Adverse effects of testosterone supplementation may include increased cardiovascular events (including strokes and heart attacks ) and deaths based on three peer-reviewed studies involving men taking testosterone replacement.  In addition, an increase of 30% in deaths and heart attacks in older men has been reported.  Due to an increased incidence of adverse cardiovascular events compared to a placebo group , a Testosterone in Older Men with Mobility Limitations (TOM) trial (a National Institute of Aging randomized trial) was halted early by the Data Safety and Monitoring Committee .  On January 31, 2014, reports of strokes , heart attacks , and deaths in men taking FDA-approved testosterone-replacement led the FDA to announce that it would be investigating the issue.  Later, in September 2014, the FDA announced, as a result of the "potential for adverse cardiovascular outcomes", a review of the appropriateness and safety of Testosterone Replacement Therapy (TRT).    The FDA now requires warnings in the drug labeling of all approved testosterone products regarding deep vein thrombosis and pulmonary embolism . 
It is suggested that bioavailable testosterone represents the fraction of circulating testosterone that readily enters cells and better reflects the bioactivity of testosterone than does the simple measurement of serum total testosterone. Also, varying levels of SHBG can result in inaccurate measurements of bioavailable testosterone. Decreased SHBG levels can be seen in obesity, hypothyroidism , androgen use, and nephritic syndrome (a form of kidney disease ). Increased levels are seen in cirrhosis , hyperthyroidism , and estrogen use. In these situations, measurement of free testosterone may be more useful.