TRT and Heart Health: What the Evidence and FDA Say in 2026

TRT and heart health: in TRAVERSE, testosterone gel and placebo had similar rates of cardiovascular death, nonfatal heart attack, or nonfatal stroke combined: 7.0% versus 7.3%. That is reassuring for men like those studied, not proof of heart protection. Blood pressure, rhythm problems, clots, treatment format, and your own heart history still matter. ^{1 3}

By TRT Provider Guide · Editorial research, not clinically reviewed · Last verified: October 2026 (source checks completed October 5, 2026)

Last updated: October 5, 2026.

Educational information, not medical advice. This page doesn't diagnose low testosterone or tell you whether TRT is right for you.

Chest pressure or pain, sudden shortness of breath, face drooping, arm weakness, or slurred speech? Call 911. Don't wait for a clinic message or finish an online form first. A painful, swollen, warm, or red leg without those emergency symptoms still needs prompt medical assessment. ^{10 11}

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The heart-attack finding is reassuring. TRT isn't risk-free either. And there's a catch: the trial tested a daily gel, with a planned testosterone range of 350–750 ng/dL, in men whose low testosterone was confirmed twice. Some treatment plans look different. We'll show you exactly how — and what to ask about it. ¹

When this answer fits you — and when it doesn't:

• Closest to the trial: men aged 45–80 with symptoms, two low fasting testosterone tests, and existing heart disease or high heart risk, considering the gel treatment studied. Matching that description is not medical clearance. ¹
• Talk to your doctor before considering treatment if: you had a heart attack or stroke in the last 6 months, have heart failure that isn't under control, have blood pressure that isn't under control, have had a blood clot or have a clotting disorder, or already have high hematocrit (a high share of red blood cells). ^{3 5}
• Outside this trial: injections, high target levels, and compounded creams. The trial didn't study those. ¹
• What to check: blood pressure and hematocrit before and during treatment, with other checks based on your health history and the product prescribed. Monitoring can find problems; it cannot guarantee safety. ^{3 6}

The TRAVERSE trial at a glance (testosterone gel vs. placebo)

Sources: TRAVERSE and FDA-approved prescribing information reporting its results. "Plain English" column is our own arithmetic on the published percentages. These are observed group differences, not proof that treatment caused every extra event. Average follow-up was 33 months; the blood-pressure row is the 36-month measurement. These are not annual rates or your personal risk. Full table below.

TRT Provider Guide is the independent decision resource for testosterone replacement therapy — helping U.S. adults understand how low testosterone is evaluated, compare online and local care models and providers, and choose the next step that fits their health needs, fertility plans, budget, state, and care preferences, with every material claim verified and dated.

This page covers prescribed treatment for adult male hypogonadism, the medical term for testosterone deficiency. TRAVERSE does not establish safety for women, adolescents, gender-affirming treatment, or bodybuilding and other nonmedical use. Those questions need their own evidence and care framework. ^{1 5}

Where do you fit? Heart history changes the right first step. TRT Provider Guide's Find My TRT Path tool helps you explore care routes and prepare questions before you pay. Free and educational. It doesn't assess your heart safety, diagnose you, or decide whether you can get a prescription.

Use Find My TRT Path to explore care routes →

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Is TRT bad for your heart?

For men like those in TRAVERSE, testosterone gel had a similar rate of cardiovascular death, nonfatal heart attack, or nonfatal stroke combined to placebo. Atrial fibrillation, pulmonary embolism, and acute kidney injury were more common in the testosterone group. That is reassurance about one key outcome, not proof that every form of TRT is harmless. ^{1 3}

Here's why so many men still worry.

Early studies raised concerns about testosterone and heart risk. In 2014 the FDA began reviewing that possible risk. In 2015 it added cardiovascular warnings to testosterone labels and required a clinical trial to study the question. ²

That trial was TRAVERSE. It took years. The results came out in 2023, and in early 2025 the FDA required labeling changes based on them and separate blood-pressure studies. ^{1 2}

What about the claim that TRT is good for your heart? You'll see it online a lot. Here's the honest version:

• Low testosterone is linked to heart disease in observational research. That is an association, not proof that low testosterone caused the disease. ⁶
• But "linked" doesn't mean fixing your testosterone fixes your heart. Extra weight, diabetes, and sleep disorders can overlap with low testosterone and need their own assessment. ^{5 6}
• TRAVERSE was built to test cardiovascular safety, not prove heart protection. It met its noninferiority test for cardiovascular death, nonfatal heart attack, or nonfatal stroke combined. It did not show testosterone prevents them. ¹

So treat TRT as a treatment for low testosterone. Not as heart medicine. Your heart plan — blood pressure, cholesterol, exercise, not smoking — still does the heavy lifting. ⁴²

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What did the TRAVERSE trial find?

