Why Men Ask About Long-Term Safety
Testosterone replacement therapy (TRT) can improve energy, libido, mood, and body composition in men with confirmed low testosterone. But because TRT is often a long-term treatment, it's natural to wonder: is it safe for years or decades?
What Major Research Shows
Heart health: For years, there were concerns that TRT might increase heart attack and stroke risk. The large TRAVERSE trial, published in 2023, studied more than 5,000 men with low testosterone and existing heart disease or high cardiovascular risk. It found that TRT did not increase the risk of major cardiovascular events compared with placebo.
Based on this research, the FDA updated testosterone product labels in 2025 to reflect these findings, while adding warnings about potential increases in blood pressure. In 2026, HHS requested additional label updates, including narrowing the prostate cancer contraindication to metastatic disease.
Prostate health: Current evidence does not show that TRT causes prostate cancer. However, PSA and prostate health are monitored during treatment.
Known Risks and Side Effects
TRT isn't risk-free. Possible effects include:
- Higher red blood cell count (hematocrit): The most common lab change, which can thicken the blood if not monitored
- Reduced sperm production and fertility
- Testicular shrinkage
- Acne or oily skin
- Worsening of untreated sleep apnea
- Blood pressure increases
In TRAVERSE, men on testosterone also had slightly higher rates of atrial fibrillation, acute kidney injury, and blood clots in the lungs.
Monitoring Is What Keeps TRT Safe
Long-term safety depends heavily on proper medical supervision, including:
- Confirming low testosterone before starting
- Regular blood work to check testosterone, hematocrit, and PSA
- Adjusting the dose to keep levels in a healthy range
- Monitoring blood pressure
- Reviewing symptoms and side effects over time
Who Shouldn't Take TRT?
TRT may not be appropriate for men who want to father children soon, have uncontrolled heart failure, untreated severe sleep apnea, or certain cancers. Your provider will review your history first.
Learn more about provider-guided testosterone therapy here: Heva Hormone Optimization
The Bottom Line
For men with confirmed low testosterone, TRT appears safe long-term when it's properly prescribed and monitored. Regular labs and check-ins are essential.