---
title: "Testosterone and Atrial Fibrillation Risk: U-Shaped Relationship and Clinical Implications"
id: "endocrine-news-0-men-with-low-or-high-testosterone-may-have-higher-risk-of-irregular-heartbeat"
canonical_url: "https://medichelpline.com/clinical-feed/endocrine-news-0-men-with-low-or-high-testosterone-may-have-higher-risk-of-irregular-heartbeat"
content_type: "clinical_feed_article"
specialty: "Endocrinology"
source_name: "Endocrine News"
source_url: "https://endocrinenews.endocrine.org/men-with-low-or-high-testosterone-may-have-higher-risk-of-irregular-heartbeat/"
published_at: "2026-09-02T21:42:23.000Z"
evidence_level: "Verified Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Testosterone and Atrial Fibrillation Risk: U-Shaped Relationship and Clinical Implications
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/endocrine-news-0-men-with-low-or-high-testosterone-may-have-higher-risk-of-irregular-heartbeat
- **Specialty:** [Endocrinology](https://medichelpline.com/clinical-feed/endocrinology.md)
- **Primary Source:** Endocrine News
- **Source URL:** [Original Journal Publication](https://endocrinenews.endocrine.org/men-with-low-or-high-testosterone-may-have-higher-risk-of-irregular-heartbeat/)
- **Published At:** 2026-09-02T21:42:23.000Z
- **Evidence Rating:** Verified Feed
## Executive GIST (TL;DR)
- A narrative review published in the Journal of the Endocrine Society evaluated links between **testosterone** levels, testosterone replacement therapy, and risk of **atrial fibrillation (AF)** in men. - The review concludes evidence is consistent with a U-shaped relationship: both low and high total testosterone levels are associated with increased AF risk, while mid-range values show the lowest risk. - Support for the U-shaped pattern comes from large population studies and laboratory work reported since 2025 showing distinct cellular mechanisms by which low and high testosterone can alter cardiac cells. - For men receiving **testosterone replacement therapy (TRT)**, authors recommend aiming to restore total testosterone to the middle of the normal range (approximately 350–550 ng/dL) rather than driving levels to the high end; this therapeutic range is inferred from observational data and has not been prospectively tested. - Clinical suggestions to personalize TRT include using calculated free testosterone when SHBG is abnormal, favoring steady-release formulations over short-acting ones in men with cardiovascular or arrhythmic risk, and maintaining normal hematocrit as the principal dose-limiting safety constraint. - The review advises pre-treatment risk stratification and addressing modifiable contributors to AF risk such as obesity, sleep apnea, hypertension, and alcohol use. - Monitoring recommendations while on TRT include rhythm surveillance, hematocrit checks, blood pressure measurement, and renal and hepatic function testing. - The authors emphasize that the article is a narrative synthesis of existing literature rather than a meta-analysis, and its conclusions are interpretive rather than definitive. - The overall message is that **individualized treatment and structured monitoring** are necessary when prescribing TRT because both insufficient and excessive testosterone may increase AF risk.
## Clinical Analysis & Structured Key Points
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[Login](https://endocrinenews.endocrine.org/auth/login/?redirect=https://endocrinenews.endocrine.org/men-with-low-or-high-testosterone-may-have-higher-risk-of-irregular-heartbeat/) ![](https://endocrinenews.endocrine.org/wp-content/themes/mg-starter/assets/images/Endocrine_News_standard_logo.svg) * * * # Men With Low or High Testosterone May Have Higher Risk of Irregular Heartbeat September 2, 2026 Print this article Share this article Men with either low or high testosterone levels may face a higher risk of atrial fibrillation, highlighting the need for personalized testosterone treatment, according to a review of existing evidence on testosterone and heart health published today in the _Journal of the Endocrine Society_. Co-author Rajat S. Barua, MD, PhD, of Kansas City Veterans Affairs Medical Center in Kansas City, Mo., says: “Testosterone replacement therapy is widely prescribed for middle-aged and older men, and atrial fibrillation is a heart rhythm disorder that increases stroke risk and often requires lifelong blood-thinning medication. Our paper reviewed existing evidence on whether testosterone therapy is safe or unsafe in relation to atrial fibrillation and the range of testosterone levels associated with the lowest risk. Both too little and too much testosterone appear to raise the risk of atrial fibrillation, through separate biological mechanisms, which means the dose and the target level matter. What the review argues is that treatment should be individualized and monitored.” The researchers concluded from the available and conflicting evidence that the relationship between testosterone and atrial fibrillation (AF) appears to follow a U-shaped pattern: men with low testosterone and men with high testosterone both show a higher risk of atrial fibrillation, while the risk appears to be lowest in the middle of the normal range. Barua explains that this pattern has support from two directions: large population studies and, since 2025, laboratory work showing that low and high testosterone disturb heart cells through two different mechanisms. For men who need testosterone replacement therapy, the authors state the goal for clinicians should be aiming to restore testosterone to the middle of the normal range (approximately 350–550 ng/dL total testosterone) rather than pushing it to the high end, using steady-release formulations and structured monitoring. The therapeutic range of total testosterone, 350–550 ng/dL, is inferred from observational data and has not been tested prospectively yet. The authors expand on ways to personalize treatment and monitor symptoms for men who need testosterone therapy: * Use calculated free testosterone when Sex Hormone-Binding Globulin (SHBG) is abnormal. * Prefer stable-pharmacokinetic formulations over short-acting formulations in men with elevated cardiovascular or arrhythmic risk. * Maintain normal hematocrit as the principal dose-limiting safety constraint. * Risk-stratify before initiation and address obesity, sleep apnea, hypertension, and alcohol use. * Monitor rhythm, hematocrit, blood pressure, and renal and hepatic function. 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