controlled study. Circulation. 2000;102(16):1906–1911. PubMed
10. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. PubMed
11. Lee H, Hwang EC, Oh CK, et al. Testosterone replacement in men with sexual dysfunction. ฐานข้อมูล Cochrane Database Syst Rev. 2024;1:CD013071. ห้องสมุดค็อกเรน
12. Di Lodovico E, Facondo P, Delbarba A, et al. Testosterone, hypogonadism, and heart failure. Circ Heart Fail. 2022;15(7):e008755. PubMed

เขียนและตรวจสอบโดย: Dr. Soarawee Weerasopone — Board-Certified Urologist, Bangkok Hospital Headquarters.
Andrology Fellowship and Robotic Surgery & Minimally Invasive Urology Fellowship, Chang Gung Memorial Hospital (Taiwan) · Endourology Observership, Juntendo University Hospital (Japan) · Research Scholar & Clinical Observer, Scott Department of Urology, Baylor College of Medicine (USA)

ข้อจำกัดความรับผิดชอบ: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for general education only and does not constitute medical advice, diagnosis or treatment for any individual. Testosterone therapy is not approved or recommended for cardiovascular protection, and should only be taken when prescribed by a qualified doctor following appropriate testing and with ongoing monitoring. No advice, diagnosis or prescription is given through personal messaging channels or social media, and Dr. Soarawee operates no public social media account. In an emergency in Thailand, call 1669.