Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels

08-16-15
1. Basaria S, Harman M, Travison T, Hodis H, O’Donnell CI, Tsitouras P, Budoff M, Pencina KM, Vita J, Dzekov C, Mazer NA, Coviello A, Knapp PE, Hally K, Pinjic E, Mingzhu Y, Storer TW, Bhasin S.

Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels. JAMA. 2015;314(6):570-581.

Summary of this paper:
This study is one of the largest studies where patients are randomly allocated to receive either testosterone gel treatment or placebo (dummy) for 3 years with the aim to assess the effects of testosterone on building up and hardening of deposits in the arteries of older men (60 years and older) with low or low-normal testosterone levels (between 100-400 ng/dL). The testosterone group (n = 155) received testosterone gel packets applied daily, while the placebo group (n = 151) received placebo gel packets. The patients were assessed at 6, 12 and 18 month intervals where testosterone levels were measured to achieve levels between 500 and 900 ng/dL. In order to measure the building up and hardening of deposits in the arteries, neck ultrasound and CT scan of the coronary arteries were performed, while sexual function and quality of life were assessed using questionnaires. This study demonstrated that testosterone supplementation for 3 years did not affect the progression of building up and hardening of deposits in the neck and coronary arteries, suggesting that testosterone did not appear to increase the risk of strokes and heart attacks.

Comments of this paper:
This study is novel because it is a very well-designed study examining the building up and hardening of deposits in neck and heart arteries in older men, a group that has not been carefully examined. By examining the progression of building up and hardening of deposits in the arteries, one can estimate the risk of developing future strokes and eart attacks. These results reported by Basaria and colleagues provide reassuring evidence that testosterone administration did not appear to increase the risk of developing strokes and heart attacks, in contrast to previous studies by Vigen and Finkle who previously reported that testosterone supplementation increased the risk of strokes and heart attacks. However, testosterone administration did not also improve sexual function, sexual desire, partner intimacy or quality of life. It remains possible that testosterone supplementation may improve these aspects in older men if higher testosterone doses were used or if the men had lower baseline testosterone levels to begin with before starting testosterone supplementation. It is important to note that this study should not be interpreted as a study proving that testosterone is protective to the heart because for a study to be conducted to answer such a question, larger numbers of subjects are needed to be studied over a longer period of time.

 

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