cardiovascular safety of testosterone replacement therapy in men

Last edited 06/2023 and last reviewed 06/2023

Cardiovascular Safety of Testosterone-Replacement Therapy

• RCT (n=5246 men aged 45-80 years with hypogonadism & pre-existing/high risk of CVD (cardiovascular disease)) (1)
  • mean (+/-SD) duration of treatment was 21.7+/-14.1 months, and the mean follow-up was 33.0+/-12.1 months
  • found transdermal testosterone-replacement therapy to be noninferior to placebo for incidence of major adverse cardiac events (7.0% vs 7.3%; HR 0.96; 95% 0.78 to 1.17; P<0.001 for noninferiority)

A previous review stated (2):

• in men, testosterone levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk
• low testosterone levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes
• reduced testosterone levels in men with congestive heart failure (CHF) is associated with a poor prognosis and is associated with increased mortality
• testosterone replacement therapy (TRT) has been shown to improve myocardial ischemia in men with CAD, improve exercise capacity in patients with CHF, and improve serum glucose levels, HbA1c, and insulin resistance in men with diabetes and prediabetes.

Reference:

• Lincoff AM et al. Cardiovascular Safety of Testosterone-Replacement Therapy. NEJM (June 16th 2023)
• Goodale T, Sadhu A, Petak S, Robbins R. Testosterone and the Heart. Methodist Debakey Cardiovasc J. 2017 Apr-Jun;13(2):68-72. doi: 10.14797/mdcj-13-2-68. PMID: 28740585; PMCID: PMC5512682.