MYTHS AND CONTROVERSIES IN HYPOGONADISM TREATMENT OF AGING MALES

Area of Science:

• Endocrinology
• Metabolic Health
• Cardiovascular Health

Background:

• Low testosterone (T) is an independent risk factor for metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM).
• Patients with MetS and T2DM should be screened for hypogonadism.
• Men with low testosterone face risks including premature death.

Purpose of the Study:

• To review the effects of testosterone replacement therapy (TRT) on metabolic health, body composition, and cardiovascular parameters.
• To discuss the potential benefits and risks of TRT, particularly concerning prostate cancer and cardiovascular adverse effects.
• To highlight the need for large-scale, placebo-controlled trials to clarify TRT's cardiovascular safety.

Main Methods:

• Literature review of studies investigating testosterone levels, TRT, and associated health outcomes.
• Analysis of existing evidence on TRT's impact on insulin resistance, fat mass, lean body mass, libido, bone density, and prostate cancer.
• Examination of data regarding TRT's cardiovascular effects, including antiarrhythmic and vasodilator properties, and impact on heart failure patients.

Main Results:

• TRT improves insulin resistance, reduces fat mass, increases lean body mass, and ameliorates libido.
• TRT has shown positive effects in heart failure patients, improving exercise capacity.
• While TRT does not increase prostate cancer risk, it can stimulate the growth of existing metastatic prostate cancer.

Conclusions:

• TRT offers significant benefits for men with low testosterone, impacting metabolic health and body composition positively.
• The cardiovascular safety of TRT remains under investigation, with ongoing debate about potential adverse effects.
• Further large prospective, placebo-controlled randomized trials are essential to definitively establish the cardiovascular risks associated with TRT.