Testosterone Replacement and Heart Disease: Are You Ignoring the Risks?


Men with heart disease continue to use prescription testosterone despite FDA warnings that the drugs are associated with cardiovascular risks, according to a study in JAMA Internal Medicine.

The FDA issued warnings about supplemental testosterone and its potential heart hazards in 2014 and 2015. Yet, sales of prescription testosterone for off-label purposes among male Medicare patients ages 50 and older-and especially among those with cardiovascular disease (CVD)-remain relatively high, according to the study.

Testosterone replacement therapy is approved to treat low testosterone levels that are causing health problems. But men use prescription testosterone off-label for low levels that are age-related despite its association with a higher risk of heart attack and stroke and despite insufficient evidence showing a benefit. Researchers found that up to 7 percent of men in certain U.S. regions were prescribed testosterone, mostly for off-label use, from 2007 to 2016. The rate of testosterone use among men with CVD peaked during the study period at 3.2 percent in 2013 and 2014. Although the rate dropped in 2016 to 2 percent, that percentage is still higher than the 2007 rate of 1.2 percent.

WHAT ELSE YOU SHOULD KNOW: Researchers hypothesize that CVD patients and their doctors aren’t heeding the FDA’s warnings in part due to regional culture. The highest percentage of prescriptions were in Columbus, Ga.; Fresno, Ca.; and Baton Rouge and Lake Charles, La. The lowest rates were in parts of New Hampshire, Illinois, West Virginia, and Pennsylvania.

WHAT YOU SHOULD DO: If you’re experiencing signs of so-called “low T,” such as a reduced sex drive, fatigue, weight gain, and diminishing muscle mass, have your doctor rule out any underlying conditions or medication side effects. If you have a medical need for testosterone, such as hypogonadism-a condition in which the body doesn’t produce enough testosterone and can cause symptoms such as a decreased libido and erectile dysfunction-weigh the pros and cons of testosterone therapy with your doctor, especially if you have CVD. If your testosterone loss is age-related, try lifestyle interventions like switching to a healthier diet, losing excess weight, incorporating a regular exercise routine into your day, and addressing any sleep or psychological issues to regain lost vigor before using prescription testosterone.