Testosterone Therapy: Five New Reports Offer a Mixed Bag

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH

New findings from the NIH-supported "Testosterone Trials" offer a mixed take on the potential role of testosterone therapy in older men.

In the trials, men aged 65 and older with serum testosterone below 275 ng/dL plus sexual or physical dysfunction or reduced vitality were randomized to use testosterone gel (1%) or placebo for 1 year.

Among the findings, as reported in JAMA:

• Coronary artery plaque was assessed by computed tomographic angiography in 170 participants. From baseline to 12 months, testosterone treatment was associated with a greater increase in noncalcified plaque volume relative to placebo.

• Among nearly 500 participants with age-associated memory impairment at baseline, testosterone therapy did not confer improvements in memory or other cognitive measures compared with placebo.

A JAMA editorialist says that with these findings, "the hopes for testosterone-led rejuvenation for older men are dimmed and disappointed if not yet finally dashed."

Separately, from JAMA Internal Medicine:

• Bone mineral density (BMD) and strength were assessed among roughly 200 trial participants. Testosterone therapy was associated with increases in volumetric BMD at the spine and hip, plus increases in bone strength, compared with placebo.

• Among nearly 130 participants with anemia, hemoglobin levels increased (by at least 1 g/dL) more often with testosterone than with placebo.

• Separate from the "Testosterone Trials", researchers retrospectively studied over 44,000 men with androgen deficiency. Over roughly 3 years, the cardiovascular event rate was lower in men prescribed any testosterone than in untreated men (17 vs. 24 per 1000 person-years).

A JAMA Internal Medicine editorialist says the health benefits of the increased BMD and hemoglobin levels are unclear, and "the cardiovascular risks and benefits of testosterone replacement ... have not been adequately resolved."