High and low testosterone appear to increase AF risk

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By Olivia Bowthorpe

Both low and high testosterone levels may be associated with an increased risk of atrial fibrillation in men, according to an updated review.

Only low testosterone was historically linked to increased atrial fibrillation (AF) risk in men, but newer evidence suggests both elevated testosterone and testosterone replacement therapy may also increase risk.

Testosterone replacement therapy is widely prescribed for middle-aged and older men.

Dr Rajat Barua, chief of interventional cardiology at Kansas City VA Medical Center, said: "The key takeaway is that the therapeutic window may be narrower than previously believed."

For men who need testosterone replacement therapy, the authors recommend 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.

Barua said that that therapy should be “individualised” and "always prioritise maintaining a normal haematocrit - the primary dose-limiting safety consideration in testosterone replacement therapy”.