Giving Testosterone to Men with Low Testosterone Linked to Increased Heart Attack Risk

A study of 8,709 men followed for 28 months shows that giving testosterone to men with low levels of that hormone is associated with increased risk of death, heart attacks and strokes by 30 percent (Journal of the American Medical Association, Nov. 6, 2013;310 (17):1829-1836). In a group of men that did not receive testosterone, 19.9 percent suffered heart attacks, compared to 25.7 percent in the group that received testosterone. Those who were prescribed testosterone were slightly healthier than those who were not, although men who are obese are more likely to have lower levels of testosterone.

Association, Not Cause This study shows an association between taking testosterone and heart attacks. It does not prove that testosterone causes older men to suffer heart attacks. The study group were men in the Veterans’ Administration Hospital System, and they are known to have more disease and health problems and die earlier than men in the general population.

A previous study at the Boston Medical Center was stopped after it was shown that the men who took testosterone were at increased risk for heart attacks and high blood pressure. Testosterone injections can increase clotting (platelet aggregation), and testosterone is converted to dihydrotestosterone that increases atherosclerosis.

Drug Company Advertising In 2011, men in the United States paid 1.6 billion dollars for 5.3 million prescriptions of testosterone. Many older men take testosterone today primarily because the are exposed to voluminous advertising by drug companies encouraging older men to be tested for low testosterone. Many men who see these advertisements request the tests and ask their doctors to treat them if they have low levels of testosterone, even if they have no symptoms.

Many Normal Men have Low Testosterone All healthy men and women suffer a drop in blood levels of testosterone with aging. Low testosterone blood levels are normal in many older men who are not impotent, do not have decreased sexual desire, are not depressed and do not have excessive weakening or decreased size of their muscles. A review of studies published between 1970 and 2013 shows that men with low blood testosterone levels may be at slightly increased risk for heart attacks (Journal of Clinical Endocrinology & Metabolism, November 2013).

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