TRAVERSE enrolled 5,246 men aged 45 to 80 who had symptoms of low testosterone, two fasting testosterone results under 300 ng/dL, and either heart disease or high heart risk. The combined rate of cardiovascular death, nonfatal heart attack, or nonfatal stroke was similar with testosterone gel or placebo. AFib, pulmonary embolism, and kidney injury were more common in the testosterone group. ¹

Some quick definitions so the numbers make sense:

• Placebo: a look-alike gel with no testosterone in it.
• MACE (major adverse cardiovascular events): the trial's main outcome — cardiovascular death, nonfatal heart attack, or nonfatal stroke combined. ¹
• Atrial fibrillation (AFib): the heart's upper chambers quiver instead of beating in rhythm. It can raise stroke risk. ⁴³
• Venous thromboembolism (VTE): a blood clot in a vein. A deep-vein clot, often in a leg, is a DVT. A clot that travels to the lungs is a pulmonary embolism (PE). ¹¹

The full scorecard

Sources: Xyosted prescribing information, sections 5.2, 5.4 and 6.1, summarizing TRAVERSE; Lincoff AM et al., NEJM 2023;389:107–117. The original paper reports 5,246 men randomized; the label summary describes an analysis group of 5,198. Rows overlap — don't add them up. The additional safety findings are not interchangeable with the primary combined outcome, and the rounded differences are not a personal risk forecast.

What "not worse" means

The trial was built to test whether testosterone gel stayed within a pre-set safety margin for the combined heart outcome. The upper end of the 95% confidence interval had to stay below a hazard ratio of 1.5; the observed interval was 0.78–1.17. The trial met that test, but its estimate still allows for some decrease or increase in risk. A hazard ratio compares event rates over time; 1 means no difference, and the confidence interval shows the uncertainty around the estimate. ¹

That's real reassurance. But notice what it isn't:

• It isn't proof that TRT lowers heart risk.
• It isn't proof of safety over decades: average follow-up was about 33 months. ¹
• It isn't proof that every kind of testosterone, at any level, behaves the same way.

That last point matters more than most people realize. Let's look at it.

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Does the good news apply to you?

TRAVERSE tested a daily testosterone gel, with a planned testosterone range of 350–750 ng/dL, in men whose low testosterone was confirmed twice. If your plan is very different — injections, a high target level, or no confirmed diagnosis — the trial is a weaker guide for you. That doesn't mean danger; it means less proof for that plan. ¹

We built this check by putting what the trial actually tested next to treatment choices and provider claims a reader may encounter.

The TRAVERSE Fit Check

Sources: TRAVERSE; Xyosted prescribing information, section 6.1; Endocrine Society guidance; Male Excel’s TRT page; Taurus’s homepage. Provider wording was checked October 5, 2026 and is not evidence of clinical results. BMI means body mass index, a weight-to-height measure.

How to use this table: use each row as a question for your clinician, not a score or a safety check. One important difference can matter more than several matches. Bring this table to your doctor. Ask how your plan differs from what was tested, and what you'll monitor because of it.

A word about "optimal" levels

A new review in the Journal of the Endocrine Society (September 2026) looked at testosterone and AFib. It proposed a U-shaped relationship from mixed earlier evidence: both low and high levels might matter. That is a hypothesis, not a proven dose-response rule or a validated treatment target. ⁸

Two honest caveats. It's a review of earlier research, not a new trial. And the authors said their suggested range hasn't been tested yet. So don't treat it as a target. Treat it as one more reason to ask any clinic: what level are you dosing me toward, and why? ⁸

Your situation decides the care route

The right TRT provider is not the same for every person — it depends on whether low testosterone has been properly evaluated, your symptoms and health history, your fertility plans, your state, your insurance or cash-pay preference, your treatment-format preference, your budget, and whether online or in-person care is the better starting point. Some situations belong with primary care, urology, endocrinology, reproductive urology, cardiology, or urgent or emergency care when the symptoms warrant it. Because a general answer cannot resolve those for you, use TRT Provider Guide's Find My TRT Path tool to map your situation to the right care route and the questions to ask before you pay.

One more thing before treatment: testosterone can lower sperm production. If you might want kids, raise that first. Near-term fertility plans belong in a discussion with a fertility-aware clinician, often a reproductive urologist; neither preserved fertility nor recovery on a set timeline is guaranteed. Our TRT and fertility guide covers it. ^{5 3}

A diagnosis also needs compatible symptoms or signs plus consistently low results from reliable testing, with repeat early-morning fasting measurements. The trial’s 300 ng/dL entry cutoff is not a diagnosis by itself. The Endocrine Society reaffirmed the need for accurate testing and assessment of other causes in July 2026. ^{5 7}

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Did the FDA remove the testosterone heart warning?

