The effect of statins on testosterone in men and women, a systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundStatins are extensively used for cardiovascular disease prevention. Statins reduce mortality rates more than other lipid-modulating drugs, although evidence from randomized controlled trials also suggests that statins unexpectedly increase the risk of diabetes and improve immune function. Physiologically, statins would be expected to lower androgens because statins inhibit production of the substrate for the local synthesis of androgens and statins' pleiotropic effects are somewhat similar to the physiological effects of lowering testosterone, so we hypothesized that statins lower testosterone.MethodsA meta-analysis of placebo-controlled randomized trials of statins to test the a priori hypothesis that statins lower testosterone. We searched the PubMed, Medline and ISI Web of Science databases until the end of 2011, using '(Testosterone OR androgen) AND (CS-514 OR statin OR simvastatin OR atorvastatin OR fluvastatin OR lovastatin OR rosuvastatin OR pravastatin)' restricted to randomized controlled trials in English, supplemented by a bibliographic search. We included studies with durations of 2+ weeks reporting changes in testosterone. Two reviewers independently searched, selected and assessed study quality. Two statisticians independently abstracted and analyzed data, using random or fixed effects models, as appropriate, with inverse variance weighting.ResultsOf the 29 studies identified 11 were eligible. In 5 homogenous trials of 501 men, mainly middle aged with hypercholesterolemia, statins lowered testosterone by -0.66 nmol/l (95% confidence interval (CI) -0.14 to -1.18). In 6 heterogeneous trials of 368 young women with polycystic ovary syndrome, statins lowered testosterone by -0.40 nmol/l (95% CI -0.05 to -0.75). Overall statins lowered testosterone by -0.44 nmol/l (95% CI -0.75 to -0.13).ConclusionsStatins may partially operate by lowering testosterone. Whether this is a detrimental side effect or mode of action warrants investigation given the potential implications for drug development and prevention of non-communicable chronic diseases.See commentary article here http://www.biomedcentral.com/1741-7015/11/58

Recommendations on the diagnosis, treatment and monitoring of late-onset hypogonadism in men – a suggested update

“…This finding has now been corroborated by numerous subsequent studies [52]. It has also been reported that statins may reduce TT [53].…”

Terapia z wykorzystaniem statyn a stężenie testosteronu u mężczyzn

“…A meta-analysis of five studies in men and six studies in women with polycystic ovary syndrome (PCOS) conducted by Schooling et al confirmed the hypothesis that testosterone levels in men decreased as a result of treatment with statins [14]. The results of the studies included in the meta-analysis were congruent.…”

Testosterone deficiency in the aging male

“…Increasingly common, opioid analgesics can suppress the HPG axis centrally and peripherally, but the effects are short lived depending upon the half-life of agent used [Rajagopal et al 2004;Katz and Mazer, 2009]. Commonly used antihypertensive (β-blockers) and anticholesterol (statins) medications can induce mild to moderate reductions in serum testosterone levels [Rosen et al 1988;Schooling et al 2013]. Whether the medication, underlying medical condition, or both are at fault is unclear, but TD and comorbid medical conditions, and associated treatments can lead to a self-reinforcing cycle and development of TD symptoms.…”