Heart & Vascular Health | Heart Healthy Living | Men’s Health
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Concerns Raised About Testosterone Therapy

Study: testosterone replacement linked to heart risks

Increasing numbers of men are being treated with testosterone replacement therapy. Many cardiologists have been concerned about the potential for adverse cardiovascular effects of testosterone replacement therapy.

So the major new study published in the Journal of American Medical Association that links testosterone replacement therapy to increased risks of heart attack, stroke or death in older men isn’t necessarily surprising.

But it does raise greater concerns about testosterone therapy.

The aggressive marketing and prescribing of these testosterone gels, patches and injections — often targeted to older guys who want to feel young again — isn’t supported with nearly enough data on their long-term effects.

The U.S. Food and Drug Administration says it plans a review of these therapies to investigate the risk of stroke, heart attack and death in men taking FDA-approved testosterone products.

Greater risk of heart attack, stroke or death

The study looked at 8,709 men, average age early 60s, with low testosterone levels. Most had heart disease. After undergoing coronary angiography, one in seven men subsequently received testosterone replacement therapy.

Three years after the men’s initial heart tests, researchers found the number of patients experiencing heart problems like heart attack and stroke was 20 percent for those not on testosterone — and almost 26 percent for those who were.

After taking into account the patients’ initial heart test findings, researchers calculated that for these men using testosterone was tied to a 29 percent greater risk of heart attack, stroke or death.

More caution with testosterone therapy

This is an observational study and doesn’t prove testosterone therapy is unsafe. But it strongly signals more caution in both using and prescribing the treatment. A few things to think about:

  • If you’re thinking of testosterone replacement as a boost, consider your age and general health overall. If you’re young, healthy, have sufficient testosterone level already but think it’d be a great boost, remember: it’s an anabolic steroid. All steroid use comes with risks.
  • If you’re using testosterone already, ask yourself, what is this doing for me? Is it making me feel better? What exactly are the benefits I’m experiencing? Be sure to talk with your doctor about this if it’s been prescribed to you.
  • If you’re older and have heart or other health issues, be sure to talk over the potential benefits and risks with your doctor very carefully.

Testosterone replacement therapy may indeed be indicated for some men, but this therapy needs more long-term safety trials to clarify benefits and risks.

Tags: heart attack, heart disease, heart risks, replacement therapy, stroke, testosterone

Steven Nissen, MD, is Chairman of the Department of Cardiovascular Medicine at Cleveland Clinic. In 2007, TIME Magazine named him “one of the 100 most influential people in the world.”

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  • Peter Elias

    I’m disappointed that you provide only relative risk information and not absolute risk information. Based on what you have here (not having the study on hand), I believe the data you report shows that in a group of 100 men in their early 60s note using testosterone, 20 will have a heart attack or stroke during the next three years, while in a group of 100 men in their early 60s using testosterone, 29 will have a heart attack or stroke in the next 3 years.

    Over a three year period, there are 9 additional heart attacks or strokes our of every 100 using testosterone. The number needed to harm (NNH) is thus about 10.

    • The_Beating_Edge_Team

      see note above.

  • indy1167

    Does study suggest same about DHEA ?

    • The_Beating_Edge_Team

      see above comment from Beating Edge Team betsyRN.

  • The_Beating_Edge_Team

    I asked Dr. Nissen your questions and he stated: We don’t use observational data to calculate NNH. Not much is known about the risks of DHEA.
    We need randomized clinical trials to answer these questions in a precise
    fashion. betsyRN