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Would Testosterone Therapy Harm Your Heart? Low testosterone not only lowers a man's sex drive, energy and motivation but also has some harmful effects. Hence men with low testosterone levels can usually be prescribed, if necessary, testosterone replacement therapy (TRT) to boost their testosterone level back to normal. Almost 3 percent of American men aged 40 and above have been prescribed TRT. Their spending is estimated at $2 billion a year. However, up to 25 percent of the prescriptions were written without prior blood test by medical providers to check the hormonal levels. While bringing testosterone up to normal can have a positive impact on men’s health, TRT can lead to thickening of blood that might raise the risk of stroke. Men receiving such therapy can also have some uncommon side effects including sleep apnea, acne, and breast enlargement, though these side effects will go away if treatment is stopped. According to a paper released on November 6, 2013 in the ‘Journal of the American Medical Association’ (JAMA), TRT will raise the risk of getting heart attack, stroke and even death for men who had history of heart disease and low testosterone levels. In the study, researchers from the University of Texas at Southwestern Medical Center in Dallas reviewed records from more than 8,700 men with average age of 60 and who had low testosterone levels and underwent coronary angiography in the Veterans Affairs system between 2005 and 2011.
1,200 of the participants with low testosterone started TRT after their tests, and the participants were followed up after an average of 2.4 years after their angiography. Coronary angiography is a procedure that uses dye and special X-rays to show the insides of one’s coronary arteries, which supply oxygen-rich blood to the heart. About 1 in 5 of nearly 7,500 men who skip TRT were found to have bad cardiovascular outcomes, including stroke, heart attack or death. But for those received TRT, nearly 1 in 4 had those terrible problems, an increased risk of nearly 30 percent. In another study published January 29, 2014 in the journal ‘PLOS ONE’ and funded by the National Institutes of Health, researchers also linked TRT to higher heart disease risk. Researchers from Consolidated Research, Inc., Los Angeles, National Cancer Institute, Bethesda, and University of California compared rates of heart attacks in 55,593 middle-aged and older men in the 90 days after they received a new TRT prescription with rates during the year prior to the initial prescription. Among all men who received TRT, the risk for non-fatal heart attack was found to jump by 36 percent in the 90 days after starting TRT, compared to that during the one year prior to starting TRT. In men who aged 65 and above, the rate of heart attack jumped by 219 percent, irrespective of whether they had known heart disease. For men aged below 65 and had a prior history of heart disease, the risk had been nearly triple. The study also found that the hormone did not raise the heart attack risk in men aged below 65 without a prior history of heart disease. These 2 studies were undoubtedly in tandem with a paper published in 2010 in the ‘New England Journal of Medicine’ indicating that men with an average age of 74 who received TRT had a higher risk of getting chronic disease including heart attacks. However, a larger study published in 2012 in the ‘Journal of Clinical Endocrinology and Metabolism’ showed that among male veterans aged over 40, those taking testosterone had lower rates of death than those who were not. It seems that results from various studies have been mixed. As most of these studies were observational, they could only establish an association but not the cause-and-effect link between TRT and cardiovascular risk. Hence, scientists should carry out more randomized trials that include a sufficient number of men for an adequate amount of time in order to assess the long-term benefits and risks of TRT.
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