Testosterone therapy in hypogonadal patients and the associated risks of cardiovascular events

• Published in: Biomedicine & pharmacotherapy 2020-09, Vol.129, p.110423, Article 110423
• Main Authors: Kharaba, Zelal Jaber, Buabeid, Manal Ali, Ibrahim, Nihal A., Jirjees, Feras Jassim, Obaidi, Hala Jehad Al, Kaddaha, Adnan, Khajehkarimoddini, Laleh, Alfoteih, Yassen
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Animals; Cardiovascular ailments; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Clinical Decision-Making; Comorbidities; Endogenous testosterone; Hormone Replacement Therapy - adverse effects; Humans; Hypogonadal men; Hypogonadism - blood; Hypogonadism - drug therapy; Hypogonadism - epidemiology; Male; Male secondary sex characters; Meta-Analysis as Topic; Middle Aged; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Testosterone - adverse effects; Testosterone - deficiency; Testosterone replacement therapy; Treatment Outcome; Young Adult
• ISSN: 0753-3322; 1950-6007
• DOI: 10.1016/j.biopha.2020.110423

[Display omitted] •Clinical trials have shown presence and absence of correlation between cardiovascular risks and testosterone therapy.•Such contradictions have reduced certainty in predicting cardiovascular risks during testosterone replacement therapy.•The cardiovascular risk of such therapy was found to be associated with age.•The risk was even more severe in patients who had a previous history of myocardial infarction or stroke. Since the male secondary sex characters, libido and fertility are attributed to their major androgen hormone testosterone, the sub-optimum levels of testosterone in young adults may cause infertility and irregularities in their sexual behaviour. Such deficiency is often secondary to maladies involving testes, pituitary or hypothalamus that could be treated with an administration of exogenous testosterone. In the last few decades, the number of testosterone prescriptions has markedly increased to treat sub-optimal serum levels even though its administration in such conditions is not yet approved. On account of its associated cardiovascular hazards, the food and drug authority in the United States has issued safety alerts on testosterone replacement therapy (TRT). Owing to a great degree of conflict among their findings, the published clinical trials seem struggling in presenting a decisive opinion on the matter. Hence, the clinicians remain uncertain about the possible cardiovascular adversities while prescribing TRT in hypogonadal men. The uncertainty escalates even further while prescribing such therapy in older men with a previous history of cardiovascular ailments. In the current review, we analysed the pre-clinical and clinical studies to evaluate the physiological impact of testosterone on cardiovascular and related parameters. We have enlisted studies on the association of cardiovascular health and endogenous testosterone levels with a comprehensive analysis of epidemiological studies, clinical trials, and meta-analyses on the cardiovascular risk of TRT. The review is aimed to assist clinicians in making smart decisions regarding TRT in their patients.