Testosterone Therapy and Cardiovascular Risk: A Critical Analysis of Studies Reporting Increased Risk

Khera, Mohit; Miner, Martin; Jaffe, Jonathan S.; Pastuszak, Alexander W.

doi:10.1016/j.jsxm.2020.10.019

Cited by 11 publications

(5 citation statements)

References 133 publications

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“…The association between TRT and cardiovascular (CV) risk remains one of the most conflicting issues of the topic. Limited data, mainly derived from pharmaco-epidemiological studies published in the last 10 years, have suggested a possible increased risk of CV mortality and morbidity during TRT, especially in aging and complicated patients (see above; [62,63].…”

Section: Evidencementioning

confidence: 99%

Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE)

Isidori

Aversa

Calogero

et al. 2022

J Endocrinol Invest

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Purpose To provide the evidence-based recommendations on the role of testosterone (T) on age-related symptoms and signs remains. Methods The Italian Society of Andrology and Sexual Medicine (SIAMS) and the and the Italian Society of Endocrinology (SIE) commissioned an expert task force to provide an updated guideline on adult-onset male hypogonadism. Derived recommendations were based on Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results Clinical diagnosis of adult-onset hypogonadism should be based on a combination of clinical and biochemical parameters. Testosterone replacement therapy (TRT) should be offered to all symptomatic subjects with hypogonadism after the exclusion of possible contraindications. T gels and the long-acting injectable T are currently available preparations showing the best efficacy/safety profile. TRT can improve all aspects of sexual function, although its effect is limited in more complicated patients. Body composition (reducing fat mass and increasing lean mass) is improved after TRT, either in subjects with or without metabolic syndrome or type 2 diabetes. Conversely, the role of TRT in improving glycometabolic control is more conflicting. TRT can result in increasing bone mineral density, particularly at lumbar site, but no information on fracture risk is available. Limited data support the use of TRT for improving other outcomes, including mood frailty and mobility. Conclusions TRT can improve sexual function and body composition particularly in less complicated adult and in aging subjects with hypogonadism. When hypogonadism is adequately diagnosed, T appropriately prescribed and subjects correctly followed up, no short-term increased risk of adverse events is observed. Longer and larger studies are advisable to better clarify TRT long-term efficacy/safety profile.

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Section: Evidencementioning

confidence: 99%

Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE)

Isidori

Aversa

Calogero

et al. 2022

J Endocrinol Invest

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“…Stagnant, the influences of progesterone on the CVD organism have been tiny revisions up to now. It has similarly been stated that reduced serum testosterone concentrations are linked with elevation of the occurrence of CVD in men 33 . Progesterone acts as a chief part in CV and central nervous systems and influences mammary gland growth 34 .…”

Section: Resultsmentioning

confidence: 94%

Analysis of Adipokines and some Steroid Hormones in Myocardial Infarction

Yousif

Ismail

2023

Baghdad Sci.J

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The most common cause of death is cardiovascular disease (CVD), with ischemic heart disease being the most notable type. There is a propensity to raise the sensitivity of methods in contemporary laboratory for diagnosing of CVD, and assessing key as CVD bio-indicators. The urgent task is to seek for different indicators as a hopeful tool for early detection and monitoring of myocardial infarction in blood samples only. This study comprised 117 Volunteers, recorded with both genders in the age range of 32-64 years old. The volunteers were categorized into two groups: 67patients of myocardial infarction, other group embraced 50 healthy individuals. The samples of blood were collected and directed for biochemical analysis to evaluate estradiol, testosterone, progesterone, adiponectin, leptin, and lipid profile [total cholesterol, triglycerides, high density lipoprotein (HDL), and low-density lipoprotein (LDL)] levels in each group. The following conclusion can be drawn from this study based on statistical assessment of bio-indicator parameters, significantly reduced of testosterone and HDL (P <0.001) levels in myocardial infarction, within non-significantly elevated P <0.061 of progesterone levels in myocardial infarction patients as compared with healthy individuals. The remaining biochemical tests indicated significantly elevated levels in patients with myocardial infarction such as estradiol (P <0.001), adiponectin (P <0.001), leptin (P <0.001), total cholesterol (P <0.001), triglycerides (P <0.001) and LDL (P <0.001) levels. Adipokines (adiponectin, leptin) and some steroid hormones (estradiol, testosterone) show crucial roles in the improvement of metabolic and cardiovascular diseases and may be utilized as bio-pointer for myocardial infarction exposure, medical conduct and severity. This acknowledgment offers early diagnosis of disease and progression.

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“…For example, while some previous research has suggested that testosterone-replacement therapy increases the risk of cardiovascular disease, many of these studies were underpowered or not specifically designed to address this question [ 42 ]. Separate studies have found no impact of testosterone supplementation on cardiovascular disease [ 21 ], or even a protective effect for hypogonadal men [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Lower testosterone levels are associated with higher risk of death in men

Muehlenbein

Gassen

Shattuck

et al. 2022

Evolution, Medicine, and Public Health

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Background and Objectives Testosterone plays an important role in regulating male development, reproduction, and health. Declining levels across the lifespan may reflect, or even contribute to, chronic disease and mortality in men. Methodology Relationships between testosterone levels and male mortality were analyzed using data from multiple samples of the cross-sectional National Health and Nutrition Examination Survey (n = 10,225). Target outcomes included known deaths from heart disease, malignant neoplasms, chronic lower respiratory diseases, cerebrovascular diseases, Alzheimer’s disease, diabetes mellitus, influenza and pneumonia, kidney diseases, and accidents or unintentional injuries. Results Results of discrete time hazard models revealed that lower levels of testosterone were related to higher mortality for the majority of disease categories in either an age-dependent or age-independent fashion. Analysis of all-cause mortality—which included deaths from any known disease—also revealed greater general risk for those with lower testosterone levels. For most disease categories, the hazard associated with low testosterone was especially evident at older ages when mortality from that particular ailment was already elevated. Notably, testosterone levels were not related to mortality risk for deaths unrelated to chronic disease (i.e., accidents and injuries). Conclusions and Implications While the causal direction of relationships between testosterone and mortality risk remains unclear, these results may reflect the decline in testosterone that accompanies many disease states. Accordingly, the relationship between testosterone and male mortality may be indirect; ill individuals are expected to have both lower testosterone and higher mortality risk.

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Testosterone Therapy and Cardiovascular Risk: A Critical Analysis of Studies Reporting Increased Risk

Cited by 11 publications

References 133 publications

Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE)

Adult- and late-onset male hypogonadism: the clinical practice guidelines of the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE)

Analysis of Adipokines and some Steroid Hormones in Myocardial Infarction

Lower testosterone levels are associated with higher risk of death in men

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