Partly: in February 2025 the FDA told makers of all testosterone products to remove boxed-warning language about higher heart attack and stroke risk and to add the TRAVERSE results. At the same time, it required a warning that testosterone can raise blood pressure. In June 2026 it requested more label changes; the Xyosted label checked for this page still contains the age-related limitation. ^{2 4 3}

Headlines turned this into "FDA says TRT is safe for your heart." That's not what happened. Here's what the official record actually says.

The Heart-Label Ledger: what you heard vs. what the record says

Checked October 5, 2026. Labels update product by product, so always ask which label applies to the exact product you'd get.

What "Schedule III" means: testosterone is a federally controlled substance. You need a valid prescription from an appropriately authorized clinician. No legit shortcut exists. ^{3 13}

The blood-pressure piece, in one line: Xyosted’s label reports average 24-hour systolic/diastolic blood pressure rising about 3.9/1.5 mmHg after 12 weeks in its blood-pressure study. ³ Small on average — but not small for everyone. Our TRT and blood pressure guide covers home monitoring and what to watch.

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Can TRT cause AFib, heart palpitations, or blood clots?

TRAVERSE recorded more AFib and vein clots in the testosterone group: about 1 extra AFib event per 100 men and 1 extra vein-clot event per 200 men, using rounded group percentages. Those are safety signals, not a prediction for every patient. Testosterone can also raise hematocrit, the share of blood made of red cells, but a blood count does not measure every clot risk. ³

AFib and palpitations

AFib makes the heart beat out of rhythm, often fast. Some men feel fluttering or pounding. Some feel tired or short of breath. Some feel nothing at all. It matters because AFib can raise stroke risk. ⁴³

In TRAVERSE, rhythm problems serious enough to need treatment showed up in 5.2% of men on testosterone versus 3.3% on placebo. The September 2026 review above raises questions about testosterone levels and AFib, but does not prove which treatment target is safest. That's another reason to ask how your clinician chose the plan. ^{3 8}

What to do: tell your clinician about any new fluttering, racing, or skipped beats. Don't brush them off as "the TRT working."

Blood clots

The label lists the warning signs. Learn them:

• Clot in a leg (DVT): pain, swelling, warmth, or redness — usually in one leg.
• Clot in the lungs (PE): sudden shortness of breath or chest pain.

A painful, swollen, warm, or red leg needs prompt medical assessment. Sudden breathlessness or chest pain is an emergency. Call 911. The evaluating clinician should decide how to manage the medication; do not wait for a routine refill visit. ^{3 11}

Hematocrit: the "thick blood" question

Testosterone tells your body to make more red blood cells. That can be good if you were anemic: a TRAVERSE substudy found anemia corrected more often with testosterone in men with confirmed hypogonadism, though anemia still needs its own cause assessed. ⁴⁴ If hematocrit climbs too high, the label warns that the rise in red-cell mass may increase clot risk. A normal hematocrit result does not rule out a clot. ^{3 11}

A simple blood count measures hematocrit. The Xyosted label says to check that hematocrit isn't already high before starting, then about every three months on that product. The Endocrine Society's guideline says check at the start, again at 3 to 6 months, then yearly. Your clinician decides the exact schedule — but "never checked" is not a schedule. Our TRT side effects guide covers what happens if hematocrit runs high. ^{3 6}

The kidney finding

TRAVERSE also found a bit more sudden kidney injury on testosterone (2.3% vs. 1.5%). It's not a heart problem, but it is worth discussing, especially with existing kidney disease. The label also warns about fluid retention in men with kidney disease. Whether kidney testing is needed, and how often, depends on the clinical assessment; the trial does not create a universal kidney-test schedule. ³

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Which heart symptoms on TRT need emergency care?

Heart attack and stroke symptoms need emergency care whether or not you use TRT. In the U.S., call 911. Don't drive yourself, wait for a clinic to reply, or message your online provider first.

Call 911 for:

• Chest pain, pressure, squeezing, or fullness — especially lasting more than a few minutes or coming and going
• Pain spreading to an arm, back, neck, jaw, or stomach
• Sudden shortness of breath
• Cold sweat, nausea, or lightheadedness along with any of the above
• Stroke signs (F.A.S.T.): Face drooping, Arm weakness, Speech difficulty — Time to call 911
• Sudden chest pain or breathlessness with a swollen, painful leg (possible clot)

Sources: American Heart Association warning signs and CDC blood-clot guidance. These signs can't tell you the cause. That's what the emergency team is for.

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Can you take TRT if you have heart disease?

Stable heart disease does not automatically rule out a clinical discussion of TRT — more than half of TRAVERSE participants had existing cardiovascular disease. But the Endocrine Society recommends against starting TRT within six months of a heart attack or stroke, or with uncontrolled heart failure, high hematocrit, or a clotting disorder. The doctor who manages your heart should be part of the decision. ^{3 5}

Find your row. Then take the next step it points to.

