The era of testosterone replacement got off on the wrong foot. In a 2013 VA study composed of 8709 men with low testosterone values, 19.9% of those not treated with replacement died after 3 years of follow-up versus 25.7% in the testosterone-replaced cohort.1 But, the cohort chosen was made up of men after they underwent coronary angiography. This was a “selective” group—already at higher risk for heart disease.
So, here are some key questions about the risks of testosterone therapy:
1. Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310:1829-1836.
2. Sharma R, Oni OA, Gupta K, et al. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J. 2015;36:2706-2715.
3. Kaplan AL, Hu JC. Use of testosterone replacement therapy in the United States and its effect on subsequent prostate cancer outcomes. Urology. 2013;82:321-326.
4. Dhindsa S, Prabhakar S, Sethi M, et al. Frequent occurrence of hypogonadotrophic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab. 2004;89:5462-5468.
5. Farias JM, Tinetti M, Khoury M, Umpierrez GE. Low testosterone concentration and atherosclerotic disease markers in male patients with type 2 diabetes. J Clin Endocrinol Metab. 2014;99:4698-4703.
6. Busko M, Vega CP. Erectile dysfunction drugs improve survival in diabetic men. July 29, 2015. Medscape Internal Medicine.
7. Costarella CE, Stallone JN, Rutecki GW, Whittier FC. Testosterone causes direct relaxation of rat thoracic aorta. J Pharmacol Exp Ther. 1999;277:34-39.