Cardiovascular Safety and Efficacy of Testosterone Therapy in Elderly Men With Hypogonadism

Volume 1 - Issue 4

Ravi Kant^1,2,3* and Vipin Verma^1,2,3

Received: April 10, 2019;   Published: April 17, 2019

DOI: 10.32474/JUNS.2019.01.000121

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Opinion

Serum testosterone level steadily decreases with ageing [1]. Low testosterone levels in older adults have been associated with increased adverse cardiovascular (CV) events [2-5]. Testosterone therapy in older men with hypogonadism has consistently shown to improve sexual function, mood, depressive symptoms, muscle and bone strength, and insulin sensitivity and hence, decrease the incidence of type 2 diabetes mellitus (T2DM) and metabolic syndrome as well as favorably improve lipid profile [6-9]. These evidences suggest that exogenous testosterone replacement in men with low testosterone should have beneficial effects on adverse CV outcomes. However, literature is conflicted on CV safety and efficacy of testosterone therapy in older men with hypogonadism. Over last decade, few studies have suggested increased incidence of adverse CV events in men, particularly older adults, with testosterone replacement. Basaria S et al. [7] were the first to question the CV safety of testosterone replacement [10]. They showed, in a randomized controlled trail (RCT), that men (aged 65 years or older) with limited mobility and low testosterone levels had higher rates of adverse CV events with testosterone treatment as compared with those who received placebo. It’s important to note this study was not designed to evaluate the CV safety of testosterone therapy. In fact, primary efficacy outcome was the change from baseline in maximal voluntary muscle strength in a leg-press exercise. Elderly men treated with testosterone showed significantly greater increase in leg-press strength, chest-press strength, and stair climbing power while carrying a load. It has been argued that increased physical activity in frail elderly may have contributed to increased incidence of adverse CV events. Nevertheless, this study motivated researchers to study the CV safety and efficacy of testosterone therapy.

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