BACKGROUND: Testosterone replacement therapy has become a highly commercialized treatment over the past several years. Whether or not testosterone deficiency is a pathologic condition is a matter of debate. Testosterone levels decline as men age, and other factors including obesity and lack of exercise may play a role. Regardless of the cause, men are constantly being encouraged through advertising to have their levels checked and treated if necessary.

The long-term risks of testosterone therapy are largely undefined. Estrogen replacement in postmenopausal women was a common practice until results from the Women's Health Initiative (WHI) trial found a number of risks (see Women's Health Initiative results for a discussion). The WHI was a very large, randomized controlled trial, the likes of which are not likely to be repeated with testosterone replacement in men. Theoretical risks of testosterone therapy replacement include prostate cancer, benign prostatic hyperplasia, sleep apnea, and cardiovascular disease.

STUDY: A cohort study published in the JAMA evaluated the risk cardiovascular disease with testosterone replacement therapy in a cohort of VA patients. PubMed abstract

StraightHealthcare analysis: Patients seeking testosterone replacement therapy should be aware that the long-term risks of therapy have not been defined. While this study was observational, it was performed with advanced statistical techniques that bolster its validity. Patients using or considering testosterone replacement therapy should be aware that there is a good chance it will increase their risk of mortality, heart attack, or stroke.