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Testosterone deficiency and cardiovascular mortality.

Abraham Morgentaler1

  • 1Men's Health Boston, Harvard Medical School, Boston, MA, USA.

Asian Journal of Andrology
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Summary
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Concerns about testosterone therapy (TTh) cardiovascular risks are unfounded due to flawed studies. Evidence indicates TTh and higher testosterone levels are beneficial for cardiovascular health and mortality.

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Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Recent concerns regarding cardiovascular (CV) risks associated with testosterone therapy (TTh) have emerged.
  • These concerns largely stem from two retrospective studies with significant methodological flaws and data errors.

Purpose of the Study:

  • To critically evaluate the validity of reported cardiovascular risks linked to testosterone therapy.
  • To review existing evidence on the relationship between testosterone levels, TTh, and cardiovascular outcomes.

Main Methods:

  • Analysis of methodological limitations and data errors in two key retrospective studies questioning TTh safety.
  • Review of numerous observational studies and randomized controlled trials (RCTs) investigating TTh and CV health.

Main Results:

  • The two primary studies cited for CV risk were found to have critical flaws, including statistical misapplication and data contamination.
  • Multiple studies suggest TTh is associated with decreased mortality and reduced myocardial infarction (MI) rates.
  • RCTs show TTh benefits in men with coronary artery disease and heart failure, improving CV risk factors.

Conclusions:

  • The current evidence does not support an increased CV risk or mortality with TTh.
  • Low serum testosterone levels are linked to increased CV risk.
  • Higher endogenous testosterone and TTh appear beneficial for CV health and mortality.