The Role of Testosterone Therapy in Cardiovascular Mortality: Culprit or Innocent Bystander?

Abstract

Testosterone therapy is recommended for men with symptomatic androgen deficiency and unequivocally low testosterone levels. Although the prevalence of hypogonadism seems relatively constant, studies of prescribing patterns in both the United States and the United Kingdom show a dramatic increase in testosterone prescription in recent years, possibly due to increased marketing and inappropriate therapy. Concurrent with this, there has been growing concern regarding the potential adverse effects of testosterone therapy, particularly its cardiovascular risks. In this review, we present our current understanding of the implications of testosterone deficiency, as well as the conflicting evidence surrounding the cardiovascular effects of testosterone replacement therapy. Although there is a lack of adequate data, based on the current evidence, we conclude that testosterone therapy can be safely considered in men with appropriately diagnosed clinical androgen deficiency and increased cardiovascular risk after a thorough discussion of potential risks and with guideline recommended safety monitoring.

MR spectroscopy of hepatic fat and adiponectin and leptin levels during testosterone therapy in type 2 diabetes: a randomized, double-blinded, placebo-controlled trial

“…The safety of long-term testosterone replacement therapy (TRT) has not been clarified regarding the risk of cardiovascular disease (CVD) (1,2,3). Nonetheless, the usage of TRT has escalated in the Western countries during the past decades especially in ageing men without clear organic indication for TRT (4).…”

The impact of hypotestosteronemia on cardiometabolic effects of atorvastatin in men with hypercholesterolemia: a pilot study

“…Similar to low testosterone levels predicting increased all-cause and cardiovascular mortality, some retrospective studies and randomized trials suggest that testosterone replacement therapy may increase the risk of cardiovascular disease [30,31]. The lack of on-treatment testosterone levels in participants of these studies does not allow to exclude either inadequacy of treatment or supraphysiological testosterone levels.…”