Dr Manny's Notes

Testosterone and heart disease: Should men be concerned?



A recent report in the Journal of the American Medical Association (JAMA) has found that men who undergo testosterone therapy may be at an increased risk for cardiovascular side effects, such as heart attack and stroke.  

This study has me significantly worried, because I have personally been using testosterone replacement therapy for the last several months.  Before starting the treatment, I had all the classic symptoms of low testosterone: low energy, lack of concentration, weakening muscles and significant joint discomfort.

I have to tell you that for me, testosterone therapy was like a miracle drug.  All of my symptoms quickly reversed, and I started to have more energy again, which has allowed me to be more physically active.  Now this new study has me concerned, so I turned to Dr. David Shin, a physician in the department of urology at Hackensack University Medical Center in New Jersey for some answers.

What are the different types of testosterone therapy?

There are many topical gels.  Men can also get testosterone injections, or they can put a skin patch on. There are also these testosterone pellets that are implanted in the fat tissue, and they release testosterone over a slow period of time.

Why do most men receive testosterone supplementation?

Men get testosterone therapy usually because they’re symptomatic [of low testosterone], meaning they have low energy , low libido, low sexual drive.  Giving them testosterone has been shown to help improve those symptoms. It doesn’t work in everybody, but it works in a lot of guys.  However, in these men who have low energy, if testosterone doesn’t [give them a] boost or reverse their symptoms, then that means low testosterone isn’t the problem.

Given the results of this study, how could taking testosterone contribute to heart problems?

That’s a good question, and I don’t know if the authors even know for sure what the reason is, because it’s all speculation at this point.  They found that there was an association with increased heart problems, and of course, the main question is, “Why?”  Again I’m not sure we have the answer to that yet.

Should men taking this therapy be concerned?

Well, one of the big questions is which group are we talking about? This study was of men from the Veteran’s Affairs system, so they tend to be older and they all had heart issues to begin with.  But if you’re a young, healthy guy who doesn’t have any issues, we don’t have an answer as [whether or not you should be worried].  The message today is that before men get testosterone therapy, they should get a physical to make sure they don’t have any underlying medical problems.  And if they don’t, then it’s always a risks versus benefit scenario, which is a conversation that patients need to have with their doctor.

Dr. Manny Alvarez serves as Fox News Channel's senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. For more information on Dr. Manny's work, visit AskDrManny.com.