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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?

1 February 2015

Adherence to testosterone therapy

Adherence to testosterone therapy

Long-term treatment patterns of testosterone replacement medications.
Donatucci C, Cui Z, Fang Y, Muram D. The journal of sexual medicine. Aug 2014;11(8):2092-2099.

Medication adherence and treatment patterns for hypogonadal patients treated with topical testosterone therapy: a retrospective medical claims analysis.
Schoenfeld MJ, Shortridge E, Cui Z, Muram D. The journal of sexual medicine. May 2013;10(5):1401-1409.

Testosterone therapy confers a wide range of health benefits for hypogonadal men, including improvements in body composition (reduction in body fat, increase in muscle mass, weight loss), lipid profile, cardiovascular function, insulin sensitivity/glucose metabolism, bone mineral density, inflammatory parameters, quality of life and potentially longevity.

Despite this, there is a high discontinuation rate with testosterone therapy. This editorial presents findings from two studies which have investigated adherence to testosterone therapy and treatment patterns.

20 August 2013

Obesity is strongly linked to low testosterone levels in men

Obesity is strongly linked to low testosterone levels in men
This summary gives an overview of four research papers which discuss the link between obesity and low testosterone levels (also known as hypogonadism): one review focusing on the association between obesity, diabetes and low testosterone, and three clinical studies. The studies looked at the relationship between body mass index (BMI) and testosterone levels in men, and the effects of weight loss on testosterone levels in a group of very obese men (BMI >40 kg/m2) undergoing weight loss surgery; the link between obesity and testosterone levels in young men aged 14-20 years; and the relationship between health and lifestyle factors, including weight loss, and testosterone levels in men as they get older.

22 July 2013

Testosterone deficiency: a risk factor for heart failure

Testosterone deficiency - a risk factor for heart failure
This review summarizes the available evidence on the role of low testosterone levels (also known as testosterone deficiency syndrome [TDS] or hypogonadism) as a modifiable risk factor for heart failure. It also underlines the benefits and potential side effects of testosterone replacement therapy (TRT) in men suffering from chronic heart failure (CHF).

19 June 2013

Aortic stiffness is increased in patients with low testosterone levels

Arterial stiffness contributes to cardiovascular conditions that can increase the risk of mortality. Sex hormones have been suggested to play a role in vascular function and in this study the elastic properties of the aorta (the largest artery in the body) in men with low blood levels of testosterone (hypogonadism) were compared with those of a control group who naturally produce normal levels of testosterone.

19 November 2012

Changes in the worldwide diagnosis and treatment of testosterone deficiency between 2006 and 2010

Diagnosing and treating testosterone deficiency in different parts of the world: changes between 2006 and 2010. Gooren LJ, Behre HM. The Aging Male 2012;15(1):22-27.

This physician-based survey investigated the diagnosis and treatment of testosterone deficiency (hypogonadism) in various parts of the world in 2010. The study, conducted in Germany, Spain, the United Kingdom, Brazil and Saudi Arabia between April and May 2010, involved 353 physicians (229 urologists, 84 endocrinologists and 40 primary care physicians) who were interviewed to address the following issues (1) the reasons to use/not use testosterone in patients who have testosterone deficiency (2) the role of safety and other concerns in the decision to not provide testosterone treatment and (3) to evaluate the actual use of testosterone preparations for the treatment of erectile dysfunction. The results of this survey were compared with a previous survey conducted in Germany, Spain, the United Kingdom, Brazil and South Korea by the same investigators in 2006 to determine if any significant changes in clinical practice have occurred over the last 4 years.

Key Points

  • The majority of physicians surveyed (82%) would regularly use laboratory measurements of total testosterone to diagnose testosterone deficiency
  • Physicians consider the main symptoms of testosterone deficiency to be erectile dysfunction, lack of libido, fatigue, loss of power, depression, weight gain and loss of hair/reduced body hair

    • There was an increased awareness among physicians of depression and weight gain as clinical symptoms of low testosterone
  • For 70% of the physicians surveyed, the severity of the symptoms experienced was considered a more significant reason to start testosterone treatment than the laboratory value of testosterone
  • In 2010, significantly more physicians expressed concern about the adverse effects of testosterone treatment compared with 2006 (78% vs 54%)

    • Eleven percent of patients eligible for testosterone therapy did not receive treatment due to these concerns
  • The proportion of patients diagnosed with erectile dysfunction who have testosterone deficiency ranged from 41% to 63% depending on the country

    • These patients were more likely in 2010 to be treated with phosphodiesterase type 5 (PDE5) inhibitor monotherapy or testosterone plus PDE5 inhibitors than in 2006.

21 August 2012

Study finds that low testosterone levels are common in men with sexual problems and may be related to chronic illnesses

Image: Senior person getting blood pressure examination by a cardiologist
This large retrospective observational study of 990 men with erectile dysfunction (problems achieving or maintaining an erection) looked at the link between low levels of testosterone (also known as hypogonadism) and various chronic illnesses. The average age of men in this study was 57 years and many had chronic conditions such as diabetes mellitus, high blood pressure, work stress and anxiety/depression. Overall, 36% of these men had low testosterone levels.

21 May 2012

Evidence of a key role for testosterone in the cause and treatment of obesity, the metabolic syndrome and diabetes

Image: overweighted man
The rapid increase in rates of obesity in both the developed and the developing world has serious consequences. Nearly all obese adults suffer from at least one obesity-related disease, such as type 2 diabetes, high blood pressure, cardiovascular disease, cancer, or joint disorders. A recent comprehensive review has looked beyond the place of testosterone in the male reproductive system and for the treatment of erectile dysfunction (impotence) to examine the key role of testosterone in the development and treatment of obesity and associated diseases. The article reviewed the evidence for the effects on insulin sensitivity, visceral fat and cholesterol levels of returning low testosterone levels to normal, and addressed the safety of testosterone, particularly in elderly men.

8 March 2012

Link between low testosterone and frailty in elderly men

Image: Senior patient and doctor
This review discussed the relationship between low testosterone level and frailty in elderly men and evaluated the evidence which shows that testosterone replacement therapy improves the physical functioning and quality of life of elderly frail men with confirmed low testosterone levels.

1 April 2011

Increased risk of dying from cardiovascular disease for men with erectile dysfunction and low testosterone

Image: Human heart

There is increasing evidence that erectile dysfunction may be a warning sign of a number of disease conditions, such as high blood pressure, metabolic syndrome, diabetes mellitus, depression and coronary heart disease.

Nearly 1700 men attending an andrology clinic for erectile dysfunction were monitored for an average of 4.3 years to find out whether those with low testosterone levels were more likely to suffer a major cardiovascular disease event, such as a heart attack or stroke.

11 March 2011

Low testosterone is common in men with cardiovascular disease and decreases

A study in the United Kingdom observed 930 men with confirmed coronary artery disease over an average of nearly 7 years to find out how many had testosterone deficiency and to examine whether low testosterone affected survival.

Last updated: 2019