Low testosterone and heart disease, heart attacks, and stroke have been shown to be associated by numerous studies.1,2,3,4 In a study published in 2012, conducted by Veterans Affairs in Seattle, Washington, researchers found that in “men with low testosterone levels, testosterone treatment was associated with decreased mortality compared with no testosterone treatment.”5
This 2012 study showed that men receiving low testosterone treatment were less likely to die than men who had untreated low testosterone. In fact, “the mortality in testosterone-treated men was 10.3% compared with 20.7% in untreated men.”
Controversy has been created by another recent study done by Veterans Affairs (VA) researchers in Colorado that studied veterans between 2005 and 2011 and included 8,709 men with low testosterone.6 The study published these results:
- 8709 men with a total testosterone level lower than 300 ng/dL were included in the study
- 1710 total outcome events: 748 men died, 443 had heart attacks, and 519 had strokes
- 1223 patients started testosterone therapy after a median of 531 days following coronary angiography
- 7486 patients not receiving testosterone therapy: 681 died, 420 had heart attacks, and 486 had strokes
- 1223 patients receiving testosterone therapy: 67 died, 23 had heart attacks, and 33 had strokes
The study reports that “the absolute rate of events were 19.9% in the no testosterone therapy group vs 25.7% in the testosterone therapy group,” but how did they get these numbers? If we do the math based on the above data here is what we can calculate:
- 20% of all the men in the study had either a stroke, heart attack, or died over a 3 year time frame
- 21% of men NOT receiving testosterone therapy died or had a heart attack or stroke
- 10% of men receiving testosterone therapy died or had a heart attack or stroke
If the following is too technical please feel free to skip ahead where we talk about the results from some studies that were designed better.
Perhaps they did some fancy math to make 10% become the reported 25.7% rate of incidents in the testosterone therapy group. Or, perhaps the study was very poorly designed. In fact, “of the 1223 patients prescribed testosterone therapy, 215 patients (17.6%) filled only 1 prescription,” and only “734 patients (60.0%) had another testosterone value checked after starting treatment.”
In addition, they never actually verified with lab testing that they increased the majority of these men to “normal” testosterone levels. On average they only checked men’s testosterone levels twice after beginning treatment with 40% having no repeat lab testing and 60% “had a mean of 3.3 measurements.” Among these 60% of men receiving what the VA considers testosterone therapy, “the baseline testosterone level was 175.5 ng/dL and increased to 332.2 ng/dL for the first repeat testosterone measurement.” The normal range for testosterone levels is about 350 ng/dL to 1200 ng/dL.
The Veterans Affairs researchers do concede some potential for error in their study: “there was a relatively small group of patients with extended follow-up time (267 patients at 2000 days after coronary angiography) so that our estimates of the risk of testosterone therapy are less reliable at these extremes of follow-up; however, this is a potential limitation of any study that follows up patients for extended periods.”
What they did was far from what I’d call “testosterone therapy” as there was barely any follow-up lab testing performed and when they did lab testing the results showed that testosterone levels had barely improved. I suspect many of the subjects in the study were converting too much of their testosterone to estrogen or not even absorbing their topical testosterone at all. They even admit that many patients didn’t even refill their prescriptions for testosterone yet somehow they’re still counted as being on testosterone replacement in the study.