Can Testosterone Levels Affect Heart Rhythm?

With the proliferation of body hacking advice across the internet and podcasting world, one of the conditions that many men, especially those in middle to later age, wonder about is low testosterone. By how often it is advertised, primarily through online sales channels, you’d be forgiven for thinking it is a ubiquitous problem. Low testosterone has been implicated in many concerning male health issues, and frequently touted as a panacea for the drop in activity and muscle building that many men experience in middle age and beyond.

Testosterone has not been implicated in increases in major cardiovascular events, like heart attacks, but is there any validity to testosterone replacement therapy being blamed for so many problems, and can testosterone affect heart rhythm, and in particular, Afib?

Low And High Testosterone is Not Ideal

The short answer is that testosterone can cause heart rhythm concerns and even Afib. Low or high testosterone levels have a distinct effect on the hormonal balance of the male body and blood flow. For example, low testosterone can change the body’s normal chemical balance while too much testosterone supplementation can make blood more viscous, increase blood pressure, and, in turn, cause atrial fibrillation.

It is worth noting that low testosterone may also be associated with longer QT intervals, and hormone replacement therapy may shorten those intervals. Either of these effects can increase the risk of ventricular arrhythmias, so be sure to speak to your electrophysiologist before starting or modifying a testosterone replacement routine.

Defining Low T

We must define low testosterone and gain a better understanding of its prevalence in the broader population. For one, low testosterone is often misdiagnosed and used as an excuse Testosterone for poor lifestyle habits. This is because blood levels are usually benchmarked against a younger man’s normal testosterone results. However, all men lose some testosterone production over time, so what is typical for a 60-year-old is very different from what’s normal for someone much younger.

In addition, most urologists rightly diagnose low testosterone based on how a patient feels rather than what their levels are. As a frame of reference, normal testosterone levels can range anywhere from 250 mg/dL to 850 or even higher. Rather than focusing on current concerns about testosterone levels, it’s essential to treat the symptoms. As an example, if you ask any urologist, they’ll say that they have men at the 250 level who feel fantastic and others with much higher testosterone who feel terrible. This is important to understand.

By the same token, while many men’s clinics will offer to treat testosterone with injections, topical pills, or patches, taking too much testosterone is less about its effect on mood, which can be problematic, and more about potential cardiovascular issues. Too much testosterone can make the blood more viscous and cause a myriad of heart issues.

So What’s the Answer?

Of course, part of any workup will require a discussion about hormones. For some men, this will mean supplementing with testosterone. For others, testosterone will not be a factor. With that said, a man can often do plenty to reduce the risk of new or worsened heart rhythm issues like Afib, including losing weight, exercising, sleeping well (so important!), and more. Remember, as we age, we tend to lose some of the good habits we had as younger folks. That can, in turn, cause a more rapid decline in testosterone in middle age. Making simple lifestyle changes is the easiest and lowest-risk way to increase testosterone production. Beyond that, the less common cases of clinical hypogonadism (a medical condition that causes lowered testosterone) can be treated very effectively with testosterone replacement therapy, or TRT.