At Odds over Testosterone Therapy and Cardiovascular Risk
An estimated 13 million men in the United States suffer from low testosterone. As a result, many of them resort to testosterone therapy to boost levels. This helps address the negative health effects low T can have on cognition, muscle mass, strength, bone density, metabolic function and mood. Today, nearly one in 25 men over the age of 60 receives testosterone therapy.
However, earlier this month, the FDA issued a statement cautioning against the use of testosterone replacement products. In their announcement they warn that testosterone therapy may be associated with an elevated risk of stroke, heart attack and death.
There are two studies that prompted the FDA to reassess the safety of testosterone therapy. The first involved over 8,700 men who, on average, were about 60 years old. They all had low testosterone levels, and each of them underwent a coronary angiography to assess for coronary artery disease.
Some of the men received testosterone treatment, and others didn’t. By the end of the study, the risk of stroke, heart attack and death was reported to be 30% higher in the testosterone group.
The second study showed an increased risk of heart attack in men with pre-existing heart disease. In men 65 and older, the risk was doubled in the first 90 days after starting the prescription. In men younger than 65, the risk was about three times higher.
While these studies are compelling, there are many others that report no adverse cardiovascular effects of testosterone therapy. In fact, just one day after the FDA’s statement, the American College of Cardiology announced two new studies for presentation at their 64th Annual Scientific Session in San Diego.
Both of these studies failed to find a connection between testosterone therapy in men and heart problems. This directly contradicts the research that prompted the FDA’s statement.
One of the studies is a meta-analysis that finds the risk is not statistically significant. It includes data from 29 studies involving more than 120,000 men.
The other is an observation study from a Wisconsin health system. It included health data from over 7,200 men with low testosterone levels from 2011-2014. After obtaining data from the electronic record systems, the researchers found the event rate in men treated with testosterone was 5.5 percent. In the untreated group it was 6.7 percent. This suggests a potential cardiovascular benefit of testosterone replacement therapy.
If you would like to boost your testosterone levels without worrying about these contradictions, there are ways to do it naturally. Losing excess weight and getting enough exercise are probably the most important.
Men who are overweight tend to have lower production of testosterone. However, weight loss appears to increase the body’s ability to produce testosterone. If you add exercise into the equation, that will help kick-start testosterone production.
Cutting down on carbs and sugars, getting enough sleep and reducing stress levels can also help improve testosterone production.
FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. Safety Announcement. Food and Drug Administration. Mar 2015
FDA Drug Safety Communication: FDA evaluating risk of stroke, heart attack and death with FDA-approved testosterone products. Safety Announcement. Food and Drug Administration. Jan 2014
Vigen R, O’Donnell CI, Baron AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310(17):1829-1836.
Finkle WD, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One. 2014 Jan 29;9(1):e85805.
New studies fail to find cardiovascular risk with testosterone therapy. Press Release.
American College of Cardiology via EurekAlert. Mar 1015