Knowledge is Power

Testosterone and Cardiovascular Health: Safety of Treatment of Hypogonadism

INTRODUCTION

Controversy has arisen over the issue of the cardiovascular safety of testosterone.

AIM

The aim of this article is to examine the evidence as to the cardiovascular safety involved with the administration of testosterone.

METHODS

A literature review was performed with regard to cardiovascular safety of testosterone.

MAIN OUTCOME MEASURE

The main outcome measure was to evaluate the available evidence as to cardiovascular safety and risk of testosterone.

RESULTS

A handful of recently published and widely discussed manuscripts have suggested that administration of testosterone replacement therapy increases the frequency of adverse cardiovascular events. In contrast, there have been recent clinical reports suggesting that testosterone is either safe or actually reduces cardiovascular events and mortality. All of these studies-both those suggesting that testosterone has adverse effects, as well as those suggesting it has positive effects on the cardiovascular system-have limitations.

CONCLUSION

What is missing is a large, long-term, prospective, placebo controlled, double blind trial in which hypogonadal men receive either testosterone or placebo, testosterone levels are carefully monitored, and the primary outcomes are well-defined major adverse cardiovascular/cerebrovascular events. Kloner RA. Testosterone and cardiovascular health: Safety of treatment of hypogonadism. Sex Med Rev 2015;3:56-62.

Outcomes of testosterone therapy in men with testosterone deficiency (TD): part II

Testosterone (T) deficiency (TD) is a common clinical condition, which contributes to co-morbidities including loss of muscle mass, increased fat mass, increased inflammation, insulin resistance, risk of vascular disease, sexual dysfunction, fatigue, depressed mood and reduced quality of life. T therapy attenuates inflammation, increases insulin sensitivity, muscle mass and reduces fat mass and adiposity. T therapy improves lipid profiles and endothelial function and reduces systolic and diastolic blood pressure. In addition, T therapy may reduce risk of vascular disease and mortality. T therapy improves bone mineral density and increases energy and vitality and improves mood and sexual function and overall quality of life. T therapy appears to be safe if treatment and monitoring are appropriately executed. The evidence available to date does not support alleged concerns regarding risk of cardiovascular disease and prostate cancer. Indeed, T therapy remains controversial. The data in the contemporary literature suggest that T therapy reduces cardiovascular risk and fears promoted by some recent studies should be re-evaluated. The cardiovascular risk and mortality with T therapy must await large prospective controlled clinical trials, which depend on many complex factors. Such studies may be prohibitive in the current environment due to logistical challenges, such as recruiting large number of men to be treated for long-durations with appropriate follow-up, requiring astronomical cost.