madman
Super Moderator
Abstract
Objective
To investigate the impact of testosterone replacement therapy (TRT) on cardiovascular outcomes in hypogonadal men.
Methods
A meta-analysis of 26 randomized controlled trials involving 10 941 participants was conducted. Various clinical outcomes, including all-cause mortality, cardiovascular-related mortality, myocardial infarction, stroke, congestive heart failure, atrial fibrillation, pulmonary embolism, and venous thrombosis, were assessed.
Results
No statistically significant differences were observed between the TRT group and the control group in terms of these clinical outcomes. Sensitivity analysis and publication bias assessments supported the robustness of the findings. Meta-regression analysis found no significant associations between clinical outcomes and potential covariates, including age, diabetes, hypertension, dyslipidemia, and smoking.
Discussion
Previous research on TRT and cardiovascular events, with comparisons to studies like the Testosterone Trials and the studies conducted by Vigen et al, Finkle et al, Layton et al, and Wallis et al, is provided. The significance of the systematic review and meta-analysis approach is emphasized, particularly its exclusive focus on hypogonadal patients.
Conclusion
This study offers reassurance that TRT does not increase mortality risk or worsen cardiovascular outcomes in hypogonadal men. However, further research, especially long-term studies involving diverse populations, is essential to strengthen the evidence base and broaden the applicability of these findings.
Introduction
Testosterone, a hormone that influences various bodily functions and metabolism, including muscle, adipose tissue, bone, and cells, plays a role in regulating lipids, carbohydrates, and protein metabolism.1-4 Low testosterone levels have been linked to cardiovascular (CV) disease, which can be caused by factors such as aging, chronic health issues, obesity, or medications.5,6 Symptoms of testosterone deficiency may include visible changes in secondary sexual characteristics and body composition.
Testosterone therapy was introduced in the 1940s and was reported to improve overall health without serious adverse effects.7 While testosterone replacement therapy (TRT) is approved for treating specific conditions, it is not Food and Drug Administration-approved for age-associated decline in testosterone levels. The CV effects of TRT in middle-aged and older men with hypogonadism are still unclear, with conflicting results from retrospective cohort studies.7-15 The Food and Drug Administration issued guidance to conduct clinical trials to determine TRT's CV risk due to conflicting data.16 Furthermore, it is imperative to recognize that TRT can exert both positive and negative effects on CV health. On one hand, it may induce sodium and water retention, potentially influencing blood pressure regulation. Conversely, TRT has displayed potential benefits, including enhancements in coronary vasodilation and endothelial function. Additionally, TRT offers advantages such as mood improvement, increased muscle mass, enhanced bone density, heightened libido, and potential cognitive enhancements. These affirmative effects can significantly augment overall well-being.
Nonetheless, it is essential to acknowledge that TRT also carries potential risks, including concerns about CV health, acne, testicular shrinkage, infertility, and possible psychological side effects. While endogenous testosterone levels may not consistently predict CV events, lower levels have been correlated with elevated risks of all causes and CV mortality. Furthermore, circulating testosterone concentrations have shown an inverse association with subclinical atherosclerosis.17 Despite extensive research, the CV effects of TRT remain controversial, and this meta-analysis aims to provide further insights into its impact on CV outcomes.
Conclusion
In conclusion, the findings of this systematic review and meta-analysis indicate that TRT does not significantly impact all-cause mortality, CV-related mortality, myocardial infarction, stroke, congestive heart failure, atrial fibrillation, pulmonary embolism, and venous thrombosis in hypogonadal patients. These results offer valuable evidence for clinicians and patients in making informed decisions regarding the use of TRT. However, further research, including long-term studies and more diverse populations, is necessary to gain a comprehensive understanding of the effects of TRT on clinical outcomes and to enhance the generalizability of the findings.
Objective
To investigate the impact of testosterone replacement therapy (TRT) on cardiovascular outcomes in hypogonadal men.
Methods
A meta-analysis of 26 randomized controlled trials involving 10 941 participants was conducted. Various clinical outcomes, including all-cause mortality, cardiovascular-related mortality, myocardial infarction, stroke, congestive heart failure, atrial fibrillation, pulmonary embolism, and venous thrombosis, were assessed.
Results
No statistically significant differences were observed between the TRT group and the control group in terms of these clinical outcomes. Sensitivity analysis and publication bias assessments supported the robustness of the findings. Meta-regression analysis found no significant associations between clinical outcomes and potential covariates, including age, diabetes, hypertension, dyslipidemia, and smoking.
Discussion
Previous research on TRT and cardiovascular events, with comparisons to studies like the Testosterone Trials and the studies conducted by Vigen et al, Finkle et al, Layton et al, and Wallis et al, is provided. The significance of the systematic review and meta-analysis approach is emphasized, particularly its exclusive focus on hypogonadal patients.
Conclusion
This study offers reassurance that TRT does not increase mortality risk or worsen cardiovascular outcomes in hypogonadal men. However, further research, especially long-term studies involving diverse populations, is essential to strengthen the evidence base and broaden the applicability of these findings.
Introduction
Testosterone, a hormone that influences various bodily functions and metabolism, including muscle, adipose tissue, bone, and cells, plays a role in regulating lipids, carbohydrates, and protein metabolism.1-4 Low testosterone levels have been linked to cardiovascular (CV) disease, which can be caused by factors such as aging, chronic health issues, obesity, or medications.5,6 Symptoms of testosterone deficiency may include visible changes in secondary sexual characteristics and body composition.
Testosterone therapy was introduced in the 1940s and was reported to improve overall health without serious adverse effects.7 While testosterone replacement therapy (TRT) is approved for treating specific conditions, it is not Food and Drug Administration-approved for age-associated decline in testosterone levels. The CV effects of TRT in middle-aged and older men with hypogonadism are still unclear, with conflicting results from retrospective cohort studies.7-15 The Food and Drug Administration issued guidance to conduct clinical trials to determine TRT's CV risk due to conflicting data.16 Furthermore, it is imperative to recognize that TRT can exert both positive and negative effects on CV health. On one hand, it may induce sodium and water retention, potentially influencing blood pressure regulation. Conversely, TRT has displayed potential benefits, including enhancements in coronary vasodilation and endothelial function. Additionally, TRT offers advantages such as mood improvement, increased muscle mass, enhanced bone density, heightened libido, and potential cognitive enhancements. These affirmative effects can significantly augment overall well-being.
Nonetheless, it is essential to acknowledge that TRT also carries potential risks, including concerns about CV health, acne, testicular shrinkage, infertility, and possible psychological side effects. While endogenous testosterone levels may not consistently predict CV events, lower levels have been correlated with elevated risks of all causes and CV mortality. Furthermore, circulating testosterone concentrations have shown an inverse association with subclinical atherosclerosis.17 Despite extensive research, the CV effects of TRT remain controversial, and this meta-analysis aims to provide further insights into its impact on CV outcomes.
Conclusion
In conclusion, the findings of this systematic review and meta-analysis indicate that TRT does not significantly impact all-cause mortality, CV-related mortality, myocardial infarction, stroke, congestive heart failure, atrial fibrillation, pulmonary embolism, and venous thrombosis in hypogonadal patients. These results offer valuable evidence for clinicians and patients in making informed decisions regarding the use of TRT. However, further research, including long-term studies and more diverse populations, is necessary to gain a comprehensive understanding of the effects of TRT on clinical outcomes and to enhance the generalizability of the findings.
