Table of Contents
Reference: Clinical Endocrinology.2018;1–8.
Summary
Objective
A label change in testosterone (T) products in March 2015 followed a highly publicized FDA advisory committee meeting in September 2014. Changes included a warning of possible increased cardiovascular (CV) risks and restriction of indicated populations to younger men with a limited set of known aetiologies of testosterone deficiency (TD). These changes greatly impacted clinical practice and public perception of T therapy (TTh). Our aim was to review these changes in the light of subsequently published studies.
Design
We identified 23 studies through June 2017, including 12 clinical trials and
11 observational studies. The Testosterone Trials included 790 men aged 65 years and older with TD without known etiology, assigned to 1-year T gel or placebo. Results: Demonstrated benefits of T included sexual activity and desire, physical activity and mood.
There were 9 major adverse CV events (MACE) in the T arm and 16 in the placebo arm. No study reported increased MACE with TTh. A 3-year RCT showed no difference in carotid atherosclerosis. Several large observational studies reported reduced CV events with TRT, including one showing progressively reduced CV and mortality risk with greater duration of TTh. Men whose serum T normalized with TTh had reduced risk of MI and death compared with men whose T levels failed to normalize.
Conclusion
We conclude that existing evidence fails to support increased CV risk with TRT; on the contrary, there is evidence suggestive of real-world CV benefits. Finally, existing evidence provides benefits of TRT in older men without known aetiology for T deficiency.
