What are the treatment options for older men with testosterone deficiency and hypogonadism?

Updated: Apr 03, 2019
  • Author: Maria G Vogiatzi, MD; Chief Editor: George T Griffing, MD  more...
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Answer

For older men with testosterone deficiency, a review by the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) found that the evidence concerning the risk of serious cardiovascular side effects from the use of testosterone in men with hypogonadism was inconsistent. [12, 13] The PRAC determined that the benefits of testosterone outweigh its risks but stressed that testosterone-containing medicines should be used only when lack of testosterone has been confirmed by signs and symptoms, as well as by laboratory tests. However, a literature review by Albert and Morley indicated that testosterone supplementation in males aged 65 years or older may increase the risk of cardiovascular events, particularly during the first year of treatment, although intramuscular testosterone seemed to carry less risk than other forms. [14]

On the other hand, a study by Traish et al suggested that long-term testosterone therapy in men with hypogonadism significantly reduces cardiovascular disease–related mortality. Patients in the study’s testosterone-treated group (n=360) underwent therapy for up to 10 years, with median follow-up being 7 years. The investigators found no cardiovascular event–related deaths in the treated patients, compared with 19 such deaths in the group that received no testosterone therapy (n=296). According to the study, mortality in the testosterone-treated patients was reduced by an estimated 66-92%. [15]


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