Your heart situation → your next step

Sources: Endocrine Society guideline, recommendation 2.2; Xyosted prescribing information, sections 5.1, 5.2, 5.4, 5.9 and 7.2. Next-step routing is our editorial judgment from those sources, not a clinical eligibility decision. Six months passing is not automatic permission — it just removes one specific guideline flag.

A note on care route. If a guideline warning above applies, or you have active heart disease, your best first step is often in-person care. That means your primary care doctor, a urologist, or an endocrinologist, working with your cardiologist. Ask that practice and your insurer about coverage for evaluation and any FDA-approved treatment prescribed. Local care may be the right choice even when an online program looks easier. Not sure which specialist? See urologist vs. endocrinologist for low testosterone and online vs. local TRT care. Prostate, fertility, and other non-heart reasons to wait are in who should not take TRT.

Still unsure where to start after discussing your heart history? Find My TRT Path can help you explore care routes and prepare questions. It cannot decide which heart-history row applies to you or clear you for treatment.

Explore care routes with Find My TRT Path →

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Which type of testosterone is easiest on the heart?

TRAVERSE cannot tell you which treatment format is safest for the heart because it tested one gel against placebo, not different formats against each other. Some injection regimens have produced more high-hematocrit results than gels, while blood-pressure warnings also apply across testosterone products. Your clinician should match the form to your blood counts, blood pressure, and preferences. ^{1 2 9}

Two terms first:

• FDA-approved: the FDA reviewed the product's safety, effectiveness, and manufacturing before it could be sold. Approval applies to the specific product, not every preparation with testosterone in its name. ¹²
• Compounded: a pharmacy prepares a customized drug. The FDA says compounded drugs are not FDA-approved — the agency doesn't review them for safety, effectiveness, or quality before sale. ¹²

FDA-approved testosterone products

Sources: TRAVERSE; Xyosted; AndroGel; Testim; testosterone cypionate labeling; Jatenzo; Kyzatrex; Tlando; Testopel; Pastuszak et al..

Compounded testosterone preparations

A compounded cream is not the same product as an FDA-approved gel. For an injection, also ask whether the proposed method of administration is on-label or off-label for the exact product. Off-label use and compounding are different issues. ^{12 14 16}

About that clinic study. Researchers at one center looked back at men on a single form of testosterone for up to three years. Hematocrit above 50% showed up in 66.7% of men on injections, 35.1% on pellets, and 12.8% on gel. It's a small study. The injection group was also younger and started with higher hematocrit. So treat it as evidence about those study groups, not a heart-safety ranking or your personal chance of a high result. The study used hematocrit above 50% as its outcome; that is not a universal treatment-decision cutoff. ⁹

What about daily small injections? Male Excel markets daily dosing and says it helps regulate red blood cell levels. That's the provider's claim, not a heart-outcome benefit established by TRAVERSE. A different injection schedule does not remove the need for an individualized blood-count and blood-pressure monitoring plan. ^{26 1 3}

Want the full head-to-head? Read testosterone injections vs. gel.

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What heart checks should happen before and during TRT?

Before a new diagnosis and prescription, the clinical assessment should include symptoms or signs, repeat early-morning testosterone testing, hematocrit, blood pressure, and heart and clot history. Cholesterol, kidney, and prostate checks depend on the product, clinical history, age, and risk. Follow-up timing must match the prescribed product and the person, not just a membership calendar. ^{3 5 6}

Feeling better is great. It isn't the follow-up plan. Here's the checklist we'd want for anyone with heart worries.

Before your first prescription

Once you're on TRT

• Hematocrit: the Xyosted label says about every 3 months on that product; the Endocrine Society says baseline, 3 to 6 months after starting, then yearly. These are different source-specific schedules, not interchangeable rules. ^{3 6}
• Blood pressure: regularly, using a method and schedule agreed with your clinician. Home readings can be part of that plan. ³
• Testosterone level: the Endocrine Society describes checks at 3 to 6 months, at 12 months, and annually after starting; product-specific checks may be earlier. Ask when the sample should be drawn relative to treatment. ⁶
• Cholesterol: periodically, as the product label and clinician advise. ³
• Symptoms: report new palpitations or swelling promptly. Sudden breathlessness, chest pain, or stroke signs need emergency care — don't wait for your next lab. ^{3 10 11}

More detail on lab timing lives in our TRT blood tests guide. Use this checklist to judge any program, online or local. Now let's do exactly that.

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Which online TRT programs publish useful heart-monitoring details?

A provider’s published lab list can help you ask better questions, but it cannot prove that the program is safest for your heart. Of these three, Hone publishes the clearest plan-specific testing schedules; Male Excel’s starter-kit gaps and Taurus’s incomplete testing disclosures still need answers. None replaces a clinical assessment or proves that an online program is the right care setting for you.

