Is Testosterone Therapy Actually Bad for Your Heart — Or Have We Been Misled?

In 2013 and 2014, two studies made major headlines claiming that testosterone therapy raised the risk of heart attacks and strokes in men. Doctors stopped prescribing it, patients stopped taking it, and lawyers started filing lawsuits. But here's what most people didn't hear: one of those studies had serious math errors — including accidentally including women in an all-male study — and 29 medical organizations from around the world demanded it be retracted.

This review looked at decades of research on testosterone and heart health. What the evidence actually shows is the opposite of what those scary headlines said: men with low testosterone are the ones at higher risk — for heart disease, diabetes, obesity, and even early death. In fact, two large studies found that men with low testosterone who received therapy cut their risk of dying in half compared to those who went untreated.

Testosterone therapy was also shown to reduce body fat, shrink waist size, improve blood sugar control, and even help men with heart failure exercise better. The largest review of 75 studies found no increased heart risk from testosterone — and actually found protective benefits in men with metabolic problems like diabetes and obesity. No study found that testosterone made any of these conditions worse.

The bottom line: there is no strong, reliable evidence that testosterone therapy, when used, appropriately harms the heart — and a large body of research suggests it may actually help protect it. This matters because millions of men with low testosterone go untreated every year, possibly at a real cost to their health. The authors urge doctors and patients not to let flawed, sensational studies get in the way of a treatment that the science, taken as a whole, continues to support.

Millions of women take D-mannose to prevent repeat urinary tract infections — but a major new study says it may not be doing anything at all.

D-mannose is a natural sugar sold as a supplement, and many women with recurrent UTIs (defined as 2 or more in 6 months, or 3 or more in a year) have turned to it as a safer alternative to long-term antibiotics. To find out if it actually works, in this study, researchers ran a large, high-quality study across 99 clinics in the UK, involving almost 600 women ages 18 to 93. Half took 2 grams of D-mannose powder daily for 6 months, and the other half took a placebo (a harmless look-alike powder). Neither the women nor their doctors knew who was taking which.

The results were disappointing. About 51% of women taking D-mannose still got another UTI bad enough to seek medical care. In the placebo group, it was 55.7%. That small difference of about 5% was not statistically meaningful, meaning it could easily be due to chance. There were also no differences in how long symptoms lasted, how many UTIs each woman had, how often antibiotics were needed, or how many women ended up in the hospital.

What makes this study stand out is its rigor. Unlike earlier studies that seemed to show D-mannose working, those did not use a placebo group — meaning the improvement may have simply been from paying more attention to patients, not from the supplement itself. This well-designed trial fills that gap, and the answer is clear: D-mannose did not work better than a sugar powder with no active ingredient.

The takeaway is simple but important: D-mannose should not be recommended to prevent recurrent UTIs, especially in everyday (primary care) settings. It's also not cheap — costing around $29 or more per month — making it a costly option with no proven benefit. Researchers are now looking into newer approaches, including experimental vaccines and more powerful compounds, which may offer real hope in the future.

This week, someone asked me, “Hi Dr. Malik, My husband has been facing delayed ejaculation for 3 years now. He’s able to ejaculate only when he masturbates but even that doesn’t help recently. He hasn’t been able to ejaculate at all for 3 months now. This is something that has seriously affected on his self confidence. It started all of a sudden, not from certain way of masturbation. Please help us with recommendations. Thank”. Delayed ejaculation can deeply affect confidence and intimacy, especially when it seems to happen suddenly. There are many possible causes, including medications (especially antidepressants), diabetes, low testosterone, nerve changes, stress, anxiety, or changes in brain stimulation and arousal pathways. The fact that he now cannot ejaculate even during masturbation suggests it’s important for him to have a full evaluation with a urologist or sexual medicine specialist. There are treatments available (mostly off-label) that can absolutely help men improve time to ejaculation.

I love hearing from you, so if there’s a question you’ve been wanting to ask, just let me know. Who knows? Your question might be the one I dive into next!

This week I’m going to share some personal news. I’ve unfortunately been diagnosed with breast cancer. I’m undergoing surgery this week and will share more throughout my journey. As far as I know now, it is small and we will know more about what to expect after it’s removed and analyzed by pathology.

There will still be lots of content for you to learn from as I recover (I pre-planned). If you want to support, the best way to do so is continue engaging with my content or if you have any interest consider pre-ordering my book The Hard Truth for yourself or bulk order for your friends, family, organizations or employees. If you are interested in a bulk order, we can organize mailing it to each individual on your list - just reply directly to this newsletter for more information!

I just shared some surprising insights about how intense training affects men’s bodies in ways most people don’t realize—especially when it comes to leakage and pelvic health. "The more intensely and more frequently you train, the higher risk of urinary symptoms or leakage."

Here are some quick takeaways

If you’re experiencing any leaking during exercise, remember: "It’s not something you have to push through or live with. It can be fixed." Get checked out and pay attention to your pelvic floor just like any other muscle!

Check out the full episode for more on how to keep your body performing at its best.

I just had such an eye-opening chat with Dr. Maria Sophocles about long-term intimacy and keeping passion alive—even when life gets busy, or desire disappears. She shared this gem: “We have a culture of productivity over pleasure. We prioritize productivity over pleasure.”

Dr. Sophocles unpacks why communication, redefining sex, and trying new things together matter so much. Some super quick takeaways:

If you’ve ever wondered how to restart intimacy, or why sex feels tough to talk about, you’ll love this episode! So listen on Apple Podcasts, Spotify, or here and see why people are commenting, “Good info. As an 80 year old man who hasn't had sex in way too long but finally in a relationship where that appears likely to change, definitely good stuff to help us both enjoy each other sexually and intimately”.

Can treating erectile dysfunction actually save lives? Check out my new Substack: Can Treating Erectile Dysfunction Save Lives? The Overlooked Link to Men’s Mental Health.

In this article, I explore the surprising research linking erectile dysfunction treatment to improved mental health and lower suicide rates—plus why sexual health is deeply connected to confidence, relationships, and overall wellbeing.