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8 August 2012

In a retrospective observational cohort study testosterone therapy was associated with decreased mortality in men with low testosterone levels compared with no testosterone treatment

Testosterone Treatment and Mortality in Men with Low Testosterone Levels. Shores MM, Smith NL, Forsberg CW, et al. Testosterone. J Clin Endocrinol Metab 2012; Published ahead of print April 11, 2012; doi:10.1210/jc.2011-2591.

This observational, retrospective cohort study based on a clinical database that included seven Veteran Affairs medical centres in the US was the first to examine the association between testosterone treatment and mortality in men with low testosterone levels. Mortality was compared in testosterone-treated compared with untreated hypogonadal men, using appropriate statistical models adjusted for age, diabetes and coronary heart disease. Testosterone formulations included intramuscular injections (88.6%), patch (9.1%) or gel (2.3%). The cohort included 1031 men aged >40 (mean 62) years with low total testosterone levels ≤8.7 nmol/L (250 ng/dL) at study entry, no history of prostate cancer, who were assessed in 2001–2002 and followed-up until the end of 2005 (mean follow-up time 40.5 months).

Mean body mass index (BMI) was 32.0 kg/m2, and mean total testosterone level was 6.3 nmol/L (181 ng/dL). There was a high degree of medical comorbidity in the cohort; a mean of 6.7 pharmacologically-treated medical conditions, including diabetes (38%), sexual dysfunction (36%) and coronary heart disease (21%). There was an association between lower testosterone levels and higher medical comorbidity (p=0.037).

Key Points

  • Testosterone (T) replacement therapy was started in 39% of 1031 men with low testosterone levels [≤8.7 nmol/L (250 ng/dL)] during routine clinical care at 7 Veteran Affairs medical centres in the US
  • After a mean follow-up of 40.5 months, overall mortality in T-treated men was 10.3%, compared with 20.7% for untreated men (p<0.001)
  • The mortality rate was 3.4 deaths/100 person-years in T-treated men, compared with 5.7/100 person years in untreated men
  • T-treated men had longer a survival time than untreated men (p=0.029)
  • There was a 39% reduction in mortality risk for T-treated compared with untreated men when data were adjusted for age, treatment site, BMI, baseline testosterone level, overall medical morbidity, hospitalisation, and for the presence of coronary heart disease and diabetes mellitus
  • T treatment appeared to be associated with greater mortality reduction in younger men (age <60 years), diabetic men and men without coronary heart disease
  • During the retrospective observational study, 1.6% of T-treated men and 2.0% of untreated men were diagnosed with incident prostate cancer (p=0.68).

11 March 2011

Low testosterone is common in men with coronary heart disease and negatively impacts survival

Man clutching his chest

Low serum testosterone and increased mortality in men with coronary heart disease. Malkin CJ, Pugh PJ, Morris PD, et al. Heart 2010;96(22):1821-1825.

A total of 930 men (mean age 61 years) were followed in a prospective cohort study for a mean of 6.9 years to determine the prevalence of testosterone deficiency and to investigate the effect of serum testosterone levels on survival in men with confirmed coronary disease.1 The cohort was a consecutive series of men referred to a tertiary cardiothoracic centre for diagnostic coronary angiography between June 2000 and June 2002. Significant coronary artery disease was defined as 70% or greater stenosis in any epicardial coronary artery or 50% or greater stenosis of the main stem of the left coronary artery.

Key Points

  • 20.9% of men had biochemical testosterone deficiency defined as bioavailable testosterone <2.6 nmol/L, 16.91% using testosterone <8.1 nmol/L and 24% using either
  • There was excess mortality in testosterone-deficient men; 21% versus 12% in those with testosterone levels in the normal range (>2.6 nmol/L), p=0.002 (Figure 1)
  • Low serum testosterone was one of only four variables found to influence the time to all-cause mortality in multivariate analysis (hazard ratio [HR] 2.27)
  • The other variables significantly influencing time to all-cause mortality were presence of left ventricular dysfunction (HR 3.85), aspirin therapy (HR 0.63) and β-blocker therapy (HR 0.45)
  • Low bioavailable testosterone more than doubled adjusted all-cause and vascular mortality (HR 2.2, p<0.0001 for all-cause mortality and HR 2.2, p=0.007 for vascular mortality) compared with those with normal levels of testosterone
  • Overall, serum total testosterone was inversely associated with mortality (HR 0.96), with a baseline level of <15.1 nmol/L associated with an all-cause HR of 1.86 and vascular mortality with a HR of 2.5.

11 March 2011

Low testosterone is common in men with cardiovascular disease and decreases

A study in the United Kingdom observed 930 men with confirmed coronary artery disease over an average of nearly 7 years to find out how many had testosterone deficiency and to examine whether low testosterone affected survival.

Last updated: 2019