Affiliate disclosure: TRT Provider Guide may earn compensation through provider links elsewhere on this site, including links for Hone Health, Male Excel, and Taurus Meds. The comparison below is public-source research, not a recommendation that any program is safer for your heart. Read our affiliate disclosure.

What we actually verified

Published monitoring check

"Not shown" means we couldn't find it in the public sources listed here — not that the program never does it. Every "not shown" is a question to ask.

Sources: Hone’s Plus plan, Premium plan, Plus lab schedule, Premium lab schedule, state list, and insurance policy; Male Excel’s TRT page, starter kit, and FAQ; Taurus’s campaign and terms. All are provider-stated. A scheduled lab visit does not mean every marker is measured at that visit.

Lab terms: a CBC is a complete blood count, which includes hematocrit. A metabolic panel checks several blood chemicals, including kidney markers; a lipid panel checks cholesterol and related fats. These are different panels, not interchangeable names for a full health check. ^{22 24}

Ask about timing, not just panel size. “Labs every three months” and “hematocrit every three months” are different promises. Ask whether the published schedule changes for your exact prescription, results, or heart history.

Medication and pharmacy disclosure check

Sources: Hone’s testosterone page and pharmacy policy; Male Excel’s FAQ; Taurus’s campaign and terms. Pharmacy names are disclosures, not an independent license check or assurance about a specific prescription. FDA-approved products and compounded preparations are not equivalent categories. ¹²

What can you calculate before you pay?

These are published-price calculations, not complete first-year quotes. The assumptions matter: twelve paid membership months, any separately charged starting tests, and no assumption that an advertised medication minimum fits your prescription.

Sources: Hone Plus, Plus lab schedule, Premium, and retesting FAQ; Male Excel TRT page and pricing page; Taurus campaign and terms, section 28. Calculations are our arithmetic on provider-stated prices, checked October 5, 2026.

Hone advertises testosterone from $28 per month on its product page, while its plan pages also use a per-vial minimum. Neither is a guaranteed monthly prescription cost. Male Excel’s $2,727 example would be $99 + 12 × $99 + 12 × $120, but it includes the advertised thyroid bundle and excludes medication shipping; six 60-day supplies are also only 360 days. Those figures should not be compared as complete, equivalent first-year TRT bills. ^{21 22 28 33}

Ask for one written total covering repeat testing, medication, visits, required follow-up labs, shipping, renewals, and any fees if treatment is not prescribed. Thyroid medication is a separate treatment, not a routine component of TRT or a reason to buy a bundle.

Hone Health — clearer published monitoring, not a heart-safety winner

Of the three, Hone publishes the most detailed plan-specific lab schedules. It requires confirmatory testing before TRT and names AUA guidelines as its reason. The important distinction is the plan: Premium lists the broad blood-count, kidney, and cholesterol panels; Plus’s published monitoring is narrower. These are useful disclosures, not evidence that Hone prevents more heart problems than another care setting. ^{21 22 23 24 37}

The tradeoff: Hone does not give you a low, all-in monthly price — the membership ($135–$155 a month) is separate from medication. If the lowest monthly bill is your top priority, compare the full numbers in our Hone TRT cost breakdown, or ask your own doctor whether insurance would cover an FDA-approved product. But scheduled follow-up labs and consultations are included in the membership, which makes those charges easier to plan for. It does not guarantee that the published schedule is enough for your health history. ^{21 22}

Who should choose another starting point: men outside the relevant plan’s state list; men who need insurance billing or prior-authorization help; and men with recent or unstable heart disease who need coordinated clinical care first. The $25 Basic membership is not Hone’s TRT plan. ^{25 34 36}

Comparing Hone’s testing with what your clinician recommends? Check the plan-specific labs, state list, and full cost before a paid intake.

Review Hone’s plans, testing, and cost assumptions →

Read our full Hone Health TRT review.

Male Excel — ask how the starter kit becomes a full monitoring plan

Male Excel serves every state but eleven, according to its FAQ. It advertises daily injections or a compounded cream, checks in every 60 days, and describes its care as physician-led. Its safety information includes clot and fluid-retention warnings, but a safety-information page does not establish which checks happen before your prescription. ^{26 29}

The honest limit: Male Excel's at-home starter kit, as listed on its site, checks testosterone, estradiol, DHEA-S, Free T3, and PSA. It does not list hematocrit, cholesterol, or kidney function. Its symptom-focused and “optimal” wording does not show the complete diagnostic process or the actual testosterone target. Ask how it confirms the diagnosis and obtains any missing baseline information. ^{26 27}

Its safety text also retains older wording about a possible increased risk of heart attack or stroke. That does not describe the full current FDA position, which includes the 2025 cardiovascular-warning change and the blood-pressure warning. ^{26 2}

Who might investigate further: a reader comparing its treatment formats and care model who can get clear written answers about repeat testing, blood pressure, blood counts, medication, pharmacy, and follow-up. Recent outside labs may help the clinical assessment; they do not by themselves make this program appropriate.

