Men face a substantially higher risk of testosterone-related heart disease as they age. Research shows at least 25 million American males aged 40-55 experience some form of andropause (male menopause) . Most men start experiencing a natural testosterone decline in their mid-30s, with levels dropping about 1.6% each year . The average man's testosterone levels at age 75 drop roughly 30% compared to their levels at age 25 .
This hormonal change deeply affects cardiovascular health. Research indicates that men with unusually low testosterone levels show higher rates of coronary artery disease . Heart health concerns become especially important when you have half of all heart failure patients in the USA above 75 years old . The link between testosterone's effect on cholesterol balance and blood pressure regulation plays a vital role in overall heart health. A clear understanding of heart attack and testosterone level correlation becomes essential as men grow older.
This piece explores how andropause and cardiovascular health interconnect. It details testosterone's declining levels' impact on heart function, presents current research about hormone replacement therapy, and outlines practical heart health protection steps for ageing men.
Understanding Andropause, Testosterone, and Heart Disease
Image Source: Herstasis® Health Foundation
"Andropause refers to a generalised decline of male hormones, including testosterone and dehydroepiandrosterone in middle-aged and ageing men." — Research Team at National Centre for Biotechnology Information, NIH/NLM peer-reviewed research institution
The media often calls it "male menopause," but andropause represents a gradual hormonal change rather than a sudden transformation. Medical professionals use the term late-onset hypogonadism, which better describes how male hormones decline with age [1].
What is andropause and how is it different from menopause?
Women experience menopause as a rapid hormonal decline over a short period, with complete cessation of ovulation. Men's experience differs significantly. Their testosterone levels decrease slowly, falling at approximately 1% to 3% annually starting around age 40 [2]. This gradual decline continues throughout life, and some studies show testicular function keeps decreasing into the ninth decade [2].
There's another significant difference - all women experience menopause, but not all men develop symptomatic andropause. The American Urological Association reports that andropause affects about 20% of men between ages 45 and 60 [1].
Late-onset hypogonadism - the preferred medical term - specifically refers to a testosterone deficiency that develops later in life and can affect quality of life [1]. Many ageing men have low testosterone levels without noticeable symptoms [1].
The role of testosterone and DHEA in ageing men
Testosterone and dehydroepiandrosterone (DHEA) are vital androgens that affect many physiological processes in men. The testicles produce 95% of a man's testosterone under luteinizing hormone (LH) control, while the adrenal glands produce the remaining 5% [3]. The adrenal glands produce DHEA, which serves as an important precursor to testosterone [3].
These hormones do more than regulate sexual function. Recent studies reveal that serum levels of DHEA and testosterone are inversely associated with coronary artery calcification in elderly men, suggesting they contribute to male cardiovascular health [4]. Men with lower testosterone levels show worse overall health [2], and greater declines in circulating androgens link to increases in all-cause mortality [2].
Both hormones influence:
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Muscle mass and strength
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Bone density
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Fat distribution
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Red blood cell production
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Cognitive function
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Cardiovascular health
Testosterone exists in the bloodstream in two forms: bound to proteins or free (unbound). The free and weakly-bound forms make up "bioavailable testosterone," which is biologically active [3]. Sex hormone-binding protein increases with age, so older men might have normal total testosterone levels yet still lack bioavailable testosterone where needed most [3].
How testosterone levels decline with age
Male testosterone production starts early - during the seventh week of embryonic development - and fluctuates throughout life [3]. Levels peak at around age 17 and stay high for the next two to three decades [3].
Men start losing testosterone-producing Leydig cells in their testes around age 35 to 40. The adrenal cortex cells responsible for DHEA production also decline [2]. This leads to a steady decrease in both hormones, with studies showing yearly reductions of 1% to 3% for testosterone and up to 4% for DHEA [2].
Several factors cause this age-related decline. The number of Leydig cells decreases [3], and these cells become less responsive to luteinizing hormone. Research shows that Leydig cells in men over 65 respond less effectively to hormonal stimulation compared to men under 50 [3]. Chronic microvascular disease and fibrotic changes in testicular tissue may also contribute to this decline [3].
A 70-year-old man typically produces about 30% less testosterone than during his peak [3]. Yet all but one of these men maintain testosterone levels within normal range [3], explaining why many can father children into their 80s and beyond.
