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Testosterone and cardiovascular disease.

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  • 1aCity University New York School of Public Health and Hunter College, New York, USA bSchool of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.

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Testosterone use is rising, but evidence suggests it increases cardiovascular risks, contrary to some prior beliefs. Further large trials are needed to confirm these findings and guide clinical practice.

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Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Background:

  • Testosterone use in men is increasing, with low levels linked to cardiovascular disease.
  • Large randomized controlled trials (RCTs) evaluating testosterone's cardiovascular effects are lacking.
  • Existing evidence from observational studies, Mendelian randomization, and meta-analyses needs synthesis.

Purpose of the Study:

  • To review recent evidence on testosterone's impact on cardiovascular outcomes.
  • To inform current clinical practices regarding testosterone therapy.
  • To assess the cardiovascular risks associated with testosterone use.

Main Methods:

  • Review of pharmacoepidemiology studies.
  • Analysis of Mendelian randomization studies.
  • Meta-analysis of randomized controlled trials (RCTs).

Main Results:

  • A large pharmacoepidemiology study linked testosterone prescription to myocardial infarction.
  • Mendelian randomization studies did not support beneficial cardiovascular effects and suggested adverse lipid changes.
  • A meta-analysis of 27 RCTs (2994 men) showed an increased risk of cardiovascular events with testosterone (OR 1.54).

Conclusions:

  • Current evidence suggests testosterone therapy may cause ischemic cardiovascular disease, contradicting some observational data.
  • The findings have significant implications for clinical practice and testosterone prescribing.
  • A definitive large RCT is warranted, but synthesizing existing data may offer timely insights.