“Several recent publications have raised concern that testosterone replacement therapy in men increases cardiovascular risk. There have also been reports of decreased mortality with testosterone treatment. However, all these studies have significant methodological limitations and do not permit us to draw any firm conclusions. There is no compelling evidence that testosterone therapy either increases or decreases cardiovascular risk. Meta-analyses of short-term randomized controlled trials do not show an effect of testosterone on cardiovascular events or mortality,” Dhindsa told Endocrinology Advisor.
He said any candidate for testosterone replacement therapy should undergo a thorough diagnostic work-up, and the decision to undergo treatment should be guided by the signs, symptoms and testosterone concentrations rather than the underlying cause.
Testosterone Therapy in Women
Panel member Susan Davis, PhD, director of the Women's Health Research Program in the School of Public Health and Preventive Medicine at Monash University in Melbourne, Australia, addressed the issue of testosterone therapy in women.
The treatment is safe and effective for treating women who are experiencing hypoactive sexual desire disorder (HSDD), a condition that persistently affects female sexual function, according to Davis.
Moreover, testosterone has been used to treat women with HSDD for decades with no evidence of emergent adverse effects, she said.
Davis also explained that testosterone therapy is an effective treatment and safe management option not just for sexual function but also for effects on muscle and bone.
“Some people believe that the use of testosterone to treat women with low libido is a construct of big pharma. Some feminists believe that if women have low libido that increasing their libido is just about appeasing men,” Davis told Endocrinology Advisor.
“Some people do not feel the data are strong enough to justify the use of testosterone in women, but in fact, the treatment effect size seen is similar to that seen with antidepressant therapy for depression. Testosterone is as much a female hormone as it is a male hormone. There are women who are truly androgen-deficient and would benefit from testosterone therapy.”
Symptoms of Low Testosterone In Women
These comments aligned with the soon-to-be-published AACE Reproductive Endocrinology position statement on the association of testosterone and cardiovascular risks, according to a press release from the association.
The position statement notes that there is no compelling evidence that testosterone replacement therapy either increases or decreases cardiovascular risks and concludes that testosterone therapy favorably changes many cardiovascular risk factors by decreasing fat mass, increasing muscle mass and decreasing insulin resistance.
The potential benefits include improved libido, improved energy level, improved mood and sense of well-being, increases in lean body mass and strength, and decreases in body fat mass, according to Dhindsa.
The treatment of hypogonadism should not depend on the cause of hypogonadism; instead, diagnostic thresholds that are more likely to identify patients who would benefit from testosterone replacement therapy are needed, he said.