In Low T Patients, an Unexpected Hormone Therapy Benefit

Testosterone therapy may decrease heart attack and stroke risk in older men who achieve normal testosterone levels


Older men with low T may wind up reaping some unexpected benefits from hormone therapy.

A new study from the Kansas City VA Medical Center found that men who were successfully treated with testosterone replacement therapy (TRT) were less likely to have a heart attack or stroke.

"With such widespread and ever increasing use of TRT, there has been growing concern regarding its effect on mortality, as well as conflicting results," said corresponding study author Rajat S. Barua, MD, PhD, a cardiologist at Kansas City VA Medical Center, in a press release. "Our aim was to address the knowledge gap."

Testosterone is the primary male sex hormone. Many men with low levels report improved energy levels, sex drive and mood after TRT.

While these findings may be intriguing, Aaron Michelfelder, MD, a family physician at Loyola University Health System, warned that TRT may not be right for all older men.

Only men with low testosterone should consider TRT.

"Asymptomatic men should not be screened for low testosterone levels, because there is no evidence that supplementing testosterone in men without symptoms makes any difference in their lives," Dr. Michelfelder told dailyRx News. "Aging is a normal process, and many men do not develop sexual issues or significant fatigue as they age, which would be symptoms of low testosterone."

According to Dr. Michelfelder, the Endocrine Society recommends checking testosterone levels only in men who persistently have symptoms. The reason for this is that men can naturally raise their testosterone levels with weight loss and muscle-building exercises.

Dr. Barua and team looked at more than 83,000 male veterans treated with TRT — in the form of injections, patches or gels — between December 1999 and May 2014.

All of these men had a documented history of low testosterone based on lab tests. They did not have a history of heart disease or stroke.

The patients were divided into three groups. The first group did not receive TRT.

In the two groups that received testosterone, about 40 percent continued to have low testosterone levels despite treatment.

The remaining men experienced a normalization of testosterone levels.

Dr. Barua and team found that men whose testosterone levels became normal after treatment experienced fewer deaths from all causes.

They also experienced fewer heart attacks and fewer deaths from strokes.

These researchers noted, however, that TRT was not found to provide this protection unless the patients’ testosterone levels became normal after testosterone therapy.

"This is the first study to demonstrate that significant benefit is observed only if the dose is adequate to normalize the testosterone levels," Dr. Barua said.

This study was published in August issue of the European Heart Journal.

The Kansas City VA Medical Center and the Midwest Biomedical Research Foundation funded this research.

No conflicts of interest were disclosed