Who should not use this comparison as permission to start: anyone with recent or unstable heart disease, AFib, or a clot history that has not been assessed. Start with the clinician managing that condition, not a promise of convenience. ^{3 5}

Already have outside bloodwork? Use it to ask what the program still needs to review and who will act on abnormal results.

Review Male Excel’s testing, costs, and limitations →

Taurus Meds — why we did not make it a heart-monitoring recommendation

We couldn't establish which heart-related labs Taurus requires, how often it retests, or a current state list from the pages checked. We did find its $49 test-and-consult campaign and $149 monthly treatment offer, alongside the recurring-fee conflict above. Cost details are in our Taurus Meds cost guide. ^{31 32}

Its homepage advertises a “2–5x” rise in total testosterone. Without starting and final levels, that claim does not show that treatment exceeds TRAVERSE’s range. The more useful questions are the exact diagnostic process, intended treatment, and monitoring plan. ^{30 1}

There is also a concrete disclosure problem: the campaign repeats an injection description under gel and other treatment listings and refers to an “Excel Advantage HRT program” in its compounding text. Those inconsistencies make it unreliable as a source for the exact formulation you would receive. That doesn't establish that Taurus is unsafe; it means the public material is not enough for a heart-monitoring recommendation. ³¹

Before a subscription, ask how care continues or ends

Hone’s policy treats membership cancellation and pending medication orders separately. Membership cancellation does not produce a partial-month refund, and processed medication orders have different limits. Male Excel’s terms say paid fees are nonrefundable unless a written exception applies, and its FAQ says medication sales are final. Taurus’s refund policy requires cancellation at least 72 hours before the next billing date. ^{35 39 29 40}

Hone and Male Excel describe possible HSA/FSA payment; whether an expense qualifies depends on the account rules and your situation. That is different from accepting insurance. ^{34 29}

Before paying, ask who sends the refill order, which results are required first, what happens when a refill is delayed, and how to obtain your full records or send them to your own doctor. A listed pharmacy partner or a patient portal is not proof that every transfer is automatic. A lab schedule is not an urgent-care service.

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What should you ask any TRT clinic about your heart?

Before you pay, ask seven questions — in writing if you can. The answers should explain what gets checked, when it gets checked, and who acts on the result; they cannot guarantee that a problem will be caught.

Copy these into the clinic's chat, or bring them to an appointment:

1. Will you confirm low testosterone with two early-morning tests before prescribing?
2. Do you check my hematocrit before my first prescription? Which lab, which test?
3. Do you check cholesterol and kidney function at the start?
4. How will you track my blood pressure?
5. What testosterone level are you dosing me toward, and why?
6. How often will you recheck hematocrit in my first year — and what happens if it runs high?
7. Will you send my results to my cardiologist or primary care doctor?

Short on time? Start with #2 and #6. Clear answers about blood counts are useful, but they do not replace diagnosis, blood-pressure assessment, or a review of your heart history.

Bring this with you:

• The exact product and form you're being offered (gel, injection, cream)
• Your most recent blood count, cholesterol, and kidney results, with dates
• A week of home blood-pressure readings, if you have them
• Your medication list — especially blood thinners
• Your heart history: dates of any heart attack, stroke, stent, AFib, or clot

Your heart-health visit sheet

Copy or print this section. You do not need an account or a paid intake to use it.

For emergency symptoms, use emergency care rather than this worksheet. ^{10 11}

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What don't we know yet about TRT and the heart?

TRAVERSE does not settle safety over decades or compare gel directly with common injection protocols. It also does not prove that TRT lowers heart risk. The evidence is encouraging, not final, and its remaining gaps should shape the discussion with your clinician. ^{1 7}

The research result, regulatory decision, and debate are different things:

• The regulatory action: FDA required removal of the boxed-warning language about increased adverse cardiovascular outcomes in February 2025, while also requiring blood-pressure warnings. That is a specific labeling decision, not a blanket safety guarantee. ²
• The more cautious view: Public Citizen, a consumer-advocacy group, urged the FDA in February 2026 to restore the heart warning. It called for more independent research before expanding use. That is its advocacy position, not a new trial result or an FDA ruling. ⁴¹
• The clinical guidance: the Endocrine Society’s July 2026 statement kept the focus on accurate diagnosis, remaining safety gaps, and monitoring. It called for longer-term research. ⁷

Our take: TRAVERSE provides strong reassurance about its main combined cardiovascular outcome. It also showed safety signals for AFib and clots. And it did not test every treatment format, target, or pattern of long-term use. All three things are true at once. That's why the checks above matter. ^{1 3}

For the trial-by-trial evidence across 11 randomized studies, see our research page: testosterone cardiovascular risk data. That dataset has its own source notes and verification scope; this page focuses on the questions to take into care.

