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Safety of Testosterone Therapy Remains Uncertain for Many Patients

CardioSmart News

While low testosterone has been linked to increased heart risks, testosterone therapy may not be safe for all men, according to a recent paper published in the Journal of the American College of Cardiology.

Testosterone is the principal male sex hormone that plays a key role in muscle mass, bone density and sex drive. As men age, testosterone levels typically fall, causing a range of symptoms from low sex drive to depression. Unfortunately, low testosterone has been linked to more serious side effects such as increased risk of heart disease, heart attack and stroke. This leads experts to wonder whether testosterone therapy may offset increased cardiovascular risk in men with low testosterone levels. To learn more, researchers reviewed the latest evidence.

First, there’s no question that low testosterone is, in fact, associated with increased heart risks. A total of 70 past studies have demonstrated that low testosterone is linked to increased risk for heart disease, heart events and even death.

Evidence regarding the safety and efficacy of testosterone therapy in improving heart health, however, is less clear. As authors explain, there appear to be no real concerns about the use of testosterone in young, healthy men with low testosterone levels. In younger men, hormone therapy can minimize symptoms associated with low testosterone and has few serious side effects.

But the use of testosterone therapy in older men or men living with heart disease is a different story. After reviewing the latest evidence, researchers found that there are an equal number of studies both for and against hormone therapy in older men. Some studies have found that hormone therapy is both safe and effective in reducing cardiovascular risk in older men or those living with heart disease. Others found that testosterone therapy actually increases risk for heart events in this population. In fact, based on evidence, authors believe the safety of testosterone therapy is too uncertain to recommend in patients with a history of heart attack, stroke, or heart failure.

Ultimately, authors conclude that the use of testosterone remains controversial in older men and men living with heart disease. Although testosterone therapy may be appropriate for some patients, authors stress the importance of education and counseling on potential risks associated with hormone therapy.

Authors also encourage clinical trials to further our understanding about testosterone and heart health. According to experts, it’s unclear whether the low testosterone levels directly cause increased heart risks or are simply a marker of poor health. It’s also uncertain whether hormone therapy is safe and effective when it comes to heart health. With additional research, authors hope to create well-established guidelines on the use of testosterone therapy and help patients with low testosterone reduce risk for heart disease—America’s No. 1 killer.

Read the full article in the Journal of the American College of Cardiology. Learn about CardioSmart's editorial process. Information provided for educational purposes only. Please talk to your health care professional about your specific needs.