Someone posted this in another group and I wanted to share it here.
A review by Goodale et al. (2017) on testosterone and cardiovascular disease.
Testosterone (T) has a number of important effects on the cardiovascular system. In men, T levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk. Low T levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes. Reduced T levels in men with congestive heart failure (CHF) portends a poor prognosis and is associated with increased mortality. Studies have reported a reduced CV risk with higher endogenous T concentration, improvement of known CV risk factors with T therapy, and reduced mortality in T-deficient men who underwent T replacement therapy versus untreated men. Testosterone replacement therapy (TRT) has been shown to improve myocardial ischemia in men with CAD, improve exercise capacity in patients with CHF, and improve serum glucose levels, HbA1c, and insulin resistance in men with diabetes and prediabetes. There are no large long-term, placebo-controlled, randomized clinical trials to provide definitive conclusions about TRT and CV risk. However, there currently is no credible evidence that T therapy increases CV risk and substantial evidence that it does not. In fact, existing data suggests that T therapy may offer CV benefits to men.
Two recent observational studies reported increased CV risks
in men who received testosterone prescriptions.17,18 Although they gained a significant amount of media attention, neither study pro- vided credible evidence of increased CV risk. In one study, Vigen et al. made an official correction for misreporting their primary results, which actually showed a lower percentage of adverse CV events in the T-treated group compared to untreated men.19 In the other study, Finkle et al. had no control group, so it is unknown whether CV events differed between treated and untreated men with TD.19 The U.S. Food and Drug Administration (FDA) re- viewed the CV safety of T products shortly after publication of these articles. In its assessment of CV risks and T therapy, the FDA identified a total of only 4 studies suggesting an increased risk,
yet none provided solid evidence to support this. By comparison, more than 100 studies have reported reduced CV risk with high-
er endogenous T concentration, improvement of known CV risk factors with T therapy, and reduced mortality in T-deficient men who underwent TRT versus untreated men.19 Two recent studies in men who received TRT found reduced CV events in those whose follow-up T level normalized compared to men whose T concen- tration remained low.20,21 Another large observational study noted that T therapy was associated with reduced risk of myocardial in- farction in men in the highest risk category.22 A recently published meta-analysis of 75 placebo-controlled studies, the largest to date, found no evidence of increased CV risk with T therapy and clear evidence of improved metabolic profiles.23 An international expert consensus regarding testosterone deficiency and treatment, pub- lished in the July 2016 Mayo Clinic Proceedings, concluded: “There is no credible evidence at this time that T therapy increases CV risk and substantial evidence that it does not. Indeed, there is