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1 May 2015

Testosterone, Cardiovascular Risk, Mortality and Longevity

Testosterone, Cardiovascular Risk, Mortality and Longevity

Testosterone Therapy and Cardiovascular Risk: Advances and Controversies. Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Mayo Clin. Proc. 2015;90(2):224-251.

Testosterone and mortality. Muraleedharan V, Jones TH. Clin. Endocrinol. (Oxf). 2014;81(4):477-487.

One of the most debated issues related to testosterone replacement therapy is its effects on cardiovascular risk and clinical events, like for example heart attack. A few flawed studies over the past years made it appear that testosterone replacement therapy increases cardiovascular risk and incidence of heart attacks. However, less known is the vast and rapidly accumulating body of evidence showing the contrary; that higher testosterone levels and testosterone replacement therapy actually may reduce mortality and increase longevity.

This editorial summarises key conclusions from a special medical review article on testosterone and cardiovascular risk, written by the Androgen Study Group, as provides answers to the following two questions:

  1. Is testosterone deficiency directly involved in the pathogenesis of these conditions or is it merely a biomarker of ill health and the severity of underlying disease processes?
  2. Does testosterone replacement therapy retard disease progression and ultimately enhance the clinical prognosis and survival?

1 January 2015

Testosterone-boosting Medications and Cardiovascular Risk

Testosterone-boosting Medications and Cardiovascular Risk

- a systematic review and meta-analysis

Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Corona G, Maseroli E, Rastrelli G, et al. Expert opinion on drug safety. Oct 2014;13(10):1327-1351.

Accumulating evidence shows beneficial effects of testosterone therapy on a wide range of health outcomes, including inflammation, insulin sensitivity, muscle mass, body fat mass, lipid profiles, endothelial function, bone mineral density, energy and vitality, mood, sexual function and overall quality of life. Despite this, concerns have been raised that testosterone therapy could have detrimental effects on cardiovascular disease.

This editorial summarizes results from a comprehensive systematic review and meta-analysis, the largest to date, of all placebo-controlled randomized clinical trials (RCTs) on the effect of testosterone therapy on cardiovascular-related problems.

Key Points

  • Meta-analysis of the largest number of studies collected so far, concludes that testosterone therapy is not related to any increase in cardiovascular risk, and that data do not support a causal role between testosterone therapy and cardiovascular events.
  • Testosterone therapy in hypogonadal men can be a valuable strategy to improve metabolic profile, reduce body fat and increase lean muscle mass, which would ultimately reduce the risk of heart disease.
  • The principal outcome of this analysis was the effect of testosterone therapy, as compared with placebo, on the incidence of new major adverse cardiovascular events (MACE). This was done to comply with requirements for drug safety assessment, as required by regulatory agencies.
  • In studies performed in subjects with metabolic derangements a protective effect of testosterone therapy on cardiovascular risk was observed.
  • No sponsorship bias was detected, because no difference in MACE risk was found when the analysis was performed according to the presence or absence of drug company financing.

1 January 2015

Testosterone-boosting Medications and Cardiovascular Risk

Testosterone-boosting Medications and Cardiovascular Risk

- a systematic review and meta-analysis

Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Corona G, Maseroli E, Rastrelli G, et al. Expert opinion on drug safety. Oct 2014;13(10):1327-1351.

Accumulating evidence shows beneficial effects of testosterone therapy on a wide range of health outcomes, including inflammation, insulin sensitivity, muscle mass, body fat mass, lipid profiles, endothelial (blood vessel) function, bone mineral density, energy and vitality, mood, sexual function and overall quality of life. Despite this, concerns have been raised that testosterone therapy could have detrimental effects on cardiovascular disease.

This editorial summarizes results from a comprehensive systematic review and meta-analysis, the largest to date, of all placebo-controlled randomized clinical trials (RCTs) on the effect of testosterone therapy on cardiovascular-related problems.

19 August 2014

Testosterone Treatment and Heart Attack Risk

Testosterone Treatment and Heart Attack Risk

- New study shows testosterone treatment can even be beneficial

Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy. Baillargeon, J., et al., Ann Pharmacother 1060028014539918, first published on July 2, 2014 as doi:10.1177/1060028014539918, 2014

Testosterone therapy has been in use for more than 70 years for the treatment of hypogonadism, also called testosterone deficiency. Over the past 30 years there has been a growing body of scientific research demonstrating that testosterone deficiency is associated with increased body weight/adiposity/waist circumference, insulin resistance, type 2 diabetes, hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased risk of mortality. In line with the detrimental health outcomes seen with testosterone deficiency, testosterone therapy has been shown to confer beneficial effects on multiple risk factors and risk biomarkers related to these clinical conditions.

Despite these well-documented health benefits, testosterone therapy is still controversial, in large part due to a few flawed studies about potential elevated heart attack risk with testosterone therapy. On July 2, 2014, a study was published which demonstrated that testosterone therapy is not associated with an increased risk of heart attack, and may actually confer protection against heart attack.

19 August 2014

Testosterone Treatment and Heart Attack Risk

Testosterone Treatment and Heart Attack Risk

- New study shows testosterone treatment can even be beneficial

Risk of Myocardial Infarction in Older Men Receiving Testosterone Therapy. Baillargeon, J., et al., Ann Pharmacother 1060028014539918, first published on July 2, 2014 as doi:10.1177/1060028014539918, 2014

Testosterone therapy has been in use for more than 70 years for the treatment of hypogonadism, also called testosterone deficiency. In the past 30 years there has been a growing body of scientific research demonstrating that testosterone deficiency is associated with increased body weight/adiposity/waist circumference, insulin resistance, type 2 diabetes, hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased risk of mortality. In line with the detrimental health outcomes seen with testosterone deficiency, testosterone therapy has been shown to confer beneficial effects on multiple risk factors and risk biomarkers related to these clinical conditions.

Despite these well-documented health benefits, testosterone therapy is still controversial, in large part due to a few flawed studies about potential elevated myocardial infarction (MI) risk with testosterone therapy. On July 2, 2014, a study was published which demonstrated that testosterone therapy is not associated with an increased risk of MI, and may actually confer protection against MI.



Key Points

  • Testosterone deficiency is associated with increased body weight/adiposity/waist circumference, insulin resistance, type 2 diabetes, hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased risk of mortality.
  • Testosterone therapy beneficially impacts multiple risk factors and risk biomarkers related to highly prevalent clinical conditions that are associated with testosterone deficiency.
  • The most recent study reported in this editorial demonstrates that testosterone therapy does not increase risk of MI, and that it actually may protect against MI in high-risk population. This is in line with a large body of research showing beneficial effects of testosterone therapy in hypogonadal men.
  • Three large meta-analyses specifically focusing on identifying potential adverse effects of testosterone treatment report no significant increases in cardiovascular risk.
  • A review of all testosterone trials up to 2012 found that testosterone therapy in patients with preexisting cardiovascular conditions, the effect on disease markers has typically been either neutral or beneficial, and does not increase the incidence of cardiovascular events.
Last updated: 2018
L.ZA.MKT.GM.10.2016.1381