Short-Term, but Not Long-Term, Testosterone Replacement Linked to Higher CV Risk

By Kelly Young

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Short-term use of testosterone replacement in older men is associated with higher risk for mortality and cardiovascular events, while longer use showed a beneficial effect, according to an observational study in Lancet Diabetes and Endocrinology.

Using Canadian health registries, researchers identified 10,000 men aged 66 years and older with new prescriptions for testosterone replacement therapy for symptomatic testosterone deficiency and matched them to 28,000 men not taking testosterone. Men with prior CV events were excluded.

The overall 5-year cumulative mortality rate was lower among patients receiving testosterone therapy (15.4% vs. 17.7% among controls). Shorter therapy durations (median, 2 months) were associated with higher risks for mortality (hazard ratio, 1.11) and cardiovascular events (HR, 1.26), compared with controls. However, longer durations (median, 35 months) were associated with lower risks (HRs, 0.67 and 0.84, respectively). Longer exposure was also tied to lower risk for prostate cancer diagnosis.

A commentator concludes: "In view of current knowledge, we do not know whether testosterone therapy in older men is beneficial or safe."