Testosterone Therapy: Scant Evidence of Benefit in CVD Risk

Although there is some evidence that low endogenous testosterone levels may be linked to cardiovascular risk, a review of the last 43 years of literature finds scant definitive evidence that testosterone supplementation affects that risk.

Johannes B. Ruige, MD, PhD, from the Department of Endocrinology, Ghent University Hospital, Belgium, and colleagues. report their findings in an article published online September 24 in the Journal of Clinical Endocrinology & Metabolism.

Widespread use of testosterone replacement therapy, especially in aging men, needs to be supported by a clear understanding regarding the effects of that hormone on the cardiovascular system, they note.

Therefore, Dr. Ruige and colleagues searched PubMed from 1970 through 2013, using a variety of terms relating to androgens and cardiovascular disease. They identified 19 prospective observational studies on endogenous testosterone and the incidence of cardiovascular disease in otherwise healthy men, as well as 10 randomized, double-blind, placebo-controlled trials, each of which included more than 100 men.

"On the one hand, a modest association is suggested between low endogenous T and incident cardiovascular disease or cardiovascular mortality, implying unrecognized beneficial T effects, residual confounding, or a relationship with health status," they write. "On the other hand, treatments with T to restore 'normal concentrations' have so far not been proven to be beneficial with respect to cardiovascular disease; neither have they definitely shown specific adverse cardiovascular effects."

At least for the time being, they say, the cardiovascular risk-vs-benefit of testosterone replacement therapy remains an open question.

"The important knowledge gap as to the exact relationship between T and cardiovascular disease would support a cautious, restrained approach to T therapy in aging men, pending clarification of benefits and risks by adequately powered clinical trials of sufficient duration," they conclude.

The authors have disclosed no relevant financial relationships.

J Endocrinol Metabol. Published online September 24, 2013. Abstract

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