Testosterone Replacement Shows CV Benefit in Hypogonadal Men

Neil Osterweil

July 12, 2021

Data from a long-term study suggest that testosterone replacement therapy (TRT) for men with hypogonadism may reduce the risk for major adverse cardiovascular events (MACE). Previous studies have yielded conflicting results on whether there is a benefit.

The latest results come from a study of 805 men with hypogonadism from Germany and Qatar who were followed for nearly a decade. For those who received parenteral testosterone 1000 mg every 12 weeks, there were improvements in classical cardiovascular risk factors, such as obesity, lipid level, and inflammatory markers, whereas among those who chose not to take testosterone (control patients), all of these factors worsened.

In addition, there were only 16 deaths among patients in the TRT group, and none of the deaths were from myocardial infarction (MI) or stroke.

In contrast, there were 74 deaths among the control patients, as well as 70 cases of MI and 59 strokes.

The men in the study were all at relatively high risk for cardiovascular adverse events. In the TRT group, the mean Framingham Risk score was 15.5; in the control group, it was 15.8. This translates into mean 10-year risks of 22.7% and 23.5%, respectively.

"Given that all these men would normally have been expected to suffer a heart attack or stroke in the next 5 to 10 years with no other intervention, it was a real surprise to see no cardiovascular events at all in the group on testosterone therapy. It's clear that this treatment can significantly reduce the risks in this particular group," commented lead investigator Omar Aboumarzouk, MD, from the Hamad Medical Corporation, in Doha, Qatar.

He presented the new data at the European Association of Urology 2021 Annual Meeting (EAU 2021).

Aboumarzouk emphasized, however, that "while men need testosterone for certain psychological and biological functions, only those with low levels who display other symptoms are likely to benefit from testosterone therapy."

Maarten Albersen, MD, a urologist at the University of Leuven, in Leuven, Belgium, who was not involved in the study, noted that although the study showed a reduction in MACE and mortality among the men who received TRT, the risk scores were in the intermediate range, and the men in the TRT group were slightly younger and were at slightly lower risk at baseline.

"The study was long enough to see differences in the rate of cardiovascular events. However, the numbers involved and the fact that the trial was not randomized mean it's still difficult to draw any hard conclusions," he said.

Registry Study

The data came from a cumulative registry study begun in 2004 to assess the long-term efficacy and safety of TRT every 3 months in men with hypogonadism. The study, conducted in Bremen, Dresden, in Muenster, Germany, and in Doha, Qatar, is ongoing.

At total of 805 men were enrolled; 412 received TRT, and 393 declined testosterone replacement and served as control patients.

The investigators reported 10-year data. Statistical models controlled for age, body mass index, smoking, alcohol, total and high-density lipoprotein cholesterol level, systolic blood pressure, and type 2 diabetes.

The median age at baseline was lower among those in the TRT arm, at 57.7 years, vs 63.7 years for control patients (P < .001).

All classical cardiovascular risk factors, including obesity, glycemic control, lipid pattern, and C-reactive protein, improved in the TRT group and worsened in the control group.

Albersen noted that "a new trial is now underway, aiming to recruit 6000 participants, and this should provide definitive answers on the cardiovascular risks or even benefits of hormone therapy in men with low testosterone."

No funding source for the study was reported. Aboumarzouk and Albersen have disclosed no relevant financial relationships.

European Association of Urology 2021 Annual Meeting (EAU 2021): Abstract PO532. Presented July 10, 2021.

Neil Osterweil, an award-winning medical journalist, is a long-standing and frequent contributor to Medscape.

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