How Andropause Affects the Cardiovascular System
"Low levels of testosterone have been linked to a higher incidence of coronary artery disease." — Research Team at National Centre for Biotechnology Information, NIH/NLM peer-reviewed research institution
The heart-related effects of andropause go way beyond simple hormone changes and can affect heart function in many ways. Research shows testosterone plays a key role in heart health, and its decrease sets off a chain of effects throughout the heart and blood vessels.
Link between low testosterone and heart disease
Scientists have found a clear link between falling testosterone levels and higher risks of heart problems. Long-term studies show men who don't treat their low testosterone face worse heart outcomes [1]. A new large study that followed more than 4,000 men for 19 years confirmed that lower testosterone levels are strongly associated with incident heart failure [1].
This relationship works both ways—low testosterone leads to heart disease while heart problems can lower testosterone production [1]. This creates a worrying cycle where each problem makes the other worse.
Research shows that lower testosterone levels match up with more severe coronary artery disease (CAD). Four separate studies back this up [5]. Men with ongoing heart failure often have low testosterone—good studies show this happens in 25% to 56% of cases [1].
Several things happen at once. Low testosterone throws off the body's building and breakdown balance. This leads to less muscle mass, reduced oxygen use, lower exercise tolerance, and higher risk of severe muscle loss in heart patients [1]. Low testosterone can also directly harm how well the heart muscle works [1].
Impact on blood pressure and vascular function
Testosterone's role in controlling blood pressure turns out to be quite complex. Studies of the general population show that all forms of testosterone have an opposite relationship with high blood pressure [2]. Put simply, blood pressure tends to rise as testosterone drops.
Scientists tested this in mice with low testosterone to model andropause. These mice had higher diastolic and average blood pressures than normal mice [2]. Their blood vessels showed thicker walls (10.4 vs. 8.2 ratio) and didn't relax as well [2]. This proves low testosterone directly changes blood vessel structure and function.
Testosterone can both relax and tighten blood vessels, but lack of it seems to raise blood pressure [2]. This hormone affects blood pressure through:
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Blood vessel tightness and resistance
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Blood vessel lining function
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How the body handles salt
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Heart muscle growth and function
The situation gets worse for patients with moderate high blood pressure. Their luteinizing hormone (which rises when testosterone drops) links to higher heart disease risk [2]. This suggests an extra risk for men with more serious high blood pressure.
Low testosterone and cholesterol imbalance
Another heart risk from andropause comes from how testosterone affects cholesterol balance. Studies show that testosterone-deficient males have higher levels of low-density lipoprotein (LDL) [4], which adds to their heart risks.
Lab studies show low testosterone makes it harder for the liver to remove cholesterol from blood [4]. This happens because the body makes more PCSK9, a protein that breaks down LDL receptors [4]. With fewer receptors, the liver can't clear cholesterol from blood effectively.
Many studies find that middle-aged men with low testosterone have worse cholesterol numbers—higher triglycerides, higher total cholesterol, and lower good cholesterol (HDL) [2]. Scientists call this pattern "potentially harmful to arteries" [2].
Research reveals an interesting U-shaped connection between testosterone and LDL levels [6]. Both very low and very high testosterone might harm cholesterol balance. This explains why studies on testosterone replacement therapy show mixed results for cholesterol [7].
Despite these complications, several clinical trials suggest testosterone replacement might help lower total cholesterol, LDL cholesterol, and triglycerides in men with low testosterone [8]. Doctors need to carefully consider the benefits and risks for each patient.
Cellular and Molecular Changes in the Ageing Heart
Image Source: researchgate.net
Beyond hormonal changes, andropause disrupts cardiovascular health through basic changes at cellular and molecular levels. These microscopic processes help explain why lower testosterone levels affect heart function in ageing men by a lot.
Mitochondrial dysfunction and oxidative stress
The heart's massive energy needs make it vulnerable to mitochondrial dysfunction. Cardiac mitochondria go through major structural changes with age. These include cristae disorganisation, swelling, and fragmentation among reduced oxidative phosphorylation (OXPHOS) efficiency [9]. These changes directly harm energy metabolism—especially when you have declining testosterone.
Age-related mitochondrial dysfunction shows up through:
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Increased reactive oxygen species (ROS) production
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Decreased ATP generation and bioenergetic insufficiency
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Disruption of calcium homeostasis
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Compromised mitophagy (clearance of damaged mitochondria)
Ageing hearts produce much more mitochondrial superoxide. One study showed doubled ROS levels in aged cardiomyocytes compared to adult cells [10]. This oxidative stress creates a harmful cycle where damaged mitochondria make more ROS and cause more cellular damage [3].
