Controversies regarding the cardiovascular effects of testosterone replacement therapy in older men

Testosterone (T) levels decline with the advancement of age and have been associated with increased incidence of cardiovascular disease (CVD). Indeed, several epidemiologic and prospective cohort studies have suggested that low T levels (lower tertile or quartile) are associated with increased incidence of CVD, type 2 diabetes mellitus (T2DM), obesity and dyslipidemia. In contrast, correction of low T levels with testosterone replacement therapy (TRT) is associated with a decrease in the incidence of CVD, T2DM and dyslipidemia as has been demonstrated by several randomized, controlled trials as well as prospective cohort studies. However, recent studies have shown that TRT is associated with an increased incidence of adverse CV events and these studies have created a great controversy regarding the CV benefits of TRT. In order to get a better perspective on the current status of TRT, a focused MEDLINE and Cochrane database search of the recent English language literature between 2010 and 2017 was conducted and 29 pertinent papers were retrieved. The studies reviewed could not definitely confirm the beneficial or adverse CV effects of TRT. Therefore, on the basis of the current stage of knowledge, older male subjects with low T levels could continue to receive TRT, but this decision should be discussed with their physicians.