Testosterone and Men’s Health: Controversy Unraveled

Testosterone treatment in men has been controversial due to reports of potential heart health risks

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Testosterone treatment — what’s a guy to do? This therapy is under heavy scrutiny because of fears that it may increase heart disease risks. Those fears, however, may be unfounded.

A new review found that the benefits of testosterone therapy may outweigh the risks. Several large studies have fueled the perception that testosterone can negatively affect men’s heart health. A careful study of available research found more positives than negatives.

The authors of this review noted that public perceptions may prevent men from receiving treatment that could help them.

But Sandeep Singh, MD, a board certified internist and cardiologist on the medical staff at Baylor Heart and Vascular Hospital, has some reservations about these researchers' conclusions.

"The results of this study do not really change the way a clinician should think about testosterone replacement therapy," said Dr. Singh. "Without a large scale randomized double-blind study, we cannot conclusively say one way or another about the relationship between [testosterone] replacement and risk of heart disease or stroke."

Dr. Singh explained that the data used in this review was mostly retrospective (data pulled from past events) or observational, which can be misleading because of bias or factors that were not accounted for during the study.

He said a similar situation arose in the 1990s when hormone replacement therapy was given to women because some thought it might protect heart and bone health. But the 2002 Women's Health Initiative (WHI) — a large randomized controlled trial — showed that women who received hormone replacement had a greater risk of heart disease, stroke and venous thromboembolism (a type of blood clot), suggesting that "hormone replacement therapy was not for everyone," Dr. Singh said.

"When making a decision about any medical treatment (whether it's testosterone replacement or other medications), the decision should only be made with a licensed MD who can carefully weigh the risk and benefit of the intervention based on the patient's individual needs," he said.

Abraham Morgentaler, MD, is the Director of Men's Health Boston and a urologist on staff at Beth Israel Deaconess Medical Center. For this review, Dr. Morgentaler led a team of medical experts to examine the issue of testosterone treatment and men’s heart health.

"Testosterone has been presented as if there were a debate about whether it is good or evil," Dr. Morgentaler said in a press release. "Rather, it is a long-accepted medical treatment for a medical condition recognized for centuries. Our intention was to cut through the confusion of loudly expressed opinions on non-scientific issues — such as pharmaceutical advertising, anti-aging claims, and the importance of sexuality in older men — to provide the most comprehensive review to date of the literature on testosterone and cardiovascular risk."

Testosterone is the primary male sex hormone. During puberty, testosterone levels increase. Increased testosterone causes changes like a deeper voice, increased body hair and larger muscles.

Adult men need adequate testosterone to maintain muscle and bones. Testosterone also affects men’s sex drive.

After age 30, testosterone levels gradually drop. Testosterone replacement therapy has become increasingly common, aided by widely-advertised gels and other treatments.

Dr. Morgentaler and colleagues assessed four major studies often used to support the idea that testosterone may cause heart problems. These researchers found that two of these studies were flawed.

Dozens of other smaller studies, however, found multiple benefits when men who had testosterone deficiencies were treated with the hormone. For instance, waist circumference, obesity and fat mass are all risk factors for heart disease. Each improved with testosterone therapy.

Several studies showed that men with lower testosterone levels had an increased risk of death from heart problems.

"There's no good evidence that we could find that testosterone therapy increases cardiovascular risk," Dr. Morgentaler said. "That's not to say it's perfectly safe. But we cannot find evidence and the headlines that jumped out on recent retrospective studies appear to be too strong."

More importantly, Dr. Morgentaler added, "review of the literature clearly reveals a strong relationship between higher serum testosterone concentrations ... as being beneficial for reduction in cardiovascular disease and cardiovascular risk factors."

Patients should speak with their doctors about the safety of testosterone treatment.

This review was published online Jan. 27 in Mayo Clinic Proceedings.

The authors disclosed no funding sources for this research. Several authors received consulting fees or research funding from companies like AbbVie Inc., Auxilium Pharmaceuticals, Inc., Clarus Therapeutics, Endo Pharmaceuticals, TesoRx, Antares Pharma, Eli Lilly and Co., Bayer, Pfizer and Forest Laboratories, Inc. Some of these organizations manufacture or distribute medications and lab tests used for testosterone treatment.

Review Date: 
January 27, 2015
Last Updated:
January 30, 2015