From my friend Lee Meyers (who passed away a year ago in an accident).
Testosterone Therapy Cardiovascular Studies
Within just a few months (Oct 2013 to Jan 2014) testosterone therapy appeared to be on the ropes with two back-to-back studies showing increased cardiovascular risk for men on TRT. [1][2] These studies were controversial and widely criticized in the TRT community, however. And one of the reasons is that, in general, testosterone therapy has done very well in the research, and so this was quite a shock. In my opinion, Dr. Morgentaler did an incredible job of showing the issues with these studies in two papers. Below is a quick recap by Dr. Morgentaler of the key problems:
"However, methodological flaws and data errors invalidate both studies as credible evidence of risk. One showed reduced adverse events by half in T-treated men but reversed this result using an unproven statistical approach. The authors subsequently acknowledged serious data errors including nearly 10% contamination of the dataset by women. The second study mistakenly used the rate of T prescriptions written by healthcare providers to men with recent myocardial infarction (MI) as a proxy for the naturally occurring rate of MI. Numerous studies suggest T is beneficial, including decreased mortality in association with TTh..." [6]
Although one of our posters pointed out that Dr. Morgentaler has disclosed considerable financial ties to the testosterone manufacturers, Dr. Morgentaler's position seemed completely vindicated by two ensuing major studies showing that testosterone therapy actually IMPROVES cardiovascular risk. [3] So, oddly enough, 2014 and 2015 proved to be very good years for male TRT after all. Because these studies are much less well-known, I go into some details with them below:
1. Senior Men Receiving Injections. This study found that "older men who were treated with intramuscular testosterone did not appear to have an increased risk of MI [heart attack]. For men with high MI risk, testosterone use was modestly protective against MI." [4] Injections, in particular, have been criticized - more on that below - as posing some additional cardiovascular risk but notice that testosterone actually lowered the risk of a heart attack in those who need it most.
2. NORMALIZATION Greatly Improves Risk of Heart Attack, Stroke, and Mortality. This recent study in The European Heart Journal pointed out that the major component missing from the two negative CVD studies were normalization of testosterone levels, i.e. proof that the patients actually had their testosterone boosted significantly. The authors of this study used a VERY large set of 83,000+ veterans data and found results that were so positive it has silenced virtually all TRT critics from what I have seen: [6]
a) A 47% reduction in all-cause mortality!
b) An 18% reduction in heart attacks
c) A 30% reduction in strokes.
These are incredible numbers and, as I often point out, it is no wonder considering that testosterone lowers insulin levels and improves insulin sensitivity, something that is a major issue for most 45+ men in modern societies. Again, just because a man goes on TRT does not necessarily mean that anyone has proven that his testosterone has normalized. He may not have been complaining and some delivery systems just do not work in some circumstances.
