Testosterone Revisited: 6 New Degrees of Separation

Testosterone Lowers Cardiovascular Risks. Testosterone replacement therapy (TRT) is not linked with increased cardiovascular (CV) risks in men with androgen deficiency. In this study, the primary outcome was a composite of CV end points, eg, acute myocardial infarction, coronary revascularization, unstable angina, stroke, transient ischemic attack, and sudden cardiac death. The risk of CV outcomes was lower in ever dispensed testosterone men than in never dispensed men during long-term follow-up.

Higher Hemoglobin in Older Men With Anemia. Testosterone treatment significantly increases hemoglobin levels in older men with low testosterone levels who have unexplained anemia and those who have anemia from known causes, such as iron deficiency. Measurement of testosterone levels is suggested in men aged ≥ 65 years who have unexplained anemia and symptoms of low testosterone levels. No recognized cause can be found in one-third of older men who have anemia.

Treatment Boosts Bone Density, Strength in Older Men. Testosterone treatment of older men who have low testosterone levels significantly increased volumetric trabecular bone mineral density of the lumbar spine and estimated bone strength. Whether testosterone treatment also reduces fracture risk has not been determined.

No Help for Cognitive Function. Testosterone treatment for older men with low testosterone levels and age-associated memory impairment was not significantly associated with improved memory or other cognitive functions. Testosterone was not associated with significant differences in visual memory, executive function, or spatial ability. The findings do not support the use of testosterone for the treatment of age-associated memory decline in older men with symptomatic hypogonadism.

Testosterone Gel Builds Coronary Artery Plaque Volume. In older men who have symptomatic hypogonadism, treatment with testosterone gel was associated with a significantly greater increase in noncalcified coronary artery plaque volume compared with placebo. The clinical significance is not well understood.

Older Men Realize Other Testosterone Benefits. Testosterone treatment that raised testosterone concentrations in symptomatic men aged ≥ 65 years from moderately low to the mid-normal range for men aged 19 to 40 years had the following effects: sexual function, moderate benefit; mood and depressive symptoms, some benefit; vitality and walking distance, no significant benefit. No conclusions were drawn about treatment risks.