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How did we check this page?

We checked the medical and regulatory statements against the primary trial, current prescribing information, FDA and HHS announcements, Endocrine Society guidance, and official emergency guidance. We checked provider statements against the public pages linked here on October 5, 2026, without treating a published claim as proof that a service was delivered. We keep trial results, label warnings, regulator announcements, and our own judgment separate, and we tell you which is which.

This page is published by TRT Provider Guide. It has not been reviewed by a clinician, and we don't claim it was. Our published method, How We Review TRT Providers, separates verified facts, provider-stated claims, customer-experience signals, and our editorial conclusions. Here, incomplete quotes remain incomplete: we show the arithmetic and missing items instead of calling a subtotal the full cost.

TRT Provider Guide is not a clinic, pharmacy, lab, drug maker, insurer, or medical practice. See our editorial standards, privacy policy, or report a correction.

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TRT and heart health: frequently asked questions

The answers below address common questions about the trial, warning labels, and care options. They explain the evidence without deciding whether you should use testosterone.

Does TRT increase the risk of heart attack?

TRAVERSE found similar rates of cardiovascular death, nonfatal heart attack, or nonfatal stroke combined: 7.0% with testosterone gel and 7.3% with placebo over an average 33 months of follow-up. It met its noninferiority test; it did not prove zero risk for every patient or testosterone product. ¹

Can TRT cause heart palpitations or AFib?

AFib showed up in 3.5% of men on testosterone gel versus 2.4% on placebo in TRAVERSE. Tell your clinician about new fluttering, racing, or skipped beats; chest pain, fainting, or sudden breathlessness needs urgent or emergency assessment. ^{3 10 11}

Does TRT thicken your blood?

It can raise hematocrit, the share of your blood made of red cells. Some injection regimens have produced more high results than gels in comparative studies. A blood count measures it; the monitoring schedule depends on your product and clinical situation. ^{3 6 9}

Can I take TRT after a stent or heart attack?

The Endocrine Society recommends against starting within six months of a heart attack or stroke. A stent alone is not the same event or a separate six-month rule in that recommendation. Your clinical stability and full history still need assessment; passing a date is not clearance. ⁵

Can TRT cause a stroke?

TRAVERSE’s main combined cardiovascular outcome was similar between groups, but that does not prove that testosterone can never contribute to a stroke. Blood pressure and AFib still matter. A leg-vein clot usually threatens the lungs, not the brain; it is a different clotting problem. ^{1 3 8 11}

Is TRT good for your heart?

That hasn't been proven. Low testosterone is linked to heart disease, but TRAVERSE tested cardiovascular safety, not heart protection. Don't use TRT as a substitute for your heart care. ^{1 6}

Are injections worse for the heart than gel?

TRAVERSE cannot answer that comparison because it only tested gel against placebo. A small retrospective study found more high-hematocrit results with its injection regimens than with gel, but it cannot establish which format causes fewer heart attacks or strokes. ^{1 9}

Does TRT raise cholesterol?

Testosterone labels say to check cholesterol periodically because it can change; they do not promise that every cholesterol measure will rise or fall. Ask what baseline and follow-up lipid testing fits your health history. ³

Can I take TRT if I'm on blood thinners?

Possibly. The label says warfarin users may need more frequent INR checks. Tell whoever manages your blood thinner before you start. Do not assume every blood thinner has the same monitoring requirements. ³

Did the FDA say TRT is safe for the heart?

Not exactly. In 2025 it required removal of boxed-warning language about increased adverse cardiovascular outcomes and required blood-pressure labeling changes. That is a specific regulatory decision, not a blanket "safe." ²

Can I get TRT online if I have heart disease?

Through December 31, 2026, the current federal temporary rule permits qualifying DEA-registered practitioners to prescribe Schedule II–V controlled medications without a prior in-person examination when its conditions are met, including legitimate medical purpose, the required telemedicine interaction, and applicable federal and state authority. For testosterone, this is not permission for a questionnaire-only prescription; real-time audio-video requirements apply under this flexibility. State rules, the provider, or your clinical needs may still require in-person care. Active heart disease belongs in a discussion with the clinician managing it before choosing a new TRT program. ¹³

Should I stop TRT if I'm worried about my heart?

Don't change a prescription based on an article. Talk to the clinician who prescribed it. For emergency symptoms, call 911. ^{10 11}

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Still not sure which TRT care route fits you? Use our free Find My TRT Path tool.

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Sources

Medical and regulatory sources are primary research, official guidance, or prescribing information. Provider sources document what each business publishes, not an independent test of care. Sources checked October 5, 2026.

