I dunno if you’ve seen this KSman but you might find it interesting:
Long-term Testosterone May Decrease Cardiovascular Risk
May 10, 2016
SAN DIEGO — Long-term testosterone replacement therapy is associated with a decreased — not increased — risk for cardiovascular disease in men, according to a large population-based cohort study.
This finding “answers the controversy” fueled by recent warnings from the US Food and Drug Administration (FDA) suggesting that the opposite is true, said senior investigator Robert Nam, MD, from the Sunnybrook Health Sciences Centre in Toronto.
The study was published online May 7 in Lancet Diabetes & Endocrinology to coincide with its presentation here at the American Urological Association 2016 Annual Meeting.
On the basis of this study, “we can conclude that long-term testosterone is safe,” Dr Nam told Medscape Medical News.
“We need to do further study, but with our large sample size and long follow-up, these data provide some powerful findings,” he explained. “Physicians still need to individualize their recommendations to patients, but it certainly helps to address some of the controversy around testosterone.”
The FDA recently required testosterone products to carry a warning about possible cardiovascular risk, as reported by Medscape Medical News. But that ruling was made on the basis of studies with a short duration of treatment, short follow-up, and no dose–response analysis, said Dr Nam.
“We weren’t convinced that long-term testosterone had a detrimental effect because all the science says otherwise. That’s why we wanted to look at it in a larger population with a longer duration of use,” he explained.
The study involved 10,311 men 66 years and older newly treated with testosterone replacement therapy and 28,029 untreated control subjects, all gathered from Canadian databases.
Control subjects were matched for age, comorbidity, diabetes, region of residence, and index year.
At a median follow-up of 5 years, overall mortality was lower in patients treated with testosterone replacement therapy than in control subjects (hazard ratio, 0.88).
Duration of Treatment
When the duration of exposure was analyzed, mortality and heart-related morbidity were higher in patients who received short-term therapy (median, 2 months) than in those who received medium-term (median, 9 months) or long-term (median, 35 months) therapy. There was a “protective effect against both mortality and rates of heart-related events” with longer duration of treatment, Dr Nam reported.
Specifically, with short-term exposure, mortality increased by 11% and cardiovascular risk increased by 26%. However, with medium-term exposure, mortality decreased by 10%, and with long-term exposure, mortality decreased by 33% and cardiovascular events decreased by 16%.
There was no increase in prostate cancer risk with short-term exposure, and the risk decreased with increasing exposure; with long-term exposure, prostate cancer decreased by 40%.
Importantly, when the investigators looked at testosterone exposure over time, they controlled for immortal time bias, which can falsely attribute short-term risk to a treatment when deaths are actually due to the treatment having not taken effect, explained lead investigator Christopher Wallis, MD, also from Sunnybrook.