Headlines screamed in 2013 after a study in the Journal of the American Medical Association (JAMA) reported increased cardiovascular risk in men given testosterone replacement. The study compared the incidence of heart disease in 8709 low testosterone men in the Veterans Administration health system who underwent coronary angiography. Their data showed that the testosterone-treated group had a 25.7% absolute rate of stroke, heart attack and death compared to 19.9% in the untreated group. These findings received enormous media attention and were repeated in a widely quoted accompanying editorial.
However, it was later found that the statistical analysis was incorrect and instead the number of adverse evens was lower by one-half in the testosterone-treated group! In March 2014, JAMA published a second correction of additional data errors involving more than 1000 individuals. Furthermore, it was revealed that the “all-male” study population actually comprised nearly 10% women. To date, 29 medical societies have called for the retraction of the original article, arguing that the data are not credible.
In clinical practice, when giving testosterone to men with deficient levels, we routinely see improvement in sex drive, sexual function, muscle mass, bone density and reduced fat mass.
With regard to the cardiovascular system, a review article of several dozen studies, revealed:
Untreated low testosterone is associated with increased mortality, generalized hardening of the arteries and heart disease;
Mortality is reduced by one half in testosterone deficient-men treated with testosterone therapy compared with untreated men;
Exercise capacity is increased with testosterone treatment compared to placebo in men with know heart disease.
Testosterone replacement compared to placebo results in uniform improvement in cardiovascular risk factors (fat mass, waist circumference, insulin resistance).
The media tends to sensationalize the news. When you read headlines warning about risks from a hormone, you need to pause and use some common sense. Does it really make sense that a hormone that’s part of your body’s design suddenly becomes dangerous when you give it to someone who’s deficient? Each hormone plays a vital role in your body. The whole specialty of endocrinology is devoted to evaluating and treating diseases caused by hormones that are deficient or in excess.
As a board-certified endocrinologist who’s been in practice for over 25 years, I’ve learned to have a healthy respect for the body’s ability to self-heal. When I see men with low testosterone, before rushing in with testosterone replacement, I first want to determine WHY
a man is deficient in testosterone. Does he have a treatable underlying condition that’s interfering with his body’s ability to produce testosterone? For example, testosterone is primarily produced during sleep. Does he have a correctable condition like sleep apnea that’s causing his low testosterone state? If I can get his body to restore its own testosterone production, that’s better than anything I can prescribe! If testosterone levels are deficient and testosterone replacement is needed, it’s important to avoid excessive levels because those can lead to adverse events. Hormones are powerful therapies and it’s always best to respect the wisdom of the body.
Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310;1829-1836
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Correction. Incorrect number of excluded patients reported in the text and figure. JAMA. 2014;311:967. http://jama.jamanetwork.com/article.aspx?articleid=1835478
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