Men with low testosterone whose levels normalize with testosterone replacement therapy (TRT) may enjoy lower risks of heart attack, stroke, and early death, a new study suggests.
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The researchers divided the men into three clinical groups: those who were treated to the point where their total testosterone levels returned to normal (Group 1); those who were treated but without reaching normal (Group 2); and those who were untreated and remained at low levels (Group 3).
This week, investigators from Brigham and Women’s Hospital (BWH) report the results of the Testosterone’s Effects on Atherosclerosis Progression in Aging Men (TEAAM) trial in the Journal of the American Medical Association (JAMA).
The research team enrolled more than 300 men over the age of 60 with low to low normal range testosterone levels in a three-year, double-blind study.
New research offers both reassurance and disappointing news to men who take testosterone supplements to improve their energy levels, libido and general health: The popular therapy does not appear to hasten progression of cardiovascular disease; neither, however, does it appear to improve sexual function or overall health-related quality of life.
“But what our study shows is that middle aged and older men whose testosterone levels are in the normal range – or slightly below normal – do not benefit to the same degree, and that they should not indiscriminately use testosterone”, he said. “Many men, as they get older, experience a decline in testosterone and in sexual function and vitality”.
However, future research will be needed.
Barua and his team took into consideration several factors that could affect the overall risk and cardiovascular state, such as the age of the participants, their body mass index (BMI), levels of LDL cholesterol, chronic illnesses, as well as their use of statins, beta blockers and aspirin. The men who received treatment were 56% less likely to die, 24% less likely to have a heart attack and 36% less likely to have a stroke than those who were untreated. Group 1 was given the TRT and saw normalization of their levels of testosterone.
Similar differences emerged between the second and third groups but were less pronounced.
The researchers say Testosterone had no effect on the rate of hardening of arteries over the course of the therapy.
Possible explanations, they said, could involve body fat, insulin sensitivity, lipids, blood platelets, inflammation, or other biological pathways.
But “asymptomatic men should not be” considered for testosterone replacement therapy, or even screened for low testosterone levels.
The authors also caution that “off-label” use remains a concern.
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The study – the largest to-date on TRT and with the longest followup period – involved men who were treated between December 1999 and May 2014 at the Kansas City VA Medical Center.
