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For several years, there has been controversy in the medical community about the benefits and risks of testosterone therapy for men. Overall, testosterone therapy has been thought to improve quality of life, but has not been considered to be lifesaving.

Now, the largest observational study ever performed to assess the impact of testosterone therapy in men has just been published in the European Heart Journal, August 6, 2015. 1 They evaluated 83,000 men from 140 hospitals in the Veterans Affairs Health System with 14 years of follow up.

Compared to men who did not receive testosterone (T) therapy, men treated with testosterone therapy had a 47% decrease in death, an 18% reduction in heart attacks (myocardial infarction), and a 30% decreased risk for stroke. To qualify for testosterone therapy, men first had to have low testosterone levels measured. (For most labs that means a T level less than 300.  With therapy, men who achieved normal testosterone levels (considered a T level of 500 to 1000) were followed separately from men who did not achieve normal levels (T less than 500). Men who were treated with testosterone but did not reach normal levels had worse outcomes for death, heart attack, and stroke than men who did achieve normal levels.

The findings were considered a surprise to the authors, who didn’t expect to see this great a benefit from testosterone therapy.

Despite the benefits, this study won’t resolve all the controversies related to testosterone therapy and the potential risk for heart disease. First, this was not a randomized trial, so there is always some bias when interpreting observational studies; physicians to a small degree might have inadvertently selected healthier subjects to receive testosterone therapy. Second, a much smaller study in 200 older men (the TOM trial with an average age 75) who were very inactive (nearly disabled) showed an increase in cardiovascular risk with testosterone therapy. So giving testosterone to elderly, inactive men may turn out to be harmful.

For the moment, this helps to dispel some of the concerns associated with testosterone therapy in older men.

The bottom line is that the benefits of testosterone therapy for men with low testosterone levels are numerous and well established. Men with therapy have more energy and drive, sharper mental function, stronger bones, slight improvement in body composition, and better sexual function, and in future studies we may conclude that testosterone therapy for active men is good for the heart.

It is worth sharing that testosterone therapy in this study generally aimed to bring testosterone levels back to normal (T levels greater than 500). They were not trying to convert the testosterone levels of 40 to 70 year old men into twenty year old levels, which might be above 1000, which would be typical for a 20 year old male. There is no established data that elevated testosterone levels (over 1000) are safe for older men, and several reasons to think high levels may have elevated cardiovascular risk.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, FAAFP

1(Sharma R et al. European Heart Journal doi:10.1093/eurheartj/ehv346.)