Considering Testosterone Therapy in Florida? What Men Should Know About Testosterone, Heart Health, and Safety
As men get older, questions about testosterone become increasingly common.
For men in Florida considering testosterone therapy, the most important question is whether treatment is medically appropriate—not simply whether testosterone levels have declined with age.
Fatigue, reduced sexual desire, changes in body composition, decreased motivation, and other symptoms can lead men to wonder whether low testosterone may be contributing.
But testosterone therapy isn't something that should be started simply because a man is over 40—or because he wants to feel younger.
The first step is determining whether testosterone deficiency is actually present.
At Apex Coastal Wellness, our approach is to evaluate the symptoms, obtain appropriate laboratory testing, consider other potential causes, and then determine whether testosterone therapy is medically appropriate.
Who May Benefit From Testosterone Therapy in Florida?
Testosterone naturally changes throughout a man's life. However, an age-related decline in testosterone does not automatically mean that a man has hypogonadism requiring treatment.
The Endocrine Society recommends diagnosing testosterone deficiency only when a man has compatible symptoms or signs together with consistently and unequivocally low testosterone concentrations. Testosterone should initially be measured in the morning, and a low result should generally be confirmed with a repeat morning measurement.
This is important because testosterone levels fluctuate.
A single low laboratory value doesn't necessarily mean that a man has testosterone deficiency.
Symptoms that may warrant evaluation include:
Reduced sexual desire
Erectile difficulties
Decreased energy or persistent fatigue
Reduced sense of well-being
Loss of muscle mass or strength
Changes in body composition
Decreased spontaneous or morning erections
Difficulty concentrating
Reduced motivation
These symptoms aren't specific to testosterone deficiency, however. Poor sleep, obesity, medications, thyroid disorders, depression, excessive stress, anemia, nutritional deficiencies, and other medical conditions can produce similar symptoms.
That's why testing and clinical evaluation matter.
How Is Testosterone Deficiency Diagnosed?
A proper evaluation generally begins with an early-morning total testosterone level.
The American Urological Association recommends obtaining two separate early-morning testosterone measurements before making the diagnosis of testosterone deficiency.
If testosterone is low or borderline, additional testing may help determine why.
Depending on the situation, this can include:
Free testosterone
SHBG
LH
FSH
Prolactin
TSH
CBC
PSA
Additional metabolic testing when appropriate
LH and FSH can help distinguish between problems originating primarily in the testes and problems involving the hypothalamus or pituitary.
This distinction matters because the goal isn't simply to raise a laboratory number. The goal is to identify and appropriately treat an underlying medical problem.
Testosterone and Heart Health: What Do We Know?
This is one of the most important questions men ask—and understandably so.
For years, observational studies and smaller clinical trials produced conflicting information about testosterone therapy and cardiovascular risk.
The landmark TRAVERSE trial, published in the New England Journal of Medicine in 2023, provided much stronger evidence.
Researchers enrolled 5,246 men between 45 and 80 years old who had symptoms of testosterone deficiency, two testosterone measurements below 300 ng/dL, and either established cardiovascular disease or a high cardiovascular risk. Participants were randomized to testosterone gel or placebo and followed for an average of approximately three years.
The primary cardiovascular outcome occurred in:
7.0% of men receiving testosterone
7.3% receiving placebo
Testosterone therapy was therefore noninferior to placebo for the study's primary major cardiovascular outcome.
That's reassuring—but it doesn't mean testosterone therapy is risk-free.
The testosterone group had higher rates of certain adverse events, including atrial fibrillation, acute kidney injury, and pulmonary embolism.
So the appropriate conclusion isn't:
"Testosterone is good for your heart."
Nor is it:
"Testosterone is dangerous for your heart."
The evidence is more nuanced:
In appropriately selected men with hypogonadism and cardiovascular disease or elevated cardiovascular risk, testosterone therapy did not increase major adverse cardiovascular events compared with placebo in the TRAVERSE trial, but individual risks and contraindications still need to be considered.
The FDA subsequently removed the boxed warning regarding increased cardiovascular events from testosterone products after reviewing the TRAVERSE data, while also requiring warnings regarding increased blood pressure for testosterone products.
Testosterone Therapy Isn't a Substitute for Cardiovascular Risk Management
This distinction is especially important.
A man can have low testosterone and have hypertension, elevated cholesterol, obesity, diabetes, sleep apnea, or other cardiovascular risk factors.
Treating testosterone deficiency doesn't replace treatment of those conditions.
