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Does Testosterone Therapy Contribute to Atherosclerosis?

male testosterone patient

The use of testosterone replacement therapy (TRT) has been increasing, yet some have expressed concerns about potentially life-threatening side effects of testosterone gels, creams, patches, and other products. Cardiovascular complications are of particular concern. Some men have filed lawsuits against a handful of TRT product manufacturers, claiming that the drugs led to life-threatening problems such as heart attack and stroke.

Yet, the evidence for TRT as a catalyst for heart disease remains controversial. A group of researchers recently published a study that explored their findings on the possible link between TRT and atherosclerosis.

Low T drugs linked to atherosclerosis

The study was published in the August 11, 2015 issue of the prestigious Journal of the American Medical Association (JAMA). “Effects of Testosterone Administration for 3 Years on Subclinical Atherosclerosis Progression in Older Men with Low or Low-Normal Testosterone Levels” was the result of work by researchers from Boston University School of Medicine, Harvard Medical School, Los Angeles Biomedical Research Institute, and other notable research centers.

The researchers conducted a placebo-controlled, double-blind, parallel-group, randomized trial to evaluate the potential long-term effects of testosterone products on subclinical atherosclerosis progression.

Atherosclerosis refers to the buildup of plaque in the arteries. The arteries also become narrower and harder. Atherosclerosis is a significant risk factor for heart attacks. Eventually, plaque can rupture in the coronary arteries, which results in the development of a blood clot. If the blood clot is large enough, it may obstruct blood flow to the heart, causing a heart attack and inflicting irreversible damage to an area of heart muscle.

Just over 300 men participated in the study. The study participants were all 60 years or older with low or low-normal testosterone levels. One hundred fifty-six study participants were randomly assigned to receive 7.5 g of one percent testosterone, while 152 men were randomly selected to receive placebo gel packets. The participants used the testosterone or placebo gel for three years. Dosages were adjusted to achieve testosterone levels of 500 to 900 ng/dL.

Testosterone therapy fails to improve sexual health

In analyzing the data, the researchers accounted for other health problems. Forty-two percent of the participants had hypertension; 15 percent had diabetes; 27 percent were obese; and 15 percent had cardiovascular disease. To develop accurate results, the researchers precisely measured the rate of change of intima-media thickness of the arteries. In the testosterone group, the rate of change was 0.012 mm/year, compared to 0.010 mm/year in the placebo group.

The rate of change of the coronary artery calcium score was 31.4 Agatston units per year in the testosterone group and 41.4 Agatston units per year in the placebo group. In other words, the researchers found that atherosclerosis is not necessarily one of the side effects of testosterone gel, since no significant statistical difference was observed. However, the researchers were quick to point out that their study only evaluated the rate of change of atherosclerosis and that the results did not necessarily apply to the greater risk of cardiovascular problems among testosterone product users.

Perhaps the most surprising outcome of the study was its implications regarding quality of life improvements and sexual health. TRT products are marketed toward men who experience possible symptoms of low testosterone, which include diminished libido and erectile dysfunction. Yet, the researchers evaluated sexual health and quality of life throughout the study and found that although testosterone gel may cause some side effects, it did not improve quality of life or sexual health.

  1. JAMA, Effects of Testosterone Administration for 3 Years on Subclinical Atherosclerosis Progression in Older Men With Low or Low-Normal Testosterone Levels,
  2. Medpage Today, Study: Testosterone Tx Doesn't Speed Atherosclerosis,