Ageless Forever Anti-Aging News Blog

Testosterone Replacement Therapy (TRT) - does it really increase risk of heart attack? Commentaries from medical organizations

We previously posted a commentary on the recently published and notoriously flawed study which concluded that TRT increases risk for heart attack.

Does Testosterone Therapy Really Increase the Risk of Heart Attack?

http://www.agelessforever.net/anti-aging-news-articles/entry/does-testosterone-therapy-really-increase-the-risk-of-heart-attack

This is the study which caused the media debates:

January 29th issue, the Scientific Journal PLOS (Public Library of Science) ONE published the article: 

"Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men."

Here we have gathered commentaries from other medical professionals, all in one place:

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The Androgen Study Group - Cutting Through Misleading Headlines and Exposing the Truth about Testosterone Therapy and Health

Recently several flawed studies, implicating that testosterone replacement therapy increases risk for heart attack and death, created large media headlines. This despite a large body of research evidence showing the contrary, ie. that testosterone replacement therapy decreases risk for heart disease and that higher testosterone levels are associated with reduced death rates. No wonder there is confusion and unnecessary concern and among healthcare providers and their patients.
 
In response to this, The Androgen Study Group was formed. The Androgen Study Group is a multidisciplinary group of androgen researchers and clinicians who are dedicated to education and accurate reporting on the science of testosterone deficiency in men and its treatment. With the media attention that testosterone therapy is attracting it is critical that clinical trials are properly conducted and analyzed, and that results are presented in a way that is not misleading. The mission of the Androgen Study Group is to ensure that the results of research on testosterone deficiency and its treatment is presented accurately and fairly in the medical literature as well as in public media.
 
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Multiple beneficial effects of testosterone replacement therapy in men with testosterone deficiency

Alleged concerns regarding risk of cardiovascular disease with testosterone replacement therapy (TRT) have been promulgated recently. However, a large and growing number of intervention studies show to the contrary that TRT reduces cardiovascular risk factors and confers multiple beneficial health effects. Thus, fears promoted by some recent flawed studies need to be critically re-evaluated. 
 
This article gives an overview of studies that have investigated health effects and safety of TRT.[1] As outlined here, the position that testosterone deficiency (TD) should be regarded as a risk factor for cardiovascular disease is supported by a rapidly expanding body of evidence.[2-4]
 
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Testosterone Treatment and Heart Attack Risk - new study shows testosterone treatment can even be beneficial

Testosterone therapy has been in use for more than 70 years for the treatment of testosterone deficiency, historically called hypogonadism.[1]In the past 30 years there has been a growing body of scientific research demonstrating that testosterone deficiency is associated with increased body weight/adiposity/waist circumference, insulin resistance, type 2 diabetes, hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased risk of mortality [2, 3]. In line with the detrimental health outcomes seen with testosterone deficiency, testosterone therapy has been shown to confer beneficial effects on multiple risk factors and risk biomarkers related to these clinical conditions.[4]
 
Despite these well-documented health benefits, testosterone therapy is still controversial, in large part due to a few flawed studies and media outcry about potential elevated heart attack risk with testosterone therapy. On July 2, 2014, a study was published which demonstrated that testosterone therapy is not associated with an increased risk of MI, and that is actually may protect against heart attack....[5]
 
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Video Summary of Testosterone Replacement Therapy and Cardiovascular Risk

One of the most controversial and debated issue related to testosterone replacement therapy is its effects on cardiovascular risk and related clinical outcomes.
 
In the February 2015 issue of Mayo Clinic Proceedings a comprehensive medical review paper, written by Dr. Abraham Morgentaler and his coauthors of the Androgen Study Group – www.AndrogenStudyGroup.org - was published.[1]
 
The aim of the review was to analyze all available studies on testosterone replacement therapy and cardiovascular effects, and to clarify the grossly misleading conclusions from two recent studies that caused a tremendous media scare.
 
In this 8 minute video, Dr. Morgentaler presents the key results from this comprehensive analysis…
 
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Testosterone Treatment and Hormonophobia – Cardiovascular risk, the Media, and the Authorities

 
One of the most controversial and debated issue related to testosterone replacement therapy is its effects on cardiovascular risk and related clinical outcomes.
 
