When men start testosterone replacement therapy (TRT), or what we like to call testosterone OPTIMIZATION therapy (TOT), some guys have concerns over the association with heart disease that they have heard on the news or in commercials. First, lets discuss where this connection came from.
In 2013 and 2014 there were two studies released that showed men who started TRT had a higher incidence of having a cardiovascular event. After these studies were published, the media had a frenzy over it and the FDA decided to issue a warning about testosterone therapy. These two studies were critically flawed in their designs and one study later issued a correction and stated there was actually a 50% LOWER incidence of cardiovascular disease in the men receiving TRT. The other study didn’t even have a control group!
After the FDA warning, the American Association of Endocrinologists and the American College of Endocrinology have both stated that the scientific data between the association of TRT and cardiovascular disease is lacking and that there is no conclusive evidence that it increases the risk.
Now for the good news, there are multiple studies that show men who have optimal testosterone levels have a lower incidence of cardiovascular disease. Check out this TABLE that lists over a dozen studies that show TRT improves cardiac outcomes, decreases the risk or shows no correlation at all.
A study published in 2011 by Ohlsson and colleagues report that high serum testosterone level predicted a 5-year reduced risk of cardiovascular events in elderly men.
Another study in 2010 by Akishita and colleagues studied a population of 171 men, finding that those with low testosterone levels were more likely to develop cardiovascular events than those with higher levels.
A more recent study published in 2017 by Cheetham and colleagues in the Journal of the American Medical Associated examined 8808 men who were undergoing TRT over an average period of 3.4 years had lower incidences of cardiovascular events than those not undergoing treatment.
There is simply no 100% answer about testosterone and the risk of cardiovascular disease. More studies show TRT is favorable in regards to cardiovascular risk than not, but it is a difficult subject to study and prove without a doubt a significant correlation. There are so many factors involved in cardiovascular disease, that testosterone alone is likely not a major contributing factor either way.
I tend to agree with the current opinions of the American Association of Endocrinologists and the American College of Endocrinology that TRT should be considered in men who are symptomatic and have low testosterone levels, that there is no compelling evidence that TRT either increases or decreases cardiovascular risk, and that testosterone therapy for men with testosterone deficiency is effective and safe.