Exploring the Advantages and Disadvantages of Testosterone Treatment: Research Insights
In the realm of aging, testosterone levels naturally dip, sparking interest in artificial replacement to sidestep associated health drawbacks. A fresh wave of research delves into the aftermath of testosterone replacement therapy, casting light on its impact on several aspects of health.
Recent studies published in JAMA and JAMA Internal Medicine highlight the role of testosterone treatment in multiple areas, such as sexual function, mood, bone density, anemia, and cardiovascular health.
Scholars from the Perelman School of Medicine at the University of Pennsylvania, together with several U.S. medical centers, led the research initiative in partnership with the National Institute on Aging. The Testosterone Trials (TTrials) specifically focused on men aged 65 and above who exhibited low testosterone levels.
The results from the initial three trials, published last year, demonstrated improvements in all aspects of sexual function and overall mood for those who underwent treatment. The latest studies published by JAMA conclude the research.
Investigating testosterone's influence on health outcomes
The TTrials encompassed a total of 51,085 men, with 790 participants meeting the qualification criteria for low age-related testosterone levels. The participants were then divided into two groups: one took a daily dose of testosterone gel for a year, while the other ingested a placebo. The testosterone dosage was adjusted to simulate levels found in young men.
Researchers monitored the effectiveness of the treatment every three months, employing double-blind testing methods, ensuring neither researchers nor participants knew which group received the placebo and which received the treatment.
For the bone density and strength study, researchers used quantitative computed tomography to measure spine and hip bone mineral density at the beginning of the trial and a year afterward.
To evaluate cognition, participants underwent a delayed paragraph recall test, while researchers also assessed visual memory, executive function, and spatial ability.
To determine coronary artery plaque volume, researchers deployed a coronary computed tomographic angiography.
The cardiovascular health study was observational, utilizing Cox proportional hazard models to study associations between testosterone treatment and several cardiovascular health outcomes, such as heart attacks, angina, stroke, transient ischemic attacks, and sudden cardiac death.
Testosterone boosts bone density, helps combat anemia-but may pose cardiac risk
The trials revealed that testosterone treatment improves bone mineral density and estimated bone strength, although larger-scale, long-term trials are required to determine if this treatment reduces the risk of fractures.
Testosterone treatment also elevated hemoglobin levels in participants with anemia, regardless of its underlying causes. The trial reported a nearly 40 percent higher increase in hemoglobin levels for participants who took testosterone compared to the placebo group.
Testosterone corrected both unexplained anemia as well as anemia induced by iron deficiency. However, the treatment did not appear to improve memory or any other aspects of cognitive functioning.
The trial for cardiovascular health unveiled more coronary artery plaque buildup in testosterone-treated men compared with the placebo group. Those treated experienced a greater increase in the volume of noncalcified plaque than the control group.
Nevertheless, researchers underscored the need for larger studies to ascertain the clinical significance of these findings. Furthermore, the cardiovascular health observational study found that the risk of negative cardiovascular events was lower among the testosterone-treated group, compared with the control group, over a median follow-up period of 3.4 years.
Dr. Peter J. Snyder, a professor of Medicine in the Division of Endocrinology, Diabetes, and Metabolism at the University of Pennsylvania, emphasizes that the results suggest that the treatment may pose a cardiovascular risk.
However, he also notes that the findings are based on treating 788 men for one year, which is insufficient to draw definitive conclusions about the clinical significance of the increase in coronary artery plaque volume and the cardiovascular risk of testosterone treatment.
In summary, while testosterone treatment appears to improve bone health and combat anemia, it may also carry cardiac risks. Future testosterone treatments must carefully weigh benefits against potential risks.
"Final decisions about testosterone treatment for older men will depend on balancing the results from these seven TTrials with the results from a much larger and longer-term trial designed to assess cardiovascular and prostate risk in the future," says Dr. Snyder.
Dive deeper into understanding the potential for testosterone treatment to cause blood clots.
- The TTrials investigated the influence of testosterone replacement therapy on various health outcomes, including sexual function, mood, bone density, anemia, cardiovascular health, cognitive functioning, and mental health.
- The trials revealed that testosterone treatment improves bone mineral density and estimated bone strength, but larger-scale, long-term trials are necessary to determine if this treatment reduces the risk of fractures.
- Testosterone treatment elevated hemoglobin levels in participants with anemia, yet it did not seem to improve memory or any other aspects of cognitive functioning.
- The cardiovascular health study unveiled more coronary artery plaque buildup in testosterone-treated men compared with the placebo group, but the researchers underscored the need for larger studies to ascertain the clinically significant impact of these findings.
- The possible cardiac risks associated with testosterone treatment may require careful consideration in future therapies and treatments designed for men, as final decisions will depend on the results from ongoing and future trials focused on cardiovascular and prostate risks.
