Senior Focus: Testosterone treatment questions

Testosterone use among men has increased significantly in recent years.

Much of this increase is in response to doctors recommendations for treatment of symptomatic low testosterone levels, advertising of testosterone replacement therapy and the belief that low testosterone may increase the risk of developing cardiovascular disease (heart attack and stroke).

Most recent studies that followed a population over time suggested that deficiencies in male hormones such as testosterone and dihydrotestosterone may increase the risk of cardiovascular disease. Because low testosterone is a potentially reversible condition, it makes some sense that hormone replacement would be a good idea to prevent cardiovascular disease.

Additionally, higher testosterone levels among men in these observational studies was associated with a healthier cardiovascular risk profile, such as less diabetes, lower blood pressure, lower LDL cholesterol (bad cholesterol) and higher HDL cholesterol (good cholesterol).

However, reality may tell a different story.

We had long believed that hormone replacement therapy in women would protect against heart attacks and strokes. Estrogens help lower cholesterol and have other beneficial effects. However, it was not until a major study involving about 27,000 women chosen at random to receive hormone replacement therapy or a sugar pill that we learned that there was no benefit and there was a higher rate of cardiovascular events in the group that received hormone replacement therapy.

To date, no large similar study has examined the effect of testosterone replacement on cardiovascular events in men.

However, one large study evaluating the effects of giving testosterone therapy to men with low testosterone levels recently was published. This study looked at about 8,800 men with low testosterone who had undergone a heart catheterization for suspected coronary disease. About 1,200 of these patients received testosterone replacement after their heart catheterization at their doctors discretion; the rest did not.

The researchers found that more patients who were given testosterone had a heart attack, stroke or died after three years (25 percent), compared with those who did not (19 percent).

A study in about 55,000 men found a higher rate of heart attack in older men and in younger men with a history of coronary disease in the first 90 days after starting testosterone replacement, when compared with the risk in the year prior to starting therapy. Another study examining the effects of testosterone in older, frail men was stopped early because of unexpected higher rates of heart problems.

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Senior Focus: Testosterone treatment questions

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