Short-Term, Not Long-Term Testosterone Linked to CV Risk

Short-term use of testosterone replacement therapy in older men was associated with higher mortality and risk of cardiovascular events, while long-term use was associated with reduced risk, according to the results of a recent study.

The relationship between testosterone replacement and mortality is uncertain. The FDA recently warned of a possible relationship based on results from several studies of short-term testosterone use, but no previous study has assessed the effects of therapy duration on risk.
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To further explore this association, the researchers conducted a population-based matched cohort study of 10,311 men treated with testosterone and 28,029 controls between 2007 and 2012. The participants were followed up for an average of 5.3 years in the testosterone group and 5.1 years in the control group.

Overall, participants in the testosterone group had lower mortality than controls. Those in the shortest tertile of testosterone duration had increased risk of mortality and cardiovascular events compared with controls, while those in the highest tertile had lower risk compared with controls, with a significant trend evident across tertiles. Risk of prostate cancer was also decreased in those in the highest tertile of testosterone use, but not in the shortest tertile.

“Long-term exposure to testosterone replacement therapy was associated with reduced risks of mortality, cardiovascular events, and prostate cancer. However, testosterone replacement therapy increased the risk of mortality and cardiovascular events with short durations of therapy,” the researchers concluded.  

“In view of the limitations of observational data and the potential for selection bias, these results warrant confirmation in a randomized trial.”

—Michael Potts

Reference:

Wallis CJD, Lo K, Lee Y, et al. Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study [published online May 7, 2016]. Lancet. doi: http://dx.doi.org/10.1016/S2213-8587(16)00112-1.