The past decade has seen a substantial increase in the number of older men receiving testosterone therapy—as well as a growing concern that it increases their risk for myocardial infarction (MI) and stroke.
But new research from the University of Texas Medical Branch at Galveston may ease some of those concerns.
“The most significant finding of our study was that older men who were treated with testosterone did not appear to have an increased risk of MI,” says lead study author Jacques Baillargeon, PhD, associate professor of epidemiology in UTMB’s Department of Preventive Medicine and Community Health. “In addition, for men with high MI risk, testosterone use appeared to be modestly protective against MI.”
Baillargeon and colleagues studied more than 25,000 older men. They examined enrollment and claims Medicare data for 6,355 Medicare beneficiaries ages 66 and older who had been treated with at least 1 injection of intramuscular testosterone between January 1997 and December 2005.
They compared these patients to a control group of 19,065 men of the same age, race, Medicaid eligibility, and health status who did not receive testosterone therapy.
“This was a methodologically rigorous study of a large nationally representative cohort of ‘real-world’ older males,” Baillargeon says. “We believe it should be thoughtfully weighed and considered in the debate on the issue of testosterone and cardiovascular risks.”
Not only did their analyses show that testosterone therapy was not associated with an increased risk of heart attack, but it also suggested testosterone users with a higher MI risk had a lower rate of heart attacks compared to the control group. Baillargeon says there are some plausible biological mechanisms for this protective effect—but emphasizes that more research is needed.
“This finding was statistically significant, but I think it’s important to examine this finding in the context of the broader literature, including current and upcoming clinical trials,” he says. “On this issue, given the current state of conflicting evidence, it will be important to conduct more original research and systematic reviews of the entire body of evidence. Hopefully, over time with rigorous scientific assessment, clarity will be brought to this issue.”
Baillargeon and his colleagues would also like to conduct more research into the effects of long-term exposure to testosterone as well as evaluating testosterone therapy in younger men. “Given the increased number of middle-aged men receiving testosterone prescriptions, we’d like to examine risks and benefits in these younger age groups, particularly in men who are not clearly hypogonadal,” he says.
Baillargeon J, Urban RJ, Kuo YF, Ottenbacher KJ, Raji MA, Du F, et al. Risk of myocardial infarction in older men receiving testosterone therapy. Ann Pharmacother. 2014 Jul 2. pii: 1060028014539918. [Epub ahead of print].