The purpose of this study is to review recent studies that examined the association of endogenous and exogenous testosterone and mortality in older men.
Over the past several years, there has been a steep rise in testosterone prescriptions. The increased use of testosterone occurred in the context of several studies that reported an association between low serum testosterone and increased cardiovascular events and mortality. In contrast, recent studies have reported an association between testosterone treatment and adverse events. A testosterone treatment trial of mobility-impaired elderly men with prevalent cardiovascular disease was stopped due to increased cardiovascular events in the T-treated men and a meta-analysis reported increased cardiovascular events in T-treated men. In two recent large observational studies, testosterone treatment was associated with an increased risk for serious adverse cardiovascular events.
Low testosterone is associated with mortality in multiple cohort studies; however, it is unclear if this is a causal association or due to low testosterone being a biomarker of poor health. Given recent reports of adverse outcomes associated with testosterone treatment, a conservative use of testosterone is warranted in men with cardiovascular disease who may be at greater risk for adverse outcomes.
aVA Puget Sound Healthcare System
bDepartment of Psychiatry and Behavioral Sciences
cDepartment of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington
dGeriatric Research, Education and Clinical Care (GRECC), Seattle, Washington, USA
Correspondence to Molly M. Shores, MD, VA Puget Sound Healthcare System, 1660 S. Columbian Way, S-116A, Seattle, WA 98108, USA. Tel: +1 206 764 2610; fax: +1 206 764 2225; e-mail: firstname.lastname@example.org