Testosterone Is Probably Safe For Your Heart. But It Can't Stop 'Manopause'

In 2014, Time magazine ran a cover story titled "Manopause?!" about the booming $2 billion testosterone industry, promoting it as a remedy for age-related declines in sexual function, energy, and strength.

However, as interest grew, safety concerns emerged. A small study found that while testosterone could boost muscle strength in older men, it also unexpectedly increased the risk of adverse cardiovascular events like heart attacks. Consequently, in 2015, the authorities mandated warning labels on testosterone products, leading to a drop in prescription testosterone usage.

A recent study brings reassuring news for those considering testosterone treatment. It reveals that men with low testosterone levels who were prescribed testosterone gel to boost their hormone levels did not experience a higher risk of heart attacks or strokes when compared to those who received a placebo.

The findings of this study provide reassuring and significant evidence suggesting that testosterone replacement therapy, when appropriately prescribed, does not substantially increase the risk of cardiovascular-related death. The results have been published in the New England Journal of Medicine.

It's important to note that this study did not assess over-the-counter dietary supplements containing testosterone, which are not subject to the same regulation as pharmaceutical drugs.

The study aimed to understand better how testosterone affects cardiovascular risks, but the senior author advises caution in interpreting the results. While the trial suggests that testosterone treatment may be safe for men with low testosterone levels, it should not be seen as a reason for widespread prescription. The authorities recommend this treatment only for men with confirmed low testosterone levels through laboratory tests. There is concern that athletes and bodybuilders may misinterpret these results as a green light to use testosterone for performance enhancement, which is a potential risk.

It's important to note that all participants in the study either had preexisting cardiovascular disease or were at high risk for it and experienced symptoms of hypogonadism, which is a condition characterised by insufficient testosterone production. The study involved approximately 5,200 men aged 45 to 80 randomly assigned to use a daily testosterone gel or a placebo gel applied to the skin for 22 months.

Among the men using testosterone gel, 7% experienced significant cardiac events such as heart attacks or strokes, while among those using the placebo, 7.3% had such events. Given the high-risk status of all participants, these results suggest that testosterone does not significantly increase the risk of these events. However, it's worth noting that the study identified other safety concerns, including an elevated risk of heart arrhythmias among men taking testosterone, which was unexpected. Additionally, there were slight increases in the risk of kidney injury and pulmonary embolism. The study suggests that caution should be exercised when using testosterone in men with a history of blood clot events.

The research received funding from manufacturers, with Androgel being the product used in the study. Common side effects and risks associated with the product, including a potential increased risk of prostate cancer, are typically included in marketing materials. In this study, prostate cancer was reported in 0.5% of patients in the testosterone group and 0.4% in the placebo group. The Cleveland Clinic Coordinating Center for Clinical Research independently conducted the trial.

A recent study has yielded promising results, according to a board-certified urologist specialising in sexual dysfunction in the Washington, D.C., area. This expert frequently prescribes testosterone treatments, including bioidentical hormone replacement therapy pellets, to both patients and personally utilises them.

"I was experiencing significant fatigue," mentions the urologist in their early 50s. However, they now report increased energy, attributing this improvement to the use of testosterone pellets. This therapy is viewed as a genuinely beneficial option.

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