In this video presentation, Dr. Morgentaler clarifies misperceptions of testosterone replacement therapy and cardiovascular disease risk, which have created unwarranted concerns and distorted public discussion of testosterone replacement therapy as a medical treatment.
 
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Normalization of testosterone level is associated with reduced risk of heart attack, stroke and mortality in men

The effect of testosterone replacement therapy on cardiovascular outcomes such as heart attack and stroke are controversial and have been generating heated discussions among clinicians as well as researchers. This, coupled with biased media sensationalism blowing up the supposed “dangers” of testosterone therapy has created great confusion among suffering men, who could gain tremendous health benefits from testosterone therapy.[1]
 
Here I report the results of a new study that examined the relationship between normalization of total testosterone levels with testosterone therapy and cardiovascular events as well as all-cause mortality, in patients without a previous history of heart attack and stroke.[2] This notable study was published in the European Heart Journal on August 6th, 2015.
 
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Effects of Testosterone Treatment in Older Men

The so called double-blind randomized controlled trial (RCT) is accepted by medicine as the gold standard objective scientific methodology, and provides the highest strength of evidence for the effectiveness of a treatment.[1-4]
 
An accumulating body of evidence shows that treating hypogonadal men with testosterone therapy provides a number of wide-ranging benefits beyond mere relief of symptoms, including improvements in muscle mass, insulin sensitivity, fat mass (both total body fat and visceral fat), endothelial function, blood pressure, lipid profile and bone mineral density.[5, 6]
 
Recent clinical practice guidelines state that testosterone therapy is safe if treatment and monitoring are appropriately executed [7-9], and the totality of available evidence to date does not support alleged concerns regarding risk of cardiovascular disease [10] and prostate cancer.[11] Despite this, opponents state that the clinical benefits and potential long-term risks of testosterone therapy have not been adequately assessed in large RCTs, and that therefore a general policy of testosterone replacement in all older men with age-related decline in testosterone levels is not justified.[12]
 
To address the lack of large RCTs on testosterone therapy, the US National Institute of Health has funded The Testosterone Trials, which is a coordinated set of 7 large double-blind RCTs. Here I report the first results from The Testosterone Trials,  which were released February 18, 2016.[13]
 
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Survival and cardiovascular events in men on testosterone treatment

On the surface, testosterone therapy is a controversial treatment because previous studies investigating the effects of testosterone therapy have been conflicting, with some studies showing supposed harm and others showing significant benefit.
 
Here I summarize the results of a new study published in The Lancet Diabetes & Endocrinology on May 7 2016, which addressed some shortcomings in previous studies by analyzing effects based on duration of testosterone treatment.[1]
 
 
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Hematocrit (blood thickness) elevation following testosterone therapy – does it increase risk of blood clots?

 

In discussions about side effects of testosterone treatment, prostate cancer and heart disease get most attention. However, as we have described in several study reports published here in the “Research News” section, the widespread fear of prostate cancer and heart disease is unfounded and not supported by medical research.

The expected potential side effect of testosterone treatment - which in fact is a therapeutic effect in men with anemia [1-3] - is an increased level of red blood cells, known as erythrocytosis or polycythemia.[4-7]  In the context of testosterone treatment, erythrocytosis and polycythemia are used interchangeably to refer to an abnormal increase of red blood cells or hematocrit, which may increase blood viscosity (“blood thickness”).[8, 9]


However, it should be pointed out that technically, erythrocytosis is just red blood cell elevation, while polycythemia involves elevation of red blood cells, white blood cells, and platelets. Using these terms as synonyms can cause confusion. In polycythemia, it is likely the increase in platelets that is the major culprit of blood clots.


Elevated hematocrit is the most common side-effect of testosterone treatment.[4-7] The clinical significance of a high hematocrit level is unclear, but it may theoretically be associated with an increased risk of thrombosis (blood clots).[4]

Here I summarize the results of an analysis of the effect of different testosterone preparations on hematocrit elevations, published in the journal Sexual Medicine Reviews.[10]

 
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Dr. Pierce's Medical Organization Affiliations

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