Testosterone and heart disease. Testosterone treatment has several beneficial effects when there is testosterone deficiency. But what effect does testosterone have on the risk of cardiovascular disease?
The man has no menopause in the female sense. Testosterone levels begin to decline in the 30-40s and continue to fall slowly for the rest of their lives. In a large survey, researchers found that the level of testosterone in the blood decreased by about 30 percent from the 30s to the 80s. In women, the female sex hormone drops by 75 percent in a few years.
Too little testosterone can make life difficult for men when they get older. But if they want to do anything about it, there is a effective treatment. Men who have low testosterone are often unaffected, depressed, sleepless, and lose muscle mass. The amount of fat increases and sexdrive and potency are weakened.
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The use of testosterone in older men has increased significantly in recent years. In accordance with international recommendations, testosterone is indicated by symptoms and at the same time proven testosterone deficiency. Studies have shown that testosterone improves sexual function, increases bone mass and muscle strength, improves lipid profile and insulin resistance. However, the question if testosterone treatment affects the occurrence of cardiovascular disease has been unclear. Some small studies with short follow-up time have shown positive effects. However, a study of elderly men with high incidence of cardiovascular disease (TOM study) was recently stopped due to significantly increased mortality in the treatment group.
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The current study is a retrospective cohort study of male veterans who underwent coronary angiography in the period 2005-2011, and who measured testosterone in connection with the procedure1. Clinical data, results from angiography, laboratory data and prescribing of medication were continuously recorded in an electronic patient record. Men with testosterone less than 10.4 nmol / L (<300 ng / dL) were included in the study. The intervention cohort consisted of those who received a prescription for testosterone preparation following angiography. Patients who did not start treatment constituted the control group. Anyone who already used testosterone, or who had contraindications, was excluded. The endpoints were death, heart attack or ischemic stroke.
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In total there were 23,173 men who performed coronary angiography while measuring testosterone. 8,709 men had testosterone <10.4 nmol / L, and 1223 started testosterone treatment. Already one year after treatment start, there were several deaths, heart attacks and stroke in the testosterone group. The differences in total were 1.3% after one year, 3.1% after two years, and 5.8% after 3 years of follow-up (25.7% vs 19.9%). The difference after 3 years is statistically significant. The results were not changed when only the groups were compared with and without significant coronary stenosis.
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It is concluded that testosterone treatment increases the risk of death or severe cardiovascular disease in men over 60 years who had an indication of coronary angiography. In the material there was considerable comorbidity, approx. 50% had type 2 diabetes. Therefore, the results can not easily be transferred to a younger population. The study was retrospective, with the possibilities it implies for differences in the groups being compared. Among other things, the intervention patients were younger than the control group (60 vs 63 years). The final conclusion is that, despite a very impressive and thorough analysis, a randomized study is still needed to clarify this topic.