1. There is no evidence that testosterone causes heart attacks or strokes

On November 6, 2013, an article was published by the Veterans Affairs in the Journal of the American Medical Association that made a conclusion that testosterone might be dangerous and may cause increased heart attacks, strokes, and increased mortality.[1] Unfortunately, this was not the best study as there were stated and unstated biases, inaccurate conclusions, and questionable methodology.   In fact there was a correction published[2] and the conclusions from the data still remain dubious.

We don’t want to overwhelm you with a lot of confusing information but consider the following. If the cohort taking testosterone is virtually the same as the cohort not taking testosterone, the raw numbers should speak for themselves and demonstrate that testosterone actually improves outcomes. The choice of the Kaplan-Meier methodology skewed the data in the opposite manner. The discussion part of the article admits that they had biases.

Secondly, nowhere in the study did they address the likely cause of increased cardiovascular events and that is estrogen. Elan Medical and other professionals age management physicians managed all the hormones and byproducts.

Lastly, it is also important to many of our patients is looking at how they feel. Most of our patients believe it is not how long they live but good they live. This should be particularly important to elderly males in a VA study.

But let’s look at the data and actually the raw data concludes that testosterone actually substantially decreases heart attacks (MI’s), strokes and mortality.

 

No Testosterone Taking Testosterone Higher morbidity with no Testosterone
Total 7486 1223
Died 681 9.10% 67 5.48% 166%
MI 420 5.61% 23 1.88% 298%
CVA 486 6.49% 33 2.70% 241%

This article is an aberration and the rest of the field of research including consensus articles by groups including other researchers at the Veterans Affairs that concluded that noted a 39% reduction in mortality risk among patients treated with testosterone.[3]

  1. There is a lot of evidence that testosterone is good for the heart.

The American Heart Association published a meta-analysis study on testosterone therapy. A meta-analysis refers to a methodology that combines results from multiple studies to identify patterns and eliminate sources of disagreement among those results. The article concludes that “In patients with moderate to severe HF, testosterone supplementation improves exercise capacity and metabolic indices. Testosterone is a promising therapy to improve exercise capacity in heart failure patients.”

Other quoted findings from that article include:

More recently, low testosterone levels have also been shown to be associated with decreased survival in male patients with coronary artery disease. Treatment with supplemental testosterone results in favorable acute and chronic physiologic and biochemical changes in patients with cardiovascular disease.

Testosterone therapy has also been shown to increase hemoglobin and hematocrit and decrease HDL without causing significant change in fasting glucose, triglyceride or LDL levels or blood pressure in adult men without known cardiovascular disease.

Testosterone supplementation has also proven to be beneficial in other chronic disease states like cancer, chronic renal disease, pulmonary disease, and HIV.

  1. No Safety Concerns for Testosterone

None of the publications reviewed in the AHA study of 44 studies demonstrated any increase in mortality or readmission to a hospital.

Our meta-analysis showed that there were no safety concerns reported in any of the trials, although data was limited given the small sample sizes and short durations of follow-up. Despite the concern in regards to the long-term risk of prostate cancer, currently available data does not support a link between testosterone replacement therapy and prostate cancer.

There are several studies that show that low testosterone is a risk factor for prostate cancer. That makes sense because if testosterone was a risk factor for prostate cancer, wouldn’t prostate cancer be a disease of young men who have a high level of testosterone.

[1] http://jama.jamanetwork.com/article.aspx?articleid=1764051

[2] http://jama.jamanetwork.com/article.aspx?articleid=1814192

[3] Shores MM, et al. Testosterone treatment and mortality in men with low testosterone levels. J. Clinical Endocrinology Metab. 2012;97(6) 2050-2058