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Testosterone Therapy Associated with Adverse Outcomes After Coronary Angiography — Physician’s First Watch

Medical News |
November 6, 2013

Testosterone Therapy Associated with Adverse Outcomes After Coronary Angiography

By Amy Orciari Herman

Testosterone supplementation is associated with a significantly increased risk for cardiovascular events among older male angiography patients, according to a retrospective study in JAMA.

Researchers examined outcomes among some 8700 veterans who'd undergone coronary angiography and had total testosterone levels below 300 ng/mL. Some 14% began testosterone therapy (usually patch or injection) at a median 1.5 years after angiography.

At 3 years, the primary outcome — a composite of all-cause mortality, MI, and ischemic stroke — had occurred in 26% of the testosterone group and 20% of the untreated group. After adjustment for coronary artery disease and other confounders, the relative risk for the primary outcome was 30% higher with testosterone therapy.

Harlan Krumholz, a cardiologist with NEJM Journal Watch, commented: "Amid the onslaught of ads promoting testosterone, this study provides cautionary information — and reminds us that chasing surrogate outcomes, like testosterone levels, may actually cause harm. We need outcomes studies to understand better the safety of these products."

Reader Comments (3)

Michael Rosenbaum MD Physician, Family Medicine/General Practice, solo practice

Older patients receiving testosterone convert more of the androgen into estrogen due to an increase in aromatase activity with age.
High estrogen levels contribute to coronary heart disease in men.
This may partially explain the data...This mechanism can be inhibited by providing an aromatase inhibitor to the men at a dose about one-seventh that a woman would receive...Usually one to one and a half milligrams a week...It is important to periodically measure estradiol levels in men receiving testosterone and to use an aromatase inhibitor if required..It may be no reason to stop prescribing testosterone to men in andropause...

Dr.

BRIAN BERRYMAN Physician, Family Medicine/General Practice, VA

So, after 3 years, 75% of all patients were fine, and if you had testosterone replacement, you had a 1 in 20 greater risk on having death or cardiovascular event. I think I would take my chances to feel better and a better quality of life.

Mike Fair Other, Other, retired

OF course, don't forget that very low testosterone levels can be a negative when heart failure is involved. The heart is still a muscle.

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