Cardiolipin, a vital phospholipid found almost nowhere else in mammalian cells, keeps mitochondrial structure and function optimal [9]. Age leads to loss of this essential component, which reduces electron transport chain activity—particularly in complexes I and IV [3].
Inflammation and arterial stiffness
Low-grade chronic inflammation emerges as a major factor in arterial dysfunction during ageing. This inflammatory state shows increased immune cells and cytokines (IL-6, IL-1β, TNF-α), which cause higher ROS and more vascular adhesion molecules [11].
Without doubt, inflammation and arterial stiffness relate to each other both ways. Research shows people with chronic inflammatory disorders have 14% more arterial stiffness than those without such conditions [12]. Higher plasma C-reactive protein levels also relate positively to pulse wave velocity and negatively to endothelial-dependent dilation in forearm resistance arteries [13].
The inflammatory process arranges multiple changes in both intimal and medial layers of arteries. This leads to elastin breakdown and collagen buildup [13]. These structural changes, plus functional changes like lost Windkessel function and higher pulse pressure, disrupt heart function fundamentally [11].
Large arteries stiffen more dramatically with age (70% increase from early to midlife) compared to peripheral vessels (20% increase) [11]. This explains why central cardiovascular problems often appear before peripheral symptoms.
Telomere shortening and cellular ageing
Telomeres—protective caps at chromosome ends—get shorter progressively. This represents another significant mechanism in cardiovascular ageing. They shorten with each cell division until reaching a critical length that triggers cellular senescence or death [14].
Short telomeres increase atherosclerosis risk. Studies confirm that vascular smooth muscle cells undergo telomere-based senescence in human atherosclerotic vessels [15]. This process affects heart function directly. Adult mice lacking telomerase develop cardiomyopathy with impaired cell division, increased cardiomyocyte death, and cellular hypertrophy [14].
Senescent cells develop a problematic secretory pattern. They release proinflammatory cytokines, proteases, and insoluble extracellular matrix components [14]. These substances affect nearby cells, change the tissue environment, and promote chronic inflammation [14].
Men going through andropause might face greater cardiovascular risks as these cellular and molecular changes combine with declining testosterone. Research in this field continues to grow, and understanding these microscopic mechanisms offers promising ways to support heart health in ageing men.
Testosterone Therapy: Hope or Hype?
Image Source: Nature
Men with andropause can turn to testosterone replacement therapy (TRT) to curb declining hormone levels. Medical professionals have mixed reactions about this therapy, which comes in different forms like gels, injections, and patches.
Benefits of testosterone replacement therapy
TRT shows remarkable results for men who have confirmed hypogonadism. Clinical studies prove that TRT can:
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Restore libido and sexual function
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Increase lean muscle mass while reducing fat mass
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Improve bone mineral density
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Boost energy levels and mood
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Create an overall better sense of well-being [16]
TRT's benefits go beyond just relieving symptoms. Research shows that 54% of men with unexplained anaemia saw their haemoglobin levels rise (≥1.0 g/dL), while only 15% in placebo groups showed improvement [17]. On top of that, it can boost insulin sensitivity and metabolic parameters in some patients [18].
Risks: heart attack, stroke, and blood clots
Safety concerns about TRT's effects on heart health were once a big issue. The FDA required warning labels on testosterone products in 2015 due to heart attack and stroke risks [1]. Notwithstanding that, new evidence has changed these concerns.
Red blood cell production increases with TRT (polycythemia). This can make blood thicker and raise thrombotic risk when haematocrit goes above 0.54 [18]. Studies also found more cases of atrial fibrillation in testosterone users—3.5% compared to 2.3% in placebo groups [17].
TRT can affect fertility by reducing sperm production [19]. Users might also experience acne, breast enlargement, and hot flashes [1].
What recent studies and trials reveal
A newer study, published in 2023, the TRAVERSE trial, gave an explanation about TRT safety. This complete study with 5,246 men aged 45-80 who had low testosterone levels tracked participants for 22 months on average [20].
Results showed no significant difference in major cardiovascular events between TRT and placebo groups [21]. So, the FDA removed the black box warning from testosterone products about cardiovascular risk in February 2025 [1].
We found that testosterone therapy is generally safe for heart health. Studies suggest that leaving hypogonadism untreated might actually increase cardiovascular risk [1].
When is therapy recommended?