A comprehensive evaluation should consider:
Blood pressure
Cholesterol and ApoB when appropriate
Blood glucose/A1c
Body composition and weight
Smoking history
Sleep quality and possible sleep apnea
Family history
Cardiovascular disease history
Kidney and liver function
Hematocrit
Prostate health
In other words, testosterone evaluation should occur within the context of the man's overall health, rather than in isolation.
What Should Be Checked Before Starting Testosterone?
Before treatment, clinicians should evaluate whether testosterone therapy is appropriate and safe for the individual patient.
Important considerations include:
Hematocrit
Testosterone can increase red blood cell production.
Baseline hematocrit should therefore be assessed before treatment and monitored afterward. The Endocrine Society recommends checking hematocrit at baseline, approximately 3–6 months after starting therapy, and then annually. If hematocrit rises above 54%, therapy should be stopped or adjusted while the cause is evaluated.
Prostate health
For appropriate patients, PSA and prostate cancer risk should be considered before treatment and monitored according to the patient's age and risk profile.
Sleep apnea
Untreated severe obstructive sleep apnea is one of the conditions in which testosterone therapy should generally be avoided until appropriately addressed.
Recent cardiovascular events
The Endocrine Society recommends against starting testosterone in men who have had a myocardial infarction or stroke within the previous six months.
Fertility
Testosterone therapy can suppress sperm production. Men who are actively trying to conceive should discuss this before starting treatment.
What About Testosterone for "Anti-Aging"?
This is where responsible testosterone care differs from simply selling hormone therapy.
Getting older isn't, by itself, a diagnosis of testosterone deficiency.
The FDA states that approved testosterone products are indicated for men with low testosterone associated with an underlying medical condition.
That means testosterone shouldn't be prescribed simply because a man wants:
More muscle
Better athletic performance
A higher testosterone number
An "anti-aging" boost
Performance enhancement
Instead, treatment should be based on appropriate symptoms, laboratory evidence, and clinical evaluation.
What Can Testosterone Therapy Actually Help?
When true testosterone deficiency is present, treatment can improve some clinically meaningful symptoms.
Evidence supports benefits particularly in areas such as sexual function, and testosterone therapy can also improve bone density and correct anemia in appropriately selected hypogonadal men.
The magnitude of benefit varies considerably between individuals.
That's another reason not to approach testosterone therapy as a one-size-fits-all treatment.
The Goal Isn't the Highest Testosterone Level
If testosterone therapy is appropriate, the goal isn't to push testosterone as high as possible.
The Endocrine Society recommends aiming for testosterone concentrations in the mid-normal range while monitoring symptoms, adverse effects, testosterone levels, hematocrit, and prostate health as appropriate.
The objective is straightforward:
Restore testosterone to an appropriate physiologic range and determine whether doing so improves clinically meaningful symptoms.
When Should You Consider Testosterone Testing?
If you're a man over 40 experiencing persistent symptoms such as decreased libido, erectile difficulties, unexplained fatigue, or changes in body composition, it may be reasonable to discuss testosterone testing with your healthcare provider.
Testing is particularly worthwhile when symptoms are persistent and cannot be readily explained by other factors.
But don't assume that every symptom is testosterone-related.
A good evaluation looks at the whole picture.
Testosterone Therapy Should Begin With an Evaluation—Not a Prescription
Testosterone can be an appropriate medical treatment for men with genuine testosterone deficiency.
But responsible testosterone care starts with answering three questions:
1. Does the patient have symptoms consistent with testosterone deficiency?
2. Is testosterone actually and consistently low on appropriately obtained laboratory testing?
3. Is testosterone therapy appropriate and safe for this particular patient?
If the answer to all three is yes, testosterone therapy can be considered within a structured treatment and monitoring plan.
At Apex Coastal Wellness, our approach is to evaluate testosterone in the context of the patient's overall metabolic and cardiovascular health—not simply treat a number on a laboratory report.
If you're considering testosterone testing or want to understand whether your symptoms could be related to low testosterone, schedule an evaluation to discuss your individual situation and
appropriate testing.
Ready to Take the Next Step?
If you're experiencing symptoms that may be related to low testosterone or would like to discuss whether testosterone testing is appropriate for you, schedule a consultation with Apex Coastal Wellness.
Book your appointment through our secure self-scheduling system:
Jeff Schnur, MSN, APRN, FNP-BC
Apex Coastal Wellness
Outlast the Day
References
Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. OUP Academic
Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med. 2023;389:107-117. New England Journal of Medicine
American Urological Association. Evaluation and Management of Testosterone Deficiency Guideline. American Urological Association
U.S. Food and Drug Administration. Testosterone Information. Updated 2026. U.S. Food and Drug Administration
U.S. Food and Drug Administration. FDA Issues Class-Wide Labeling Changes for Testosterone Products. 2025.
