A recent publication by Abraham Morgentaler, MD in the Mayo Clinic Proceedings challenges previous claims that testosterone replacement therapy (TRT) increases risk of cardiovascular disease among users. (Mayo Clinic Proceedings) According to Dr. Morgentaler, “There’s no good evidence that we could find that testosterone therapy increases cardiovascular risk. 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.” (Beth Israel Deaconess Medical Center)
Dr. Morgentaler references four articles detailing studies dated from 1940 to 2014 that suggest testosterone prescriptions lead to cardiovascular (CV) risks. Each of the articles covers a specific study: two analyses, one placebo-controlled trial, and one meta-analysis.
Dr. Morgentaler and his study colleagues go into detail disclaiming the validity of each study in question. In both the JAMA 2013 study and the PLoS One 2014 study, Dr. Morgentaler and his team deemed the methodology used to conduct the studies and their subsequent findings are questionable at best. (BIDMC)
The validity of the placebo-controlled trial itself (J Gerontol A Biol Sci Med Sci 2013) is also questioned due to it including few adverse cardiac incidents with multiple trial patients reporting improved cardiac function after receiving testosterone over those receiving the placebo. Finally, the meta-analysis shows no evidence of increased cardiovascular (CV) risk although the study itself includes “questionable studies and [cardiovascular] events.” (BIDMC)
In conclusion, Dr. Morgentaler and his colleagues suggest that not only is there no indication of cardiovascular (CV) risks due to testosterone treatment, but that there are in fact a “strong beneficial relationship between normal T and CV health that has not yet been widely appreciated.” (Mayo Clinic Proceedings) This could be a game-changing conclusion as more aging men are considering their long-term health in context with testosterone replacement therapy.
Dr. Morgentaler’s research review is being touted as the most comprehensive review of apparent correlation between testosterone replacement therapy and cardiovascular risk. As more studies are conducted, we anticipate greater clarity to what now looks to be a change in how both cardiologists and testosterone replacement specialists view the two areas of concentration.