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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Testosterone increases soft plaque buildup?
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<blockquote data-quote="madman" data-source="post: 227129" data-attributes="member: 13851"><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/testosterone-therapeutic-or-toxic-for-the-cardiovascular-health-of-men.25499/[/URL]</p><p></p><p></p><p><strong><em>The data remain inconclusive, and many men with hypogonadism who might benefit from testosterone replacement therapy could be unnecessarily deterred from this potentially helpful therapy.</em></strong></p><p></p><p><em><strong>To help shed light on this clinical dilemma, in this issue of The Lancet Healthy Longevity, Jemma Hudson and colleagues10 did a meta-analysis of 35 placebo-controlled trials of testosterone replacement therapy that included 5601 men with low baseline testosterone concentrations (≤12 nmol/L [350 ng/dL]) and 17 of these trials had individual patient-level data available. The mean duration of treatment was 9·5 months. However, during this short-term follow-up, reassuringly, there was no significantly increased risk of cardiovascular events between the testosterone replacement therapy group and placebo groups (odds ratio 1·07 [95% CI 0·81–1·42]; p=0·62). Furthermore, there was no particular subgroup identified at significantly increased risk for cardiovascular events with testosterone replacement therapy. The average age of participants in the trials was 65 years (SD 11), and about 8% of participants had a history of myocardial infarction. However, there was no evidence for treatment interaction by baseline cardiovascular status or age.</strong></em></p><p><em></em></p><p><em>First, congratulations to the authors for performing the largest individual-level analysis of testosterone trials to date. The authors were able to investigate the relationship of testosterone replacement therapy with multiple subtypes of cardiovascular disease and non-cardiovascular outcomes, as well as changes in several physiological markers (ie, glycemia, blood pressure, hematocrit, and lipids).</em> <em>Although the authors report significant reductions in total cholesterol, high-density lipoprotein cholesterol, and triglycerides with testosterone replacement therapy, it should be acknowledged that these changes were rather modest— for example, only a 3% difference in low-density lipoprotein cholesterol concentrations was observed.</em></p><p><em></em></p><p><em><strong>Although their analysis is reassuring for safety, meta-analyses are only as good as the underlying data available. Unfortunately, the data are still too insufficient to make conclusions on outcomes because the follow-up period was too short.</strong> <strong>The duration ranged from 3 months to 3 years in the trials and results were not changed by including follow-up time in the models, but there was little evidence to support cardiovascular safety beyond a 12-month duration. Future trials will require longer follow-ups.</strong></em></p><p></p><p><strong><em>There is an ongoing cardiovascular outcome trial for testosterone replacement therapy—the TRAVERSE trial (NCT03518034). This trial enrolled 5246 men between the ages of 45–80 years with low serum testosterone concentrations (<300 ng/dL) who have at least one sign or symptom of hypogonadism and either have established cardiovascular risk or are at high risk for cardiovascular disease.</em></strong><em><strong> Participants were randomly assigned to receive testosterone gel or placebo, and the primary outcome is a major adverse cardiovascular event (nonfatal myocardial infarction, non-fatal stroke, or cardiovascular death) at 60 months.</strong> <strong><u>The trial began in 2018 and is anticipated to finish in late 2022</u>.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>In summary, we should wait for the results of TRAVERSE to be published before the widespread use of testosterone replacement therapy is considered. Certainly, great caution is advised regarding the use of testosterone replacement therapy in people with established atherosclerosis due to the findings of plaque progression in the Testosterone Trials7 and the excess cardiovascular events observed in the TOM trial.6 At this time, hormone therapy should still be used selectively, paying attention to the cardiovascular risk profile in individuals.</strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 227129, member: 13851"] [URL unfurl="true"]https://www.excelmale.com/forum/threads/testosterone-therapeutic-or-toxic-for-the-cardiovascular-health-of-men.25499/[/URL] [B][I]The data remain inconclusive, and many men with hypogonadism who might benefit from testosterone replacement therapy could be unnecessarily deterred from this potentially helpful therapy.[/I][/B] [I][B]To help shed light on this clinical dilemma, in this issue of The Lancet Healthy Longevity, Jemma Hudson and colleagues10 did a meta-analysis of 35 placebo-controlled trials of testosterone replacement therapy that included 5601 men with low baseline testosterone concentrations (≤12 nmol/L [350 ng/dL]) and 17 of these trials had individual patient-level data available. The mean duration of treatment was 9·5 months. However, during this short-term follow-up, reassuringly, there was no significantly increased risk of cardiovascular events between the testosterone replacement therapy group and placebo groups (odds ratio 1·07 [95% CI 0·81–1·42]; p=0·62). Furthermore, there was no particular subgroup identified at significantly increased risk for cardiovascular events with testosterone replacement therapy. The average age of participants in the trials was 65 years (SD 11), and about 8% of participants had a history of myocardial infarction. However, there was no evidence for treatment interaction by baseline cardiovascular status or age.[/B] First, congratulations to the authors for performing the largest individual-level analysis of testosterone trials to date. The authors were able to investigate the relationship of testosterone replacement therapy with multiple subtypes of cardiovascular disease and non-cardiovascular outcomes, as well as changes in several physiological markers (ie, glycemia, blood pressure, hematocrit, and lipids).[/I] [I]Although the authors report significant reductions in total cholesterol, high-density lipoprotein cholesterol, and triglycerides with testosterone replacement therapy, it should be acknowledged that these changes were rather modest— for example, only a 3% difference in low-density lipoprotein cholesterol concentrations was observed. [B]Although their analysis is reassuring for safety, meta-analyses are only as good as the underlying data available. Unfortunately, the data are still too insufficient to make conclusions on outcomes because the follow-up period was too short.[/B] [B]The duration ranged from 3 months to 3 years in the trials and results were not changed by including follow-up time in the models, but there was little evidence to support cardiovascular safety beyond a 12-month duration. Future trials will require longer follow-ups.[/B][/I] [B][I]There is an ongoing cardiovascular outcome trial for testosterone replacement therapy—the TRAVERSE trial (NCT03518034). This trial enrolled 5246 men between the ages of 45–80 years with low serum testosterone concentrations (<300 ng/dL) who have at least one sign or symptom of hypogonadism and either have established cardiovascular risk or are at high risk for cardiovascular disease.[/I][/B][I][B] Participants were randomly assigned to receive testosterone gel or placebo, and the primary outcome is a major adverse cardiovascular event (nonfatal myocardial infarction, non-fatal stroke, or cardiovascular death) at 60 months.[/B] [B][U]The trial began in 2018 and is anticipated to finish in late 2022[/U]. In summary, we should wait for the results of TRAVERSE to be published before the widespread use of testosterone replacement therapy is considered. Certainly, great caution is advised regarding the use of testosterone replacement therapy in people with established atherosclerosis due to the findings of plaque progression in the Testosterone Trials7 and the excess cardiovascular events observed in the TOM trial.6 At this time, hormone therapy should still be used selectively, paying attention to the cardiovascular risk profile in individuals.[/B][/I] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Testosterone increases soft plaque buildup?
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