Controversies in Testosterone Therapy

Area of Science:

• Endocrinology
• Urology
• Cardiology

Background:

• Testosterone prescriptions have risen due to guideline changes, sparking debate on risks versus benefits.
• Concerns exist regarding testosterone therapy (TTh) and cardiovascular disease, thromboembolic events, obstructive sleep apnea (OSA), benign prostatic hyperplasia (BPH), and prostate cancer (PCa).
• TTh's potential role in managing prediabetes also remains under discussion.

Purpose of the Study:

• To systematically review current evidence on the risks and benefits of TTh.
• To affirm or refute concerns about TTh increasing the incidence of cardiovascular disease, thromboembolic events, OSA, urolithiasis, BPH, and PCa.
• To evaluate TTh's role in managing prediabetes.

Main Methods:

• A systematic review of 62 relevant publications on TTh effects and risks.
• Literature search included evidence up to December 2019.

Main Results:

• Positive associations found between TTh and OSA, erythrocytosis, and urolithiasis.
• TTh may benefit hypogonadal men with prediabetes.
• TTh does not appear to increase cardiovascular risk and may decrease it in hypogonadal men; it is unlikely to increase PCa risk.

Conclusions:

• Recent evidence suggests TTh carries less risk than previously believed for cardiovascular disease, thromboembolic events, BPH, and PCa.
• TTh is a reasonable treatment option for many hypogonadal men, even those with prior risk factors.
• Continued caution is advised, but TTh can be considered for a broader population of hypogonadal men.