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Testosterone normalization associated with lower risk of heart attack, stroke and mortality from all causes over follow-up

Tuesday, August 11, 2015. On August 5, 2015, an article published in European Heart Journal reported that normalization of low testosterone levels through the use of testosterone replacement therapy (TRT) was associated with a significant decrease in the risk of myocardial infarction (MI, or heart attack), stroke and premature mortality from all causes in a large group of male veterans.

The study included older men who received their medical care at the Veterans Health Administration from December 1999 to May 2014. Subjects were limited to men without a history of heart attack or ischemic stroke whose initial total testosterone levels were below normal laboratory reference ranges. These included 43,931 patients who had normal total testosterone levels after receiving testosterone replacement therapy, 25,701 men who continued to have subnormal testosterone after therapy, and 13,378 patients with low testosterone who were untreated.

Over follow-up, the group with normalized testosterone levels had 47% fewer deaths than men whose hormone levels failed to normalize after testosterone replacement and 56% fewer deaths than those who did not receive TRT. When myocardial infarction was evaluated, men whose testosterone levels were normalized had an 18% lower risk than those whose levels failed to normalize and a 24% lower risk than untreated men. Ischemic stroke risk in normalized men was 30% lower than those who failed to attain normal testosterone levels and 36% lower than those who did not receive the hormone. As potential protective mechanisms, the authors cite testosterone's beneficial effects on adipose tissue, insulin sensitivity and lipids, as well as its anti-inflammatory and anticoagulant effects.

"In this study of men, without previous history MI or stroke, with low testosterone levels, normalization of testosterone levels using TRT is associated with lower mortality, fewer MIs, and strokes," corresponding author Rajat S. Barua, MD, concluded. "This is the first study to demonstrate that significant benefit is observed only if the dose is adequate to normalize the testosterone levels."

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