Testosterone Treatment For Older Men Remains Controversial / Testosterone Treatment Increases Cardiovascular Risk But Improved Anemia And Bone Strength
A team led by experts from Perelman School of Medicine at the University of Pennsylvania has investigated the effects of testosterone treatment in older men with low testosterone levels and reached mixed results.
Testosterone treatment taken for 12 months is associated with improving anemia and bone density. On the contrary, it increases non-calcified coronary plague accumulation and increases risk of cardiac problems.
In a series of research trials, funded by the National Institutes of Health (NIH) and recently published in the Journal of American Medical Association (JAMA), insights into the use of testosterone treatment and related health effects were achieved.
As men age, they encounter an onset of hypogonadism, which is manifested by reduced sperm production and reduced production of male sex hormone; testosterone.
Declined testosterone levels are seen as a collateral damage of aging which can be replenished by administering testosterone treatment. However, the use of testosterone treatment had remained controversial in the past.
Testosterone Treatment, Cognitive Function And Heart Health
The ‘Testosterone Trials’ (TTrials) involved 7 trials which recruited a total of 788 older men who suffered from hypogonadism. Out of them, 493 participants suffered from age-associated memory impairment.
The participants were stratified into two groups, one group was given testosterone gel to maintain normal testosterone levels and the placebo group received a placebo gel for a period of one year.
The group that received testosterone gel included 247 men and on the other hand, the placebo group included 245 men.
By the time, this study was concluded; the use of testosterone gel was not associated with improved cognitive function when compared with the placebo group.
In another study, which was part of the TTrials enrolled 170 men which observed the association of testosterone treatment with heart health.
This trial was called ‘Cardiovascular Trial’ which measured non-calcified coronary artery plague volume as the primary outcome through the use of CT angiography.
In additional to this, the total coronary artery plague volume (inclusive of calcified, non-calcified and mixed coronary artery plague) and coronary artery calcium score were also measured.
Out of these participants, 138 received testosterone treatment and 65 participants received placebo that had an average age of 71.2 years.
Non-calcified coronary artery volume was increased in the testosterone group comparing with placebo group. This variable was measured as a cumulative value for fibrous-fatty, low attenuation and fibrous plague volumes.
Increased non-calcified coronary artery volume is a strong indicator of ailing heart health which puts individuals at an increased cardiovascular risk.
When the secondary outcomes were measured in both groups, the increase in total coronary artery plague volume was significantly increased in the testosterone treatment group while the measurements of coronary artery calcium score were not significantly different in both groups.
Furthermore, it was found that the risk of meeting with a major cardiovascular event remained statistically similar for both groups.
Does Testosterone Treatment Associate With Any Health Advantage?
This study is largest to measure the testosterone treatment efficacy in older men recruited 788 total participants after screening 51,085 to meet the study criteria.
The participants were given daily dosages of testosterone gel or placebo gel and; the effect of the gel on health determining variables were measured at the intervals of three, six, nine and 12 months.
The results of these studies are in their preliminary stages and experts believe that final verdict can still not be given on the adverse heart health observed over a period of one year.
In this context, the principle study investigator, Peter J. Synder, MD said “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.”
But, the findings weren’t discouraging altogether. The experts found that the administering testosterone treatment in older men helps in improving bone strength and bone density, which were observed through the use of quantitative computed tomography. This in turn reduces the risk of spine and hip fractures.
It was also observed that using testosterone helped in increasing the concentration of hemoglobin in the blood. Consequently, it prevented anemia and corrected anemia for men who suffered from it previously. In the treatment group, 54% with unexplained anemia and 52% with known anemia showed significant improvement in the hemoglobin concentration, whereas in the placebo group the improved hemoglobin concentration was recorded in 15% and 12% of cases, respectively.
Director of National Institute on Aging, Division of Geriatrics and Clinical Gerontology, Evan Hadley, M.D., concluded saying; “The results on diverse outcomes indicate the potential trade-offs between benefits and risks of testosterone treatment in older men.”
He added that weighing out these effects will require longer and larger studies to reach a final finding. He also signified the need for individual patient-based interventions to favor or oppose testosterone treatment which varies from one person to another based on individual health status.