Testosterone replacement therapy (TRT) does not appear to increase the risks for cardiovascular (CV) morbidity or mortality, according to recent findings published in Expert Review of Cardiovascular Therapy.

Given conflicting results from previous studies, FDA warnings, and ongoing debate, Giovanni Corona, MD, of Azienda Usl Bologna Maggiore-Bellaria Hospital in Bologna, Italy, and his collaborators conducted a meta-analysis of 31 randomized controlled trials published from 2010 to 2018. In pooled data, 2675 and 2308 men received TRT and placebo, respectively.

TRT was not associated with significantly more major adverse CV events than placebo in the 16 trials examining acute coronary syndrome, acute myocardial infarction, stroke, heart failure, or CV mortality. TRT also was not associated with other CV events (arrhythmias and aorto-coronary bypass surgery) or CV-related events overall.

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Individual study populations differed. Obese men without major comorbidities appeared to benefit from TRT. “It is possible that the improvement of body composition and glycometabolic profile, related to TTh [testosterone therapy], might explain, at least partially, the protective role of TTh and CV risk documented in this analysis,” Dr Corona and his colleagues suggested.

TRT doses and formulations also varied across studies, which is a limitation. In an analysis of men using the transdermal patch vs the injection, they found no differences in CV risk.

These data essentially confirm previous studies suggesting that TRT does not contribute to major adverse CV events, according to the investigators. The trials lasted less than 3 years, so possible long-term effects from TRT on CV health are still unknown.

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Rastrellia G, Dicuiob M, Reismannd Y, et al. Cardiovascular impact of testosterone therapy for hypogonadism. Exp Rev Cardio Ther 2018;16(9):617–625. DOI:10.1080/14779072.2018.1510314