Learn more about the benefits of testosterone and testosterone treatment.
In the study, based at Boston Medical Center, frail elderly men (the mean age was 74) with limited mobility were randomly selected to receive either testosterone gel or placebo gel. Researchers wanted to see if testosterone treatment could improve lower extremity strength and physical function. Indeed, they soon found that the testosterone treatment did in fact improve strength. But they also discovered a surprising correlation that caused them to halt the study early: More cardiovascular events (such as heart attack, stroke or cardiovascular death) were noted among men who received testosterone compared with those who received the placebo.
This sounds bad until you learn that men in the testosterone group entered the study with more pre-existing cardiovascular risk factors than those in the placebo group. For example, the testosterone group contained a higher percentage of men already being treated for hyperlipidemia and hypertension. Moreover, since previous studies never indicated that elevated testosterone levels contributed to cardiovascular disease, the men were not monitored directly for evidence of heart trouble. Instead, researchers learned of cardiovascular events by reviewing external medical records — certainly not the most rigorous method of determining whether or not a treatment causes a certain kind of problem. Finally, the cardiovascular events that were the subject of the article were varied, from stroke to edema to high blood pressure. Only two men, both in the testosterone group, suffered actual heart attacks.
For these reasons, the authors of the study cautioned readers that the differences between the two groups may well have been due to chance alone. To my mind, if you compare two groups, one of which has more risk factors for illness to start, it’s no surprise when the high-risk group demonstrates more problems later on. This is true with or without treatment.
Science demands that we give the results of all new studies their due consideration but it’s important to recognize both the historical context and the existing literature. For decades, doctors and scientists hypothesized that testosterone was bad for the heart. They based this hypothesis on the fact that men have more heart attacks than women, and on the fact that men have more testosterone than women. However, study after study failed to support this idea. In fact, men with low testosterone tend to have more atherosclerosis than men with higher testosterone. Men whose testosterone is lowered severely due to treatment for advanced prostate cancer wind up having more heart disease than men whose testosterone remains untouched. And treatment with testosterone has been shown to improve glucose control and reduce fat, both of which are believed to be beneficial in fighting cardiovascular disease.
Given all of this, I suspect the new results will turn out to be an aberration — hardly unusual in the scientific realm. The idea that testosterone treatment is risky for the heart just doesn’t fit with what we know. In fact, there are significant proven benefits to testosterone therapy, including improvement in sexual interest and performance, improved muscle mass and strength, increased energy and a heightened sense of well-being. It would be a shame if men and their physicians became fearful of such a beneficial treatment because of an isolated negative report of dubious merit.