Man grabs at his heart. He has a heart attack. risk of heart attacks, heart attack patients, alirocumab

Q. I am a 54-year-old male and I have noticed a drop-off in sexual performance and energy. I have seen commercials for products that either boost or cause your body to produce testosterone.

What can you tell me about products that improve testosterone levels? Is there a downside?

A. We are not sure how well such products may work, but an analysis showed that many of those on the market are adulterated with undeclared erectile dysfunction drugs such as sildenafil or tadalafil (Journal of Pharmaceutical and Biomedical Analysis, Jan. 5, 2015). Anyone taking a drug like sildenafil (Viagra) would be better off knowing exactly what they are getting.

Your doctor could measure your testosterone and prescribe testosterone if your level is too low. We have been concerned that taking supplemental testosterone might raise the risk of cardiovascular complications such as heart attacks.

The Great Testosterone Controversy

A year ago a study was published that scared a lot of men receiving testosterone therapy (PLOS One, Jan. 29, 2014). It was titled “Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men.” The authors found that:

“Among men aged 65 years and older, we observed a two-fold increase in the risk of MI [myocardial infarction or heart attack] in the 90 days after filling an initial TT [testosterone therapy] prescription, the risk declined to baseline in the 91 to 180 days after initial TT prescription, among those who did not refill their prescription…

“Among younger men with a history of heart disease, we observed a two to three-fold increased risk of MI in the 90 days following an initial TT prescription and no excess risk in younger men without such a history…

“Our findings are consistent with a recent meta-analysis of placebo-controlled randomized trials of testosterone therapy lasting 12 or more weeks among mainly older men, which reported that testosterone therapy increased the risk of adverse cardiovascular-related events, as well as serious adverse cardiovascular-related events which included myocardial infarction along with other conditions.”

A new analysis, however, does not show an increased rate of such problems among men using testosterone (Mayo Clinic Proceedings, Feb. 2015). The title of the review is “Testosterone Therapy and Cardiovascular Risk: Advances and Controversies.” The authors reviewed the available research on this topic and concluded:

“Testosterone [T] therapy is associated with reduced obesity, fat mass, and waist circumference  and also improves glycemic control (blood sugar control). Mortality was reduced with T therapy in 2 retrospective studies. Several RCTs [randomized controlled trials] in men with coronary artery disease or heart failure reported improved function in men who received T compared with placebo. The largest meta-analysis to date revealed no increase in CV risks in men who received T and reduced CV [cardiovascular risk] risk among those with metabolic disease. In summary, there is no convincing evidence of increased CV risks with T therapy. On the contrary, there appears to be a strong beneficial relationship between normal T and CV health that has not yet been widely appreciated.”

It is hardly any wonder that physicians and patients feel confused when confronted with two completely different conclusions about testosterone therapy. At this time we would have to say that there is growing doubt that there is a substantial cardiovascular risk associated with testosterone therapy. That said, we encourage men to discuss the latest analysis with their physicians.

Bottom Line

Testosterone ads (you know, the “Low T” commercials) on television make it seem as if adding this hormone will solve most male problems (from low sex drive to lack of energy). We find such ads offensive. Nevertheless, some men truly do suffer from a condition called hypogonadism that results in low levels of testosterone. There are blood tests that can reveal if there truly is a problem; in such cases hormone therapy might very well be appropriate.

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  1. Ed T
    DC
    Reply

    Instead of emphasizing the relative risks, which always exaggerate any adverse effects, review the actual research article. The actual article demonstrated a very low increase in absolute risk.

  2. Patrick
    Houston, TX
    Reply

    Two years after Prostate cancer surgery, I began having the symptoms of “night sweats” and “hot flashes”. After a bunch of test, it was determined I had low T.
    Since being on HRT, those symptoms have disappeared, and 14 years later I’m doing just fine. At 72, I enjoy a healthy sex life and hit the gym 3-4 times a week.
    If you need HRT, in my opinion, do it, it works.

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