Two recent studies raised new concerns regarding cardiovascular (CV) risks with
testosterone (T)
therapy. This article reviews those studies as well as the extensive literature on T and CV risks. A MEDLINE search was performed for the years 1940 to August 2014 using the following key words:
testosterone,
androgens, human, male,
cardiovascular, stroke,
cerebrovascular accident,
myocardial infarction,
heart attack, death, and mortality. The weight and direction of evidence was evaluated and level of evidence (LOE) assigned. Only 4 articles were identified that suggested increased CV risks with T prescriptions: 2 retrospective analyses with serious methodological limitations, 1 placebo-controlled trial with few
major adverse cardiac events, and 1 meta-analysis that included questionable studies and events. In contrast, several dozen studies have reported a beneficial effect of normal T levels on CV risks and mortality. Mortality and incident
coronary artery disease are inversely associated with serum T concentrations (LOE IIa), as is severity of
coronary artery disease (LOE IIa).
Testosterone therapy is associated with reduced
obesity, fat mass, and waist circumference (LOE Ib) and also improves
glycemic control (LOE IIa). Mortality was reduced with T
therapy in 2 retrospective studies. Several RCTs in men with
coronary artery disease or
heart failure reported improved function in men who received T compared with placebo. The largest meta-analysis to date revealed no increase in CV risks in men who received T and reduced CV risk among those with
metabolic disease. In summary, there is no convincing evidence of increased CV risks with T
therapy. On the contrary, there appears to be a strong beneficial relationship between normal T and CV health that has not yet been widely appreciated.