Cor Vasa 2026, 68(4):486-493 | DOI: 10.33678/cor.2026.014

Testosterone Replacement Therapy and Cardiovascular Safety: A Paradigm Shift in Cardiological Practice Jaromír Ožanaa

Jaromír Ožanaa, Katarína Moravcováa, Radek Adámekb, Eliška Sovováb
a Diabetology, Endocrinology, and Cardiology Outpatient Clinic, OzanaMed s.r.o., Zábřeh, the Czech Republic
b Department of Sports Medicine and Cardiovascular Rehabilitation, Olomouc University Hospital, Olomouc, the Czech Republic

Background: Hypogonadism is a common but frequently underdiagnosed condition in men with type 2 diabetes, obesity, and cardiovascular disease. Low testosterone levels are associated with an adverse cardiometabolic profile and increased mortality. However, testosterone replacement therapy (TRT) has long been considered potentially harmful with respect to cardiovascular risk, largely based on observational studies with significant methodological limitations.

Aim: To summarize current evidence on the relationship between testosterone, hypogonadism, and cardiovascular risk, to describe the pathophysiological mechanisms linking testosterone deficiency to cardiovascular disease, and to discuss the clinical implications of recent evidence on the cardiovascular safety of testosterone replacement therapy, with particular emphasis on the TRAVERSE trial.

Methods: A narrative review of observational studies, meta-analyses, and randomized controlled trials evaluating hypogonadism, testosterone replacement therapy, and cardiovascular outcomes was performed, with a focus on the TRAVERSE trial as the largest randomized study specifically designed to assess the cardiovascular safety of TRT. © 2026, ČKS.

Keywords: Cardiovascular risk, Hypogonadism, Testosterone, Testosterone replacement therapy, TRAVERSE

Received: January 12, 2026; Revised: February 9, 2026; Accepted: February 14, 2026; Prepublished online: August 12, 2026; Published: August 31, 2026  Show citation

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Ožana J, Moravcová K, Adámek R, Sovová E. Testosterone Replacement Therapy and Cardiovascular Safety: A Paradigm Shift in Cardiological Practice Jaromír Ožanaa. Cor Vasa. 2026;68(4):486-493. doi: 10.33678/cor.2026.014.
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