1. Lincoff AM, Bhasin S, et al. Cardiovascular Safety of Testosterone-Replacement Therapy. NEJM, 2023;389:107–117. Trial population, design, primary endpoint and follow-up.
2. FDA. Class-wide labeling changes for testosterone products, February 28, 2025.
3. DailyMed. Xyosted (testosterone enanthate) prescribing information. Sections 1, 2.1, 5.1–5.4, 5.7, 5.9, 5.11, 6.1, 7.2 and 9.1.
4. HHS. Requested updates to testosterone therapy product labels, June 18, 2026.
5. Endocrine Society. Testosterone Therapy in Men With Hypogonadism: clinical practice guideline, 2018. Diagnosis and recommendations 2.1–2.2.
6. Bhasin S, et al. Full Endocrine Society guideline. JCEM, 2018. Monitoring section and Table 9.
7. Endocrine Society. Statement on Testosterone Replacement Therapy, July 16, 2026. Diagnosis, testing quality and remaining evidence gaps.
8. Maligireddy S, Barua V, Barua RS. Journal of the Endocrine Society narrative review of testosterone and atrial fibrillation, September 2026;10(9):bvag180. Proposed relationship and untested treatment-range hypothesis.
9. Pastuszak AW, et al. Comparison of testosterone gels, injections, and pellets. Sexual Medicine, 2015. Retrospective study; Table 5.
10. American Heart Association. Heart attack and stroke symptoms.
11. CDC. About venous thromboembolism (blood clots). DVT and PE symptoms and distinction from arterial clots.
12. FDA. Understanding the risks of compounded drugs.
13. DEA and HHS. Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. Federal Register, December 31, 2025; effective January 1–December 31, 2026; 21 CFR 1307.41.
14. DailyMed. AndroGel 1.62% prescribing information. Product identity, secondary exposure, cardiovascular information and monitoring.
15. DailyMed. Testim prescribing information. Approved gel formulation and product-specific warnings.
16. Pfizer. Depo-Testosterone (testosterone cypionate) prescribing information. Intramuscular administration and diagnostic confirmation.
17. Jatenzo. Prescribing information, revised September 2025. Oral testosterone undecanoate and blood-pressure warning.
18. DailyMed. Kyzatrex prescribing information, updated August 26, 2026. Oral testosterone undecanoate and blood-pressure warning.
19. DailyMed. Tlando prescribing information, updated February 25, 2026. Oral testosterone undecanoate and blood-pressure warning.
20. Testopel. Prescribing information. Testosterone pellets for implantation.
21. Hone Health. Plus membership: plan, starting tests, confirmatory charges and medication pricing.
22. Hone Health. Premium membership: plan, starting and confirmatory tests, panels and medication pricing.
23. Hone Health. Men’s Plus HRT lab-testing schedule for TRT patients.
24. Hone Health. Men’s lab schedule on the Premium plan.
25. Hone Health. Service availability by state, 2026. Distinct Plus and Premium lists.
26. Male Excel. Online TRT page. Advertised starting and membership prices, monitoring and treatment claims.
27. Male Excel. At-home hormone-test page. Listed starter-kit markers and starting charge.
28. Male Excel. Hormone-replacement costs. Testosterone-plus-thyroid examples, 60-day billing and shipping exclusion.
29. Male Excel. FAQ. State exclusions, treatment formats, insurance, pharmacies, refills and medication refunds.
30. Taurus Meds. Homepage. Hormone-increase marketing and general service claims.
31. Taurus Meds. $49 testosterone campaign. Starting and monthly offers, compounding text and inconsistent treatment descriptions.
32. Taurus Meds. Terms of service. Recurring fee in section 28, partner disclosures and payment provisions.
33. Hone Health. Testosterone product page. Advertised cypionate preparation and compounded-drug disclosure.
34. Hone Health. Insurance policy. Cash-pay service and prior-authorization limitations.
35. Hone Health. Order cancellation and refund policy. Separate membership and medication billing.
36. Hone Health. Membership overview. Basic, Plus and Premium are different plans; Basic does not include hormone therapy.
37. Hone Health. Retesting and confirmatory-testing policy. Mandatory confirmation and conflicting general no-extra-charge wording.
38. Hone Health. Local-pharmacy policy. Ongoing membership, separate medication billing and transfer limitations.
39. Male Excel. Terms and conditions. Fees, shipping, refunds and clinical access limitations.
40. Taurus Meds. Refund policy. Cancellation timing and order restrictions.
41. Public Citizen. Comments on the FDA Expert Panel on Testosterone Replacement Therapy for Men, February 9, 2026. Advocacy position, not a regulatory action.
42. American Heart Association. Life's Essential 8. Cardiovascular prevention measures.
43. American Heart Association. What are the Symptoms of Atrial Fibrillation? Definition, symptoms and stroke risk.
44. Pencina KM, et al. Efficacy of Testosterone Replacement Therapy in Correcting Anemia in Men With Hypogonadism: A Randomized Clinical Trial. JAMA Network Open, 2023;6(10):e2340030. TRAVERSE anemia substudy.