Testosterone Treatment & Cardiovascular Risk

July 25, 2019

Men's Health

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If you’ve been contemplating taking testosterone to address symptoms associated with aging, or if your doctor has prescribed the hormone therapy to treat a disorder of the pituitary gland, brain, or testicles, you should be aware there appears to be a link between testosterone treatment and cardiovascular risk. However, all the evidence isn’t in yet.

Before we look at testosterone treatment and cardiovascular risks, you need to ask yourself—and your doctor–an important question.

Do you really need testosterone treatment?

The media has struck a chord with many men when it talks about how declining testosterone levels can be responsible for their lack of energy, increasing waistlines, loss of muscle tone and strength, lackluster libido, and depression. The so-called answer to these age-associated symptoms? Testosterone therapy.

However, this is not the approved use for testosterone therapy. The therapy has been sanctioned only for men with diagnosed hypogonadism, which is an extremely low T level caused by a disorder affecting the brain, pituitary gland, or testicles. This can include failure of the testicles to manufacture testosterone because of damage from infection or chemotherapy or because of genetic disorders.

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Taking testosterone treatment for conditions other than those approved by the FDA is highly discouraged.

Men who want to help boost their testosterone levels naturally can adopt lifestyle changes and consider other nonpharmaceutical approaches.

Testosterone treatment and cardiovascular risk

Shortly after interest in using testosterone treatment to modify aging symptoms first became popular about a decade ago, researchers began to explore the possible risks of using this hormone for unapproved reasons. The findings over the years have been mixed. However, they were serious enough for the Food and Drug Administration to require that the makers of all approved prescription testosterone products change their labels to note a possible increased risk of experiencing a heart attack or stroke when taking the hormone.

In a 2018 study appearing in the Asian Journal of Andrology, the authors point out that for now, clinicians must make their decisions about testosterone therapy based on current scientific data. Based on their review, use of testosterone replacement therapy doesn’t cause a marked increase in cardiovascular disease risk. However, men who already have cerebrovascular or atherosclerotic coronary disease should exercise caution and carefully weigh the pros and cons of treatment.

In a subsequent article authored by experts at Harvard Medical School, the authors stated that although some randomized trial and retrospective study results have indicated that testosterone treatment increases the risk of cardiovascular disease, “no trials of testosterone replacement therapy published to date were designed or adequately powered to assess cardiovascular events; therefore, the cardiovascular safety of this therapy remains unclear.”

Bottom line

When it comes to testosterone treatment and cardiovascular risk, we still don’t have all the answers. Currently there is an FDA-mandated trial underway that is evaluating the cardiovascular risks associated with use of testosterone in middle-aged and older men who have a deficiency of the hormone. Information from that trial and others may better us understand the relationship between testosterone treatment and cardiovascular risk.

References

Anawalt BD, Yeap BB. Conclusions about testosterone therapy and cardiovascular risk. Asian Journal of Andrology 2018 Mar-Apr; 20(2): 152-53

Food and Drug Administration. FDA drug safety communication; FDA cautions about using testosterone products for low testosterone due to aging. 2018 Feb 26

Gagliano-Juca T, Basaria S. Testosterone replacement therapy and cardiovascular risk. National Reviews, Cardiology 2019 May 23

Harvard Medical School. Sex hormones and your heart. 2019 May

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