Question explored with the scientific record
Is there benefit to testosterone for a 52 year old who has normal levels
The short version: for a 52-year-old man with normal testosterone levels, the evidence does not show a clear benefit from testosterone therapy, and the cardiovascular safety data is conflicting enough to give you pause.
The studies that show benefit were done in men with confirmed low testosterone, usually below 300 ng/dL. The TRAVERSE trial, the largest and most rigorous study, enrolled men with symptomatic hypogonadism and pre-existing heart disease or high risk. It found no difference in heart attacks, strokes, or cardiovascular death between the testosterone and placebo groups over about three years [13]. But that is a null result for safety in a sick population, not a benefit signal in a healthy one.
A 2025 Scottish study of men over 50 found that those on long-term testosterone had a 55% higher risk of major cardiovascular events after adjusting for age, deprivation, and other diseases [18]. The effect was strongest with transdermal gels. Other studies show no increased risk [15, 19]. The evidence is genuinely split. The mechanism is plausible on both sides: testosterone raises hematocrit, which thickens blood and reduces zeta potential, promoting sludging. The TRAVERSE anemia substudy showed testosterone raised hemoglobin by about 0.5 g/dL in men without anemia [1]. That is a real effect on blood viscosity.
For cognition, the TEAAM trial gave men with low-to-normal testosterone three years of therapy and found no improvement in any cognitive test [32]. For body composition, a small 2008 study in men with low-normal levels showed testosterone prevented visceral fat gain and preserved muscle [30]. But that study enrolled men with baseline testosterone around 13.6 nmol/L (about 392 ng/dL), which is not truly low. The effect size was modest.
| Outcome | What the evidence shows |
|---|---|
| Cardiovascular events (TRAVERSE) | No difference vs placebo in high-risk men [13] |
| Cardiovascular events (Scotland 2025) | 55% higher risk with long-term use [18] |
| Cognitive function (TEAAM) | No improvement after 3 years [32] |
| Body composition (2008 trial) | Modest preservation of muscle, less visceral fat [30] |
| Hematocrit | Rises about 3% on average [20] |
The burden of proof is on the intervention. For a man with normal testosterone, the evidence does not meet it. You would be taking a drug that changes your blood chemistry, with uncertain cardiovascular effects, for benefits that are small at best and absent at worst. The most honest reading of the data is that testosterone therapy is a treatment for a deficiency, not an enhancement for a normal system.
My call: do not start testosterone therapy with normal levels. Confidence: moderate. The evidence is thin for benefit and genuinely split on harm.
Sources used 8
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Efficacy of Testosterone Replacement Therapy in Correcting Anemia in Men With Hypogonadism
In a multicenter, randomized, placebo-controlled trial nested within the TRAVERSE study, testosterone replacement therapy significantly increased correction of anemia in men with hypogonadism and reduced the incidence of anemia in those without baseline anemia, with associated i…
DOI: 10.1001/jamanetworkopen.2023.40030 -
Cardiovascular Safety of Testosterone Replacement Therapy in Hypogonadal Men
An evidence-focused overview of the cardiovascular safety of testosterone replacement therapy (TRT) in hypogonadal men, highlighting that the TRAVERSE trial found no significant increase in major adverse cardiovascular events among high-risk men treated with testosterone, while …
DOI: 10.58931/cdet.2024.2330 -
8228 Effect of Long-Term Testosterone Therapy on Cardiovascular Safety among Adult Male Patients with Testosterone Deficiency
A multicenter retrospective real-world cohort study in adult men with testosterone deficiency found that long-term testosterone therapy did not increase cardiovascular risk, with no difference in major adverse cardiovascular events over a median ~3-year follow-up after propensit…
DOI: 10.1210/jendso/bvae163.1675 -
Association Between Long-Term Testosterone Exposure and Major Adverse Cardiovascular Events in Aging Men
A real-world retrospective cohort study in aging men found that long-term testosterone exposure is associated with an increased risk of major adverse cardiovascular events (MACE) over extended follow-up in a large NHS Scotland population.
DOI: 10.1210/jendso/bvaf156 -
8228 Effect of Long-Term Testosterone Therapy on Cardiovascular Safety among Adult Male Patients with Testosterone Deficiency
Multi-center retrospective study using REACHnet electronic health records to assess cardiovascular safety of long-term testosterone therapy in adult men with testosterone deficiency; after propensity-score matching, no increased risk of major adverse cardiovascular events was ob…
DOI: 10.1210/jendso/bvae163.1588 -
Risks and benefits of testosterone therapy in older men
This is a 2013 narrative review assessing the risks and benefits of testosterone therapy in older men, concluding that benefits are not demonstrated broadly for age-related testosterone decline, highlighting increased adverse-event concerns (erythrocytosis, potential cardiovascu…
DOI: 10.1038/nrendo.2013.73 -
Testosterone Therapy Prevents Gain in Visceral Adipose Tissue and Loss of Skeletal Muscle in Nonobese Aging Men
This study investigates the effects of testosterone therapy on body composition and metabolic indices in nonobese aging men with low-normal testosterone levels, finding that it prevents visceral fat accumulation and loss of skeletal muscle mass.
DOI: 10.1210/jc.2007-1291 -
Testosterone and the brain: the power of a negative study
A critical commentary on the TEAAM trial showing that 3 years of testosterone therapy in older men with low or low-to-normal testosterone did not improve cognitive function compared with placebo, with discussion of study design limitations and implications.
DOI: 10.1016/s2213-8587(16)30142-5