A new study confirms: Testosterone Replacement Therapy is safe!

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A new study confirms:

Testosterone Replacement Therapy is safe!

You have probably heard that Testosterone Replacement Therapy (TRT) is risky for older men. Many law firms have run advertisements along the line of this:

Attention men! If you were prescribed testosterone therapy and later suffered a heart attack or stroke, this message is for you! Many research studies have determined that prescription testosterone increases the risk of heart attacks and strokes. If you have used any type of testosterone, such as pellets, gels, or injections, and then suffered a stroke or heart attack, call the law firm of XXXXXXX at (XXX)-XXX-XXXX. The manufacturer may be liable, and you may be entitled to substantial compensation. CALL NOW and get the compensation you deserve!

How about the Food and Drug Administration (FDA) warnings on testosterone packages: “Reported serious adverse outcomes include heart attack, heart failure, stroke, depression, hostility, aggression, liver toxicity, and male infertility.” That sounds pretty serious.

But is it true that testosterone is a killer in disguise? A wolf in sheep’s clothing? A precursor to deadly, debilitating heart attacks and strokes?

Or is this merely fear-mongering from ambulance-chasing attorneys looking for a quick payday and over-zealous, unelected government bureaucrats that take joy in exercising God-like power over all aspects of our lives?

To answer those questions, we need to put emotion and hyperbole aside, look at the facts and conclusions of recent research, and see what the science says.

A recent study by researchers at the University of Aberdeen in the United Kingdom searched publication databases through August 2018 for randomized controlled trials among patients with testosterone levels of 12 nmol/L or less who had been on TRT for at least 3 months. The mean TRT duration for all study participants was 9.5 months.

The goal of this study was to “provide the most extensive individual participant dataset (IPD) of testosterone trials available, to analyze subtypes of all cardiovascular events observed during treatment, and to investigate the effect of incorporating data from trials that did not provide IPD” said Jemma Hudson, one of the leading researchers of the 37-member team.

The study was extensive, as Hudson promised. The team initially looked at 9,871 studies. After omitting irrelevant studies and duplicates, 225 studies were left. The team then further narrowed the studies to 35. The number of subjects was 5,601 men with a mean age of 65, and the mean Body Mass Index (BMI, a calculated number of pounds divided by height to measure obesity) was 35, which means that some of the men were a bit rotund. Several of them were diabetic, and others had experienced cardiovascular disease.

After rigorously delving through the data, the team's conclusion was clear: They found no evidence that TRT increased the risk of short-term to the medium-term risk of heart attack or stroke in men treated with testosterone for low testosterone (aka “Low-T).

Here are the specifics of the study’s findings:

No significant elevation of blood pressure, glucose sensitivity, or A1C (a measure of average blood sugar over the previous three months) between the groups.
Both serum total cholesterol and triglycerides were significantly lower in the testosterone groups.
The cardiovascular and cerebrovascular (lower brain blood flow) data found that the testosterone subjects reported slightly more (120) deaths than the placebo group (110), but not of statistical significance. Later sensitivity analyses (examining how changes in methods, models, or values of unmeasured variables affected results) found that the risk of cardiovascular or cardio cerebral events was lower after testosterone levels were normalized.
The testosterone group reported fewer deaths from all causes than the placebo group but, again, not of statistical significance.
Hemoglobin and hematocrit were higher in the testosterone groups, and the number was statistically relevant. This is not surprising since TRT squelches hepcidin, a hormone produced by the liver that regulates iron levels, and iron levels directly impact red blood cell production. However, only 5 cases of deep-vein thrombosis occurred in the testosterone groups, compared to 7 in the placebo group.
Most importantly, there was no difference in the groups concerning the development of prostate cancer.

The team weighs in on the results of the study.

Here is the research group statement: "The most frequently recorded cardiovascular event categories in the identified trials were arrhythmia, coronary heart disease, heart failure, cerebrovascular events, and myocardial infarction. We have also identified and reported frequencies of stable angina, peripheral vascular disease, aortic aneurysm, and aortic dissection, which have not been reported by any previous meta-analysis. None of the cardiovascular event subtypes were significantly more common in patients assigned to testosterone treatment than in patients assigned to placebo.”

“We have conducted the most comprehensive study to date investigating the safety of testosterone treatment of hypogonadism. Testosterone treatment did not increase cardiovascular event risk in the short term to medium term.”

These findings were published in The Lancet Healthy Longevity.

This study was one of the most comprehensive examinations of the effects of TRT. The results speak loudly: When undertaken with proper medical supervision, a Testosterone Replacement Therapy treatment regimen can deliver the benefits it promises.

Contrary to the hysterical warnings about TRT causing heart attacks and strokes, testosterone may exhibit “reverse causality” by lowering the risk of cardiovascular events instead of raising them!

More critical, TRT is safe! Notice the last sentence in the final statement of the team: “...Testosterone treatment did not increase cardiovascular event risk in the short term to medium term.”

Reference

Hudson J, Cruickshank M, Quinton R, et al. Adverse cardiovascular events and mortality in men during testosterone treatment: an individual patient and aggregate data meta-analysis. Lancet Healthy Longev. Published online June 1, 2022. doi:10.1016/S2666-7568(22)00096-4

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