Wednesday Nov 6, 2013 (foodconsumer.org) -- A man with testosterone deficiency can have a series of health conditions and testosterone replacement therapy can provide a wide range of benefits including weight loss, improved sexual function, bone mineral density, lipid profile, insulin resistance, and depression, increased fat free mass and strength among others.  This potent male sexual hormone can also increase risk of heart disease, myocardial infarction (stroke) and death, a recent study in JAMA revealed.   It should be noted that even high endogenous testosterone can increase the risk, according to early studies.

Estrogen, female sex hormone when used as a hormone replacement therapy has been known to increase the risk of heart disease and breast cancer.  The current study led by Rebecca Vigen, MD, MSCS from The University of Texas at Southwestern Medical Center in Dallas, Texas and colleagues also found testosterone replacement therapy increases the risk of heart disease and other associated events like stroke and death by 29%.

The authors noted that use of testosterone therapy has been on the rise in the United States over the past decade.  Annual sales for this hormone reached $1.6 billion in 2011.  One catchy term used to promote sales for this hormone is naturally identical testosterone.  By saying naturally identical, marketers mean to say that this exogenous testosterone is as safe as endogenous testosterone produced in vivo in men. The reality is, no matter it is generated exogenously or endogenously, high levels of testosterone are unsafe, according to the current and other prior studies.

The authors also noted that the increase in the risk of heart disease due to using testosterone therapy has been elusive and prior clinical studies of testosterone therapy failed to detect any adverse cardiac events ( it may all depend on who conducted the clinical studies!).  These trials as the study authors pointed out were focused mainly "on intermediate end points, of short duration and not powdered for clinical end points."

Not all trials have suggested using testosterone is trouble-free.  A recent trial was prematurely terminated due to the unexpected high prevalence of cardiovascular diseases found in older fail men who received testosterone.  It seems that this trial motivated the authors of the current study to examine the association between use of testosterone therapy and all-cause mortality, myocardial infarction or heart attack and stroke among male veterans in a national cohort study who suffered low testosterone (lower than 300 ng/dL) who received coronary angiography screening in the Veterans Affairs (VA) system between 2005 and 2011.

Of the 8709 men with low testosterone, 1223 started testosterone therapy a median of 531 days after the coronary angiography examination while 7486 patients did not.

Adverse events were counted for both the study group and the control group at three years after the coronary angiography.   The rate of adverse effects including all-cause death, myocardial infarction and ischemic stroke was found at 19.9% in those in the control group, compared to 25.7% in the study group.  The increase in the risk for adverse outcomes after adjustment for the presence of coronary heart disease was 29% higher in the group receiving testosterone, compared with the controls.

The adverse effect from testosterone was not modified by the status of coronary artery disease, the study found, meaning that all men with or without coronary artery disease who used testosterone therapy suffered an increase to a similar extent in the risk of adverse outcomes.

The researchers concluded “Among a cohort of men in the VA health care system who underwent coronary angiography and had a low serum testosterone level, the use of testosterone therapy was associated with increased risk of adverse outcomes. These findings may inform the discussion about the potential risks of testosterone therapy."

An increase heart risk is not the only adverse outcome patients undergoing testosterone therapy should expect.  High serum testosterone levels have already been associated with an increased risk of prostate cancer in studies conducted many years ago.

One study led by J. Kellogg Parsons from The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions in Baltimore, MD and colleagues revealed the potential risk of testosterone replacement therapy - an increase in the risk of prostate cancer. The study was released in 2005.

Compared with those in the lowest quartile of serum levels of free testosterone, those in the highest quartile were at 159% increased risk of developing prostate cancer.

Parsons et al. cautioned that men receiving testosterone therapy should be monitored regularly for prostate cancer.

Men with low testosterone may not have much manly activities.  But studies have shown that men with low testosterone can live many years longer.  That is because high testosterone can cause a series of problems including early death.  It is all about a balance, a high re-productivity means a shorter lifespan and vice versa. (David Liu, PHD)