Testosterone Treatment May Pose Cardiovascular Risks

Hormone levels are known to taper off as individuals age. For both sexes, the downturn in hormones can cause numerous problems, including issues related to bone density and strength.

Specifically, the effects of hormone therapy in older men is unknown. In a new study published by JAMA and JAMA Internal Medicine, investigators explored the risks and benefits of testosterone treatment in men aged 65 and older with age-induced low testosterone.

The study authors found that these patients experienced improved bone density and anemia. Unfortunately, testosterone treatment was not seen to improve brain function, and increased plaque buildup in coronary arteries.

The Testosterone Trials (TTrials) were a group of 7 clinical trials that analyzed the effects of testosterone therapy compared with placebo for 1 year in men with low hormone levels. The team of investigators previously reported that the treatment improved sexual function and mood in these patients.

Included in the new study were nearly 800 men with low testosterone levels who were randomized to administer daily testosterone gel or a daily placebo gel for 1 year. The investigators measured efficacy at 3, 6, 9, and 12 months.

The team discovered that testosterone treatment improved bone density and strength as determined by quantitative computed tomography. The treatment also increased hemoglobin concentrations, which rectified anemia in men who were not observed to have any identifiable cause of the condition, according to the study.

Although some results appeared to show the benefits of the treatment, there were also significant drawbacks. Testosterone therapy was not observed to improve cognitive function, including memory and other measures. Additionally, there were cardiovascular risks.

"The paper reporting the results of the first 3 trials published last year was the first to show there were advantages to giving testosterone treatment to older men with low testosterone levels, and the bone and anemia trial results further support a benefit," said the principal investigator Peter J. Snyder, MD. "However, the increase of plaque buildup in the coronary artery shows that this treatment may also have some risk"

In the cardiovascular portion of the trial, the researchers examined coronary artery plaque buildup, and found that more men treatment with testosterone had build-up, compared with those treated with placebo.

However, of all 788 men included in the trials, the proportion of men experiencing major cardiovascular events was similar among both groups, according to the study.

"Treating 788 men for 1 year is far too few to draw conclusions about the clinical significance of the increase in coronary artery plaque volume and the cardiovascular risk of testosterone treatment,” Dr Snyder said.

The researchers reported that the TTrials are the largest studies to explore testosterone treatment in men aged 65 and older with low testosterone due to age.

"Final decisions about testosterone treatment for older men will depend on balancing the results from these seven TTrials with the results from a much larger and longer term trial designed to assess cardiovascular and prostate risk in the future," Dr Snyder concluded.