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15 March 2015

Cardiovascular Risk and Elevation of Blood DHT Levels Vary by Testosterone Preparation

Cardiovascular Risk and Elevation of Blood DHT Levels Vary by Testosterone Preparation

Cardiovascular risks and elevation of blood DHT vary by route of testosterone administration: a systematic review and meta-analysis.
Borst SE, Shuster JJ, Zou B, et al. BMC medicine. 2014;12(1):211.

The cardiovascular effects of endogenous testosterone and testosterone replacement therapy are subject to intense investigation in medical research and have recently generated heated discussions among healthcare professionals.

While the main focus has been on testosterone per se, it is important to remember that testosterone is both a hormone in its own right, and a pro-hormone that gets converted to both estradiol and DHT (dihydrotestosterone), which exert effects themselves that are different from testosterone.

Therefore, when analyzing the effects of testosterone, especially exogenous testosterone administered as testosterone replacement therapy, it is critical to take into consideration how it affects downstream testosterone metabolites.

A recent systematic review and meta-analysis specifically investigated how different routes of testosterone replacement administration (i.e. different testosterone preparations) affect blood testosterone and DHT levels, and how this in turn relates to cardiovascular adverse events.

Key Points

  • Meta-analysis of 35 RCTs and more than 3,700 patients receiving testosterone replacement therapy shows no cardiovascular risk among studies of various testosterone replacement therapy administration routes.
  • When properly dosed, there is no significant difference in the elevation of blood testosterone between intramuscular or transdermal testosterone preparations.
  • Transdermal testosterone preparations elevate blood DHT to a greater magnitude than intramuscular testosterone preparations, 5.46-fold and 2.20-fold, respectively.
  • Too high blood DHT levels have been shown to be associated with cardiovascular risk in observational studies. The optimal range of DHT seems to be around 45-70 ng/dL.

15 March 2015

Cardiovascular Risk and Elevation of Blood DHT Levels Vary by Testosterone Preparation

Cardiovascular Risk and Elevation of Blood DHT Levels Vary by Testosterone Preparation

Cardiovascular risks and elevation of blood DHT vary by route of testosterone administration: a systematic review and meta-analysis.
Borst SE, Shuster JJ, Zou B, et al. BMC medicine. 2014;12(1):211.

The cardiovascular effects of endogenous testosterone and testosterone replacement therapy are subject to intense investigation in medical research and have recently generated heated discussions among healthcare professionals.

While the main focus has been on testosterone per se, it is important to remember that testosterone is both a hormone in its own right, and a pro-hormone that gets converted to both estradiol and DHT (dihydrotestosterone), which exert effects themselves that are different from testosterone.

Therefore, when analyzing the effects of testosterone, especially exogenous testosterone administered as testosterone replacement therapy, it is critical to take into consideration how it affects downstream testosterone metabolites.

A recent systematic review and meta-analysis specifically investigated how different routes of testosterone replacement administration (i.e. different testosterone preparations) affect blood testosterone and DHT levels, and how this in turn relates to cardiovascular adverse events.

Last updated: 2018
L.ZA.MKT.GM.10.2016.1381