Latest News on Testosterone and Heart Risk

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The American Association of Clinical Endocrinologists (AACE) has released a position statement on the use of testosterone replacement therapy (TRT) and cardiovascular (heart) risk. This follows the publication of two papers which raised concerns about the cardiovascular safety of testosterone replacement therapy (TRT) and a FDA hearing on the issue in March 2015.

The statement concludes that there is no compelling evidence that testosterone therapy either increases or decreases cardiovascular risk and that large scale trials focusing on cardiovascular benefit and risk are needed.  On this basis two recommendations were made,

1 – Symptomatic men who have unequivocally low total and/or free testosterone levels that are assayed on at least 2 samples drawn before 10 am should be considered for TRT.

2 – Practicing clinicians should be extra cautious in the symptomatic elderly with low testosterone levels prior to embarking on TRT and to avoid treatment of the frail elderly until better outcome data is available.

This statement is reassuring for those men with symptomatic hypogonadism who require TRT.  The negative press surrounding testosterone that followed the controversial publications in 2013/14 was nothing short of a grab at the headlines and may have in fact caused harm for those men who genuinely require TRT.  Further in depth analysis of the studies involved also showed them to be flawed.

Low testosterone levels are associated with an increase in cardiovascular events however it is not known if the low T levels are the cause or a marker.  What can be confirmed is that TRT does have a favourable effect on muscle mass, insulin resistance and waist circumference which in turn reduces overall cardiovascular risk.

The AACE goes on to say that men with low testosterone levels should have underlying cardiovascular risk factors addressed and those men with with vascular disease and minor symptoms of hypogonadism should be treated cautiously.

So until the results of large scale trials that look at TRT and cardiovascular risk are published common sense must prevail. Testosterone should be prescribed when there is a clear clinical need based on signs, symptoms and testosterone concentrations.

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