Men's Hormone Therapy May Be Risky for the Heart

Testosterone therapy increased sometimes deadly heart attacks and strokes in men who underwent cardiac tests in new study

(RxWiki News) Properly balanced hormones deliver benefits such as strong bones and healthy sexual function. Restoring natural hormones lost due to illness or aging with hormone supplements is an option, but it may carry risks.

Among men who had coronary angiography (a test to measure build-up of unhealthy plaque in their heart's arteries), those who used testosterone therapy to treat low levels of the hormone had an increased risk of heart attack, stroke and death.

"Ask your doctor about heart and hormonal health."

Rebecca Vigen, MD, MSCS, of the University of Texas at Southwestern Medical Center in Dallas, was lead author of this study.

She and her team of researchers set out to investigate the potential link between testosterone therapy that's delivered by injection, gels or patches and heart disease, heart attack and stroke.

These researchers studied the medical records of 8,079 men who underwent tests for blockages of heart arteries at 76 US Department of Veterans Affairs (VA) medical facilities nationwide between 2005 and 2011 and listed in the VA's medical database.

Each of those men's testosterone levels were measured as lower than normal. Also, all the men had their heart health tested by a coronary angiography. This exam uses dye injections and X-rays to determine whether and to what degree the heart's arteries are blocked and hardened by a dangerous build-up of plaque.

What the researchers found was that, within three years after the coronary angiography, 19.9 percent of the 7,486 patients who did not take testosterone therapy had a major adverse event (death, stroke or heart attack). Of those who didn't use testosterone therapy, 681 died, 420 had heart attacks and 486 had strokes.

Among the 1,223 patients who did receive testosterone therapy, 25.7 percent had a serious health crisis: 67 died, 23 had heart attacks and 33 had strokes.

The group taking testosterone was 61 years old, on average. Those who did not take testosterone were 64 years old, on average.

Out of the entire group of 8,709 study participants, 20 percent had had a heart attack before the study began. A total of 50 percent had been diagnosed with diabetes, and 80 percent had been diagnosed with coronary heart disease.

"Our findings raise some uncertainty regarding the potential safety of testosterone use in men," the researchers wrote. "Although physicians should continue to discuss the symptomatic benefits of testosterone therapy with patients, it is also important to inform patients that long-term risks are unknown and there is a possibility that testosterone therapy might be harmful."

Testosterone often is prescribed as a remedy for erectile dysfunction, which can be an early sign of cardiovascular disease, Sarah Samaan, MD, told dailyRx News. Still, erectile dysfunction may be improved by treating such risk factors for heart disease as high blood pressure, diabetes and high cholesterol, she said.

“Just like the heart and brain, the blood vessels supplying the penis can be constricted by cholesterol build-up,” said Dr. Samaan, a cardiologist at Baylor Heart Hospital’s Legacy Heart Center in Dallas, Texas. “ … Many men are unaware that obesity and lack of exercise can contribute to testosterone deficiency and erectile dysfunction.”

Dr. Samaan said that this new study “provides important information for men who are considering testosterone therapy … Diagnosing testosterone deficiency can be tricky, since levels typically vary throughout the day, yet prescriptions for hormone therapy have soared. Now that we have strong evidence that the therapy can raise heart attack and stroke risk, it is critical that doctors and their patients discuss these issues carefully — and consider other options — before choosing testosterone treatment.”

Part of what prompted their research, these researchers wrote, is the steep rise in the number of men being prescribed replacement testosterone. That number soared from roughly 1 million prescriptions in 2000 to 5.3 million by 2011, the researchers wrote.

They cited one clinical trial, Testosterone in Older Men with Mobility Limitations, that was prematurely halted after researchers concluded that it was too risky to its older, frail participants with a "high prevalence of cardiovascular diseases."

The researchers suggested more studies be conducted to more fully determine the effects of testosterone.

The study was published online November 5 in JAMA.

The VA funded the study. The authors did not report any financial investments or other involvements that might affect study design, outcomes and analysis.

Review Date: 
November 5, 2013