Study on Risks of Testosterone Replacement Therapy with Advanced Age and Underlying Heart Disease

Healthy HeartA study published January 29th, 2014, “Increased Risk of Non-fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men,” by Finkle Et. al. (you can read it here… ) was brilliant in methodology but the title is misleading.

What this huge study of over 55,000 men placed on testosterone actually found was that testosterone replacement therapy was actually protective (fewer heart attacks) for men under 55 and men under 65 who did not have prior history of heart disease.  For men over 65, this study shows an increased risk of heart attacks in the first 90 days after starting testosterone replacement therapy, with that risk increasing with age.  There was also increased risk for those men over 55 with prior heart disease.

I am seeing an increased number of young men suffering debilitating symptoms of lost libido, anxiety, fatigue, loss of energy, poor exercise tolerance, and inability to build muscle, many of whom have testosterone levels of an 80 year old man or even levels similar to those of women.  The cause of this is not completely understood, but we do know toxins such as endocrine disrupters (plastics, phthalates, pesticides, and herbicides) along with drugs of abuse (THC, alcohol, opiates, methamphetamine) have been known to lower testosterone levels in men.

While it is true that more and more prescriptions for testosterone are being written, it is also likely that many more younger men (under 55) who desperately need testosterone replacement, are not being properly evaluated or diagnosed. Many are being placed on antidepressants and anti-anxiety medications when in reality what they need is testosterone.

This is an important study, and should cause those physicians starting testosterone replacement therapy to use caution when treating men over 65 or those over 55 with underlying heart disease.

There are numerous studies showing the benefits of testosterone replacement therapy.

I list for you below links to many of the articles showing the health benefits of testosterone replacement therapy for those with low testosterone:


Testosterone Treatment and Mortality in Men with Low Testosterone Levels

Conclusions: In an observational cohort of men with low testosterone levels, testosterone treatment was associated with decreased mortality compared with no testosterone treatment.


Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes

Conclusions: Low testosterone levels predict an increase in all-cause mortality during long-term follow-up. Testosterone replacement may improve survival in hypogonadal men with type 2 diabetes.


Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men

European Prospective Investigation Into Cancer in Norfolk (EPIC-Norfolk) Prospective Population Study

Conclusions— In men, endogenous testosterone concentrations are inversely related to mortality due to cardiovascular disease and all causes. Low testosterone may be a predictive marker for those at high risk of cardiovascular disease.


Low free testosterone predicts mortality from cardiovascular disease but not other causes: the Health in Men Study

Conclusions: Low testosterone predicts mortality from CVD but is not associated with death from other causes. Prevention of androgen deficiency might improve cardiovascular outcomes


Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study

Conclusions: Lower testosterone and higher E(2) levels correlate with increased risk of CVD and CV mortality. TRT in hypogonadism moderates metabolic components associated with CV risk.


Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis

Conclusions: Low endogenous testosterone levels are associated with increased risk of all-cause and CVD death in community-based studies of men


Low serum testosterone, arterial stiffness and mortality in male haemodialysis patients

Conclusions: We showed that testosterone deficiency in male HD patients is associated with increased CVD and all-cause mortality and that increased arterial stiffness may be a possible mechanism explaining this association.


Testosterone deficiency syndrome (TDS) and the heart


Low serum testosterone and mortality in older men

Conclusions: Testosterone insufficiency in older men is associated with increased risk of death over the following 20 yr, independent of multiple risk factors and several preexisting health conditions.


Plasma total testosterone and incident cardiovascular events in hypertensive patients

Conclusions: Our results show that low plasma testosterone is associated with increased risk for a MACE (Major Adverse Cardiovascular Events) in hypertensive patients.


Low free testosterone is associated with heart failure mortality in older men referred for coronary angiography

Conclusions: Low levels of FT are independently associated with increased CHF mortality.


Relationship Between Low Levels of Anabolic Hormones and 6-Year Mortality in Older Men

Conclusions: Age-associated decline in anabolic hormone levels is a strong independent predictor of mortality in older men. Having multiple hormonal deficiencies rather than a deficiency in a single anabolic hormone is a robust biomarker of health status in older persons.


Testosterone: a metabolic hormone in health and disease

Clinical trials demonstrate that testosterone replacement therapy improves the insulin resistance found in these conditions as well as glycaemic control and also reduces body fat mass, in particular truncal adiposity, cholesterol and triglycerides


Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels


Dr. Paul



Reply To This Post