Q. I would like to know more about the use of testosterone replacement in men. My understanding is that a recent large-scale study showed that men using testosterone replacement therapy did not have more cardiovascular risks. That’s been a long-running concern of the medical community. Am I correct?

A. The Food and Drug Administration is re-evaluating its position on testosterone replacement therapy. For years, the FDA has been adamant that testosterone use should be restricted to men who have a serious medical problem with the testes or the brain that interferes with testosterone production. A low level of testosterone by itself did not warrant a prescription.

In addition, the agency classifies testosterone as a controlled substance, CIII. Prescribers have to keep a Drug Enforcement Administration registration current, and testosterone must be kept under a double-lock system similar to that required for ketamine or codeine.

The FDA recently heard from an expert panel as it contemplates changes to these requirements. One speaker was among the researchers who conducted the study you have heard about, TRAVERSE.

This large randomized, placebo-controlled trial did not detect increased cardiovascular events in high-risk men on testosterone (New England Journal of Medicine, July 13, 2023). That finding has since been bolstered by the results of other studies (Andrology, May 2025).

Earlier this year, the FDA removed its boxed warning on cardiovascular risk from testosterone labels. Several panelists urged the FDA to allow doctors to prescribe testosterone for men who have naturally low testosterone.

The American Urological Association, for example, advises its members to test men’s testosterone levels, treat them if they are below 300 ng/dL, and monitor levels during treatment. In addition, this professional organization recommends that its doctors monitor serum luteinizing hormone, prolactin, and prostate specific antigen, PSA. It remains to be seen if the FDA will revise the prescribing information for testosterone and require similar advice to prescribers.

Q. I have been taking losartan for 25 years to control blood pressure. Recently, I developed a hand tremor, so my doctor prescribed a beta blocker to help with the tremor. Could long-term use of losartan have led to the tremor?

A. Prescribing information for losartan, a popular medication for high blood pressure, does not warn of tremor as a side effect. We found one case report in the medical literature, but that man developed the problem early in treatment (Cureus, Dec. 13, 2019).

The most prescribed blood pressure medicine in the U.S. is lisinopril. Like losartan, it acts on the Renin-Angiotensin system to relax blood vessels and lower blood pressure. We have received a number of reports from people who have experienced hand tremor associated with lisinopril.

One reader wrote: “I have been taking lisinopril for the last six months and started having hand tremors. They are most noticeable when I pick up something like a cup of coffee or a glass of water. It’s very uncomfortable and annoying. I mentioned this to my doctor, but he completely ignored me.”

You don’t say if you are still taking losartan. If you and your doctor will be considering a different antihypertensive drug, you may want to read our “eGuide to Blood Pressure Solutions.” This online resource is located under the Health eGuides tab at www.PeoplesPharmacy.com.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 300 W. 57th Street, 41st Floor, New York, NY 10019, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”