Controversial Effects of Exogenous Testosterone on Cardiovascular Diseases

Abstract

The use of testosterone (T) among men aged 40 years or older was increased more than 3 times from 0.81% in 2001 to 2.91% in 2011. Until recently, the majority of the studies did not show any increased cardiovascular (CV) risk by using T in male patients with hypogonadism. What is more, some studies had observed a protective effect of using T against CV diseases. However, in 2010, a randomized clinical trial (RCT) was intended to study the advantage of T gel in older men with limitations in mobility; the study was stopped due to unexpected high prevalence of CV adverse outcome. These findings were confirmed by 2 other studies published in November of 2013 and January of 2014. Consequently, the Food and Drug Administration (FDA) had announced in January 2014 that it will reassess the safety of those treatments. Meanwhile, the agency had not reached to a definitive conclusion that FDA-approved testosterone therapy raises the risk of stroke, heart attack, or death. A report released in the broadcast of the NBC Nightly News in September of this year that the FDA says "there's little evidence that T boosting drugs taken by millions of American men are actually effective." NBC notes that the agency also pointed out that it was not convinced that they carry serious risk either. "The condition has been marketed as low 'T', and the medications are offered to help with low sex drive and fatigue among some men," notes NBC. The European Medicines Agency EMA's Pharmacovigilance Risk Assessment Committee has also responded to the concern of potential CV adverse outcomes associated with the use of T, and they have concluded in their October meeting of this year that the use of T in men who do not produce enough T raises the risk of heart diseases. In our review, we highlighted the association between exogenous T and major adverse CV outcomes. Additionally, we focused on the interplay between exogenous T and some endocrine abnormalities such as diabetes mellitus type 2, metabolic syndrome, dyslipidemia, and obesity.

Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk

“…As such, we examine the role of endogenous testosterone in patients without PrCa, the role of endogenous testosterone in PrCa patients, and the potential oncologic risks of exogenous testosterone from TRT in PrCa patients. Other aspects of TRT, including the potential benefits to hypogonadal men and risk of adverse cardiovascular effects are beyond the scope of our review and have been expertly reviewed elsewhere [Swerdloff and Wang, 2011;Spitzer et al 2013;Miner et al 2014;Al-Khazaali et al 2015;Morgentaler and Conners, 2015].…”

The Effects of Androgens on Cardiometabolic Syndrome: Current Therapeutic Concepts

“…57 In contrast to previous studies, some issues have raised concerning the cardiovascular safety of exogenous T therapy, especially in older men. 58 ADT is frequently used in the combination method for the therapy of prostate cancer and then can raise mortality from cardiovascular events. It was suggested that cardiometabolic risk due to ADT can be decreased by diet and lifestyle modification.…”

Preventive Effects of Aspirin on Cardiovascular Complications in Prostate Cancer Cases after Endocrinotherapy

“…However, with endocrinotherapy being used extensively, relevant side effects are also paid more attention by clinicians gradually. Endocrinotherapy can induce a serious of metabolic changes, such as obesity, hypertension, atherosclerosis, type 2 diabetes mellitus and osteoporosis (Al-Khazaali et al, 2015), in which the perniciousness of cardiovascular disease is the most serious. This study compared and analyzed the changes of blood indexes in patients with prostate cancer before and after treatment as well as incidence of cardiovascular disease in order to investigate whether aspirin could prevent the occurrence of cardiovascular disease in prostate cancer after endocrinotherapy, hoping to provide a certain evidences for clinical administration.…”