Doctors recommend TRT for men who have clear signs of hypogonadism—usually with testosterone levels below 300 ng/dL and symptoms [1]. Keep in mind that doctors often suggest lifestyle changes first:
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Regular exercise (both strength training and cardio)
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Adequate sleep
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Stress management
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Nutrient-rich diet high in protein
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Weight loss if applicable [1]
Men with prostate cancer, breast cancer, and heart failure should not use TRT [22]. A complete evaluation before starting therapy is crucial.
Patients without these conditions need regular blood tests and check-ups to minimise risks. They should talk to their healthcare providers if symptoms don't improve, side effects become troublesome, or they develop health conditions that might make TRT unsafe [22].
Nutritional and Lifestyle Support for Heart Health
Image Source: Freepick
Men with age-related testosterone decline can benefit by a lot from specific dietary and lifestyle changes that improve their cardiovascular health. Natural approaches are a great way to get tools to minimise low testosterone cardiovascular risk as hormonal changes happen.
CoQ10 and mitochondrial support
Coenzyme Q10 (CoQ10) is a vital component of heart health. It works as an essential part of the mitochondrial electron transport chain and acts as a potent antioxidant in cellular membranes [23]. This compound exists naturally in our bodies and protects cells from oxidative stress damage while helping the heart's mitochondria produce energy. Your body's CoQ10 levels drop as you age, which could lead to andropause heart health problems through increased reactive oxygen species production [2]. Research shows that supplements might help with mitochondrial deficiency syndrome and ease cardiovascular disease through antioxidant effects [2].
Omega-3 fatty acids and inflammation
Omega-3 fatty acids, especially EPA and DHA found in fatty fish, provide substantial benefits for men who have declining testosterone. These nutrients help lower testosterone blood pressure problems by reducing inflammation—a significant factor in cardiovascular disease progression [24]. The American Heart Association suggests eating fish rich in unsaturated fats twice weekly at least [24]. Salmon, sardines, Atlantic mackerel, cod, herring, lake trout, and light canned tuna are excellent sources of omega-3 [24]. These fatty acids can lower triglyceride levels, reduce irregular heartbeats, and support overall vascular health—vital for proper testosterone cholesterol balance.
The Mediterranean diet and cardiovascular protection
The Mediterranean diet consistently shows lower risk of heart attack testosterone complications. This eating pattern focuses on:
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Abundant vegetables, fruits, and whole grains
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Plant-based fats, especially olive oil
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Weekly consumption of fish, poultry, beans and legumes
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Limited red meat intake [25]
This diet helps maintain healthy cholesterol levels, blood pressure, and blood sugar while curbing inflammation [26]. Many healthcare providers now recommend this eating plan to patients with testosterone heart disease risk factors [25].
Exercise and testosterone regulation
Physical activity regularly offers two key benefits—it improves cardiovascular health and naturally regulates testosterone levels. Research shows that resistance exercise increases serum testosterone levels by a lot when you work large muscle groups [27]. On top of that, compound exercises like deadlifts, squats, and bench presses boost testosterone levels the most [5]. The effects seem to depend on age, and younger men see bigger testosterone increases after exercise [5].
When to Seek Medical Advice
Understanding warning signs of andropause and asking for medical advice at the time you need it are vital steps to retain control of cardiovascular health as you age.
Recognising symptoms of low testosterone
Men should ask their healthcare providers if they experience:
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Decreased sex drive and erectile dysfunction
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Excessive fatigue and diminished energy
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Depression and difficulty concentrating
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Reduced muscle mass and increased body fat
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Less facial/body hair growth
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Development of breast tissue (gynecomastia) [28]
These symptoms might appear with hot flashes, bone density loss, and sleep disturbances that point to testosterone deficiency [29].
When to see a cardiologist or endocrinologist
Your GP will likely suggest lifestyle changes first - more physical activity, better diet choices, stress management techniques, quality sleep, and cutting back on alcohol and tobacco [29].
Blood tests that show low testosterone levels make an endocrinologist visit necessary [29]. Heart health concerns need a cardiologist's evaluation [30].
Both specialists often cooperate to create treatment plans, especially when you have hormone imbalances that affect cardiovascular health through changes in cholesterol levels and blood pressure [30]. To name just one example, approximately 10% of adults develop hypertension because their adrenal glands don't work properly [31].
Tests to assess hormone and heart health
Doctors measure testosterone levels through blood tests, preferably before 11am [32]. A detailed cardiovascular assessment usually includes:
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Cardiac enzyme tests to diagnose heart attacks
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Lipid profiles that measure cholesterol levels
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BNP tests to identify potential heart failure
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Blood glucose tests to check diabetes risk [33]
These results help healthcare providers choose the right treatments to manage testosterone heart disease risk effectively.
