Low Levels of Testosterone May Raise Risk of Heart Disease

Abraham Morgentaler, MD Director and Founder Men’s Health BostonMedicalResearch.com Interview with:
Abraham Morgentaler, MD

Director and Founder
Men’s Health Boston

Medical Research: What is the background for this study? What are the main findings?

Response: There has been  tremendous media attention over the last 15 months to two retrospective studies that reported increased cardiovascular risks with testosterone. Those reports anchored a variety of stories critical of testosterone therapy for non-scientific reasons, such as alleged dangers of direct-to-consumer advertising.  In this review we investigated the two recent studies in depth, as well as the broader literature regarding testosterone and cardiovascular issues. One primary finding was that the studies alleging risk were remarkably weak and flawed- one reported low rates of MI and had no control group, and the other had such large data errors (nearly 10% of the all-male population turned out to be female!) that 29 medical societies have called for its retraction. In contrast, there is substantial literature suggesting that testosterone therapy, or naturally occurring higher levels of testosterone, is protective against atherosclerosis, and mortality.  Several small randomized controlled trials in men with known heart disease- angina and congestive heart failure- have even shown benefits for men that received testosterone compared with placebo.

Medical Research: What should clinicians and patients take away from your report?

Response: There is no currently no compelling evidence that testosterone therapy is dangerous for heart health. On the contrary, the evidence is strong that having low levels of testosterone is a risk factor for cardiovascular disease. We do not yet have enough prospective controlled data to definitively conclude that testosterone therapy is beneficial for the heart, but the evidence is suggestive.  What this means is that healthcare providers should not be dissuaded from treating men with testosterone deficiency (also called hypogonadism) if they feel it is clinically indicated.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Men die 5 years earlier than women in the US, on average, and low levels of testosterone have been significantly associated with increased mortality.  We should know whether testosterone is beneficial, or harmful, to men’s health when studied on a large scale. It is time for a large study of men’s health, similar to the Women’s Health Initiative, which published results more than 12 years ago.

Citation:

Testosterone Therapy and Cardiovascular Risk: Advances and Controversies
Abraham Morgentaler, MD; Martin M. Miner, MD; Monica Caliber, MSc; Andre T. Guay, MD; Mohit Khera, MD; and Abdulmaged M. Traish, PhD
Mayo Clinic Proceedings Published Online: January 26, 2015
DOI: http://dx.doi.org/10.1016/j.mayocp.2014.10.011