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15 May 2016

Survival and cardiovascular events in men treated with testosterone

Survival and cardiovascular events in men treated with testosterone

Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study. Wallis CJD, Lo K, Lee Y, et al. The Lancet Diabetes & Endocrinology. 2016;May 7

On the surface, testosterone therapy is a controversial treatment because previous studies investigating the effects of testosterone therapy have been conflicting, with some studies showing supposed harm and others showing significant benefit.

Here we present the results of a new study published in The Lancet Diabetes & Endocrinology on May 7 2016, which addressed some shortcomings in previous studies by analyzing effects based on duration of testosterone treatment.

Key Points

  • After a follow-up for over 5 years, men treated with testosterone had 12% lower mortality than non-testosterone treated men.
  • Compared to non-testosterone treated men, men with the shortest duration of testosterone treatment had 11% increased risk of mortality and 26% increased risk cardiovascular events. In contrast, those with the longest duration of testosterone treatment had 33% decreased risk of mortality and 16% decreased risk of cardiovascular events.
  • Risk of prostate cancer diagnosis was decreased by 40% in men with the longest duration of testosterone treatment, compared to non-testosterone treated men. No effect on prostate cancer risk was seen among men with shortest duration of testosterone treatment.
  • It is speculated that the increased risk of cardiovascular events and mortality for men with the shortest duration of testosterone treatment could be driven by the consequences of underlying testosterone deficiency and inadequate treatment, rather than the testosterone treatment.

20 July 2015

Risk of Blood Clots in Men Receiving Testosterone Therapy

Risk of Blood Clots in Men Receiving Testosterone Therapy

Venous thromboembolism is a blood clot that forms in a vein deep inside a part of the body; it mainly affects the large veins in the lower leg and thigh.

Blood clot formation (venous thromboembolism) has been suggested to be one main risk with testosterone replacement therapy. In 2014, both the US Food and Drug Administration (FDA) and Health Canada implemented a requirement for manufacturers to add a warning about the potential risks of venous thromboembolism and deep vein thrombosis to the label of all testosterone products.

However, to date no comparative studies examining an association between testosterone replacement therapy and venous thromboembolism have been reported. Here we report the results of a recent case-control study – published July 20, 2015 - that specifically examined the risk of venous thromboembolism associated with testosterone therapy in middle-aged and older men.

1 May 2015

Testosterone, Cardiovascular Risk, Mortality and Longevity

Testosterone, Cardiovascular Risk, Mortality and Longevity

Testosterone Therapy and Cardiovascular Risk: Advances and Controversies. Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Mayo Clin. Proc. 2015;90(2):224-251.

Testosterone and mortality. Muraleedharan V, Jones TH. Clin. Endocrinol. (Oxf). 2014;81(4):477-487.

One of the most debated issues related to testosterone replacement therapy is its effects on cardiovascular risk and clinical events, like for example heart attack. A few flawed studies over the past years made it appear that testosterone replacement therapy increases cardiovascular risk and incidence of heart attacks. However, less known is the vast and rapidly accumulating body of evidence showing the contrary; that higher testosterone levels and testosterone replacement therapy actually may reduce mortality and increase longevity.

This editorial summarises key conclusions from a special medical review article on testosterone and cardiovascular risk, written by the Androgen Study Group, as provides answers to the following two questions:

  1. Is testosterone deficiency directly involved in the pathogenesis of these conditions or is it merely a biomarker of ill health and the severity of underlying disease processes?
  2. Does testosterone replacement therapy retard disease progression and ultimately enhance the clinical prognosis and survival?

15 April 2015

Health Consequences of Subclinical Hypogonadism

Health Consequences of Subclinical Hypogonadism

Characteristics of compensated hypogonadism in patients with sexual dysfunction. Corona G, Maseroli E, Rastrelli G, et al. The journal of sexual medicine. 2014;11(7):1823-1834.

In discussions about diagnosis and health consequences of hypogonadism, the prime focus is given to testosterone levels and signs/symptoms. However, emerging research has identified a less clinically evident gonadal dysfunction called “subclinical” hypogonadism (or “compensated” hypogonadism).

Subclinical hypogonadism is characterized by normal testosterone levels in the presence of elevated LH level. As testosterone levels are not markedly reduced in subclinical hypogonadism, intuitively one may think it does not confer negative health consequences. However, a recent study which specifically was conducted to investigate the potential health ramifications of subclinical hypogonadism, shows that it should not be neglected.

Last updated: 2019