Conclusion
Andropause remains an often overlooked health concern for ageing men. The steady drop in testosterone levels affects many body systems. Your cardiovascular system becomes especially vulnerable to these hormonal changes. Men who notice signs of low testosterone should view these changes as treatable conditions rather than accepting them as unavoidable parts of ageing.
Declining testosterone levels lead to cardiovascular problems in men worldwide. Early lifestyle changes can protect you against these risks. Regular physical activity and resistance training help maintain healthy testosterone levels while boosting heart function. Men over 60 who want to support their hormonal balance benefit most from exercise routines that include compound movements.
Your diet plays a vital role in managing heart risks related to andropause. The Mediterranean eating pattern gives you detailed protection against inflammation and arterial damage with its abundance of plant foods and healthy fats. On top of that, omega-3 fatty acids deserve extra attention because they support testosterone production and cardiovascular health.
Medical treatments like testosterone replacement therapy have improved by a lot. Recent research shows TRT is generally safe for properly screened patients, despite past controversies. This treatment needs careful monitoring and should happen only under qualified medical supervision.
Men must watch for connections between hormonal changes and other metabolic conditions. Low testosterone often appears alongside insulin resistance. This creates a risky overlap between andropause and diabetes risk, making cardiovascular health more complex.
The link between andropause and heart disease shows why ageing men need detailed healthcare. An integrated approach works best to maintain cardiovascular wellness during this transition. This includes proper medical screening, targeted supplements, better diet choices, and regular exercise. Men should ask for medical guidance when they notice symptoms instead of accepting these changes as unavoidable.
While andropause is inevitable, it doesn't have to determine your heart health as you age. Men can direct this hormonal transition while protecting their hearts through evidence-based natural approaches combined with medical treatments when needed.
Key Takeaways
Understanding the connection between andropause and cardiovascular health empowers men to take proactive steps in protecting their heart health as they age.
• Testosterone levels decline 1-3% annually after age 40, significantly increasing cardiovascular disease risk in ageing men.
• Low testosterone directly contributes to high blood pressure, cholesterol imbalance, and arterial stiffness through multiple pathways.
• Recent studies show testosterone replacement therapy is generally safe when properly monitored, contrary to previous concerns.
• Mediterranean diet, omega-3 fatty acids, and regular resistance exercise naturally support both testosterone levels and heart health.
• Men experiencing fatigue, reduced libido, or muscle loss should seek medical evaluation for potential testosterone deficiency.
The relationship between declining hormones and heart disease isn't inevitable—with proper lifestyle interventions and medical guidance when appropriate, men can successfully navigate andropause whilst maintaining optimal cardiovascular health throughout their later years.
FAQs
Q1. How does andropause affect heart health in men? Andropause, or age-related testosterone decline, can negatively impact cardiovascular health. Low testosterone levels are associated with increased risk of coronary artery disease, higher blood pressure, and unfavourable cholesterol profiles. These changes can contribute to a higher incidence of heart disease in ageing men.
Q2. What are the signs of low testosterone in older men? Common signs of low testosterone include decreased libido, erectile dysfunction, fatigue, reduced muscle mass, increased body fat, mood changes, and difficulty concentrating. Some men may also experience hot flashes, decreased body hair growth, and development of breast tissue.
Q3. Is testosterone replacement therapy safe for heart health? Recent studies, including the large-scale TRAVERSE trial, indicate that testosterone replacement therapy (TRT) is generally safe from a cardiovascular standpoint when properly administered and monitored. However, TRT should only be used under medical supervision and after careful evaluation of individual risk factors.
Q4. Can lifestyle changes help manage andropause symptoms and heart health? Yes, lifestyle modifications can significantly impact both andropause symptoms and heart health. Regular exercise, particularly resistance training, can help maintain testosterone levels and improve cardiovascular function. A Mediterranean-style diet rich in fruits, vegetables, whole grains, and healthy fats can also support heart health and potentially mitigate some effects of low testosterone.
Q5. When should men seek medical advice about andropause and heart health? Men should consult a healthcare provider if they experience persistent symptoms of low testosterone, such as decreased libido, fatigue, or mood changes, especially if accompanied by cardiovascular risk factors. Regular check-ups are important for men over 40 to monitor testosterone levels and overall heart health, allowing for early intervention if necessary.
References
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