Testosterone therapy could increase the risk of death, heart attack, and stroke in men with “significant medical comorbidities,” according to a recent report in the Journal of the American Medical Association (JAMA).
Testosterone is often prescribed to improve muscle mass, bone strength, and sexual function. In the United States, 5.3 million testosterone prescriptions were written in 2011 alone.
However, the hormone’s effect on heart health has not been fully researched. While studies have not found heart concerns, they have also not examined the effects testosterone therapy in the long term.
However, one study [the Testosterone in Older Men with Mobility Limitations (TOM) trial], ended early because of an increase in heart problems among the participants.
With the TOM trial in mind, a team of American researchers investigated the association between testosterone therapy and death, heart attack, and stroke in a group of male veterans.
The study involved 8,709 men who had a coronary angiography between 2005 and 2011. At that time, the men’s testosterone levels were below 300 ng/dL. Comorbidities were common. About 20% had had a previous heart attack, half had diabetes, and over 80% had coronary artery disease.
Fourteen percent of the men started testosterone therapy at some point after the angiography. The testosterone was administered by gel, patch, or injection. The remaining men had no testosterone therapy.
The average follow-up occurred at approximately 27.5 months. Sixty-seven of the 1,223 men on testosterone died (from any cause), 23 had heart attacks, and 33 had strokes. For the 7,486 men who did not take testosterone, the numbers were 681, 420, and 486, respectively.
According to a press-release from JAMA, “The researchers found that the proportion of patients experiencing events 3 years after coronary angiography was 19.9 percent in the no testosterone therapy group (average age, 64 years) and 25.7 percent in the testosterone therapy group (average age, 61 years), for an absolute risk difference of 5.8 percent.”
“This study is the first observational study, to our knowledge, to suggest that testosterone therapy is associated with adverse cardiovascular outcomes,” the authors wrote. “Our findings raise some uncertainty regarding the potential safety of testosterone use in men.”
They noted that future research is necessary to learn more about the safety of long-term testosterone therapy.
The JAMA Network
“Testosterone Therapy Following Coronary Angiography Associated With Increased Risk Of Adverse Outcomes”
(Press release. November 5, 2013)
“Testosterone Therapy May Increase The Risk Of Heart Attack, Stroke And Other Cardiovascular Events”
Journal of the American Medical Association
Vigen, Rebecca, MD, MSCS, et al.
“Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels”
(Full-text. November 6, 2013)
“Testosterone Treatments Linked with Risk of Heart Problems, Deaths”
(November 5, 2013)
Wall Street Journal
“Testosterone Therapy Tied to Heart Risks”
(November 5, 2013)