Study: No Link Between Testosterone Therapy And CV Risk

According to a new review, the feared link between testosterone replacement therapy and greater cardiovascular risk is not founded.

Lead author Abraham Morgentaler, MD, director of Men’s Health Boston, and a urologist at Beth Israel Deaconess Medical Center, and colleagues identified just 4 scientific journal articles published since 1940 that suggest higher cardiovascular risks associated with testosterone prescriptions. At least 2 of those articles have “serious methodological limitations,” the authors write in their review, citing 1 placebo-controlled trial with few major adverse cardiac events, and a meta-analysis that “included questionable studies and [cardiovascular] events.”

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Conversely, Morgantaler and his co-authors cite “dozens of studies” that examine the relationship between testosterone and heart-related issues such as coronary heart disease, ischemic stroke, cholesterol levels, angina, and heart failure.

This research, along with other studies, actually demonstrate that men with low levels of testosterone who did not receive testosterone replacement therapy died at double the rate of similar men who did receive testosterone, according to the authors. Morgantaler and his colleagues note that a small number of randomized, controlled studies have shown men with heart disease functioning better when receiving testosterone, in comparison to a placebo. In addition, some studies have shown benefits connected to testosterone therapy, such as increased sex drive, energy, and bone mineral density.

“We found no compelling scientific evidence to support the recent allegations of increased cardiovascular risk with testosterone therapy,” says Morgantaler. “On the contrary, a rich literature dating back more than 70 years strongly suggests testosterone therapy may have cardiovascular benefits.”

While noting that a large, prospective trial is necessary to provide definitive answers, “what this means in the meantime is that primary care practitioners should not be discouraged from treating men with testosterone deficiency—also called hypogonadism—if they feel it is clinically indicated,” says Morgantaler. “Treatment clearly provides important benefits for many affected men with symptoms of sexual dysfunction, decreased libido, and fatigue.”

—Mark McGraw


Morgantaler A, Miner M, et al. Testosterone Therapy and Cardiovascular Risk: Advances and Controversies. Mayo Clinic Proceedings. 2015.