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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000443757.15066.e9
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Caveats About Testosterone Therapy

Wallis, Laura

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Abstract

Providers and patients should weigh risks against benefits.

The use of prescription testosterone therapy by men in the United States is at an all-time high, having reached 5.3 million prescriptions in 2011, a fivefold increase since 2000. Although understandably popular—testosterone therapy improves sexual function, bone mineral density, and strength, as well as lipid profiles and insulin resistance—the therapy is also controversial because its long-term safety hasn't been studied.

Some recent evidence, in fact, suggests that the therapy could lead to higher risks of heart attack, stroke, and death in certain patients.

A recent study published in JAMA evaluated male Veterans Administration patients with low testosterone levels (under 300 ng/dL) who underwent coronary angiography between 2005 and 2011.

What they found was a notable increased risk of adverse outcomes—including myocardial infarction, stroke, and death—among those patients receiving testosterone therapy. The study also addressed the gap in knowledge about long-term testosterone treatment, particularly in light of a recent trial (the Testosterone in Older Men with Mobility Limitations trial) that was stopped because of an increase in cardiovascular events among its subjects—all frail older men with cardiovascular disease.

Of the 8,709 patients with low testosterone levels in the JAMA study, 1,223 underwent testosterone therapy after coronary angiography. The patients who underwent testosterone therapy were younger (mean age, 60.6 years) than those who didn't (63.8 years) and tended to have fewer comorbidities, such as congestive heart failure and hypertension. But despite those factors, they had an absolute rate of adverse events of 25.7%, compared with 19.9% in the no-testosterone group—a 5.8% absolute risk difference—at three years after angiography. The presence of coronary artery disease at baseline didn't affect the outcomes.

The authors note that more research is needed to determine the safety of long-term testosterone therapy.

In the meantime, although providers should continue to discuss the symptomatic benefits of the treatment, it's also important to stress the unknown long-term risks and potential for harm.—Laura Wallis

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REFERENCE

Vigen R, et al. JAMA. 2013;310(17):1829–36

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