PhotoVisitors and newcomers to America — specifically, those who spend enough time here to waste some of it vegging out in front of the TV — are often amazed by our strange and exotic television commercials for prescription pharmaceuticals, since New Zealand is the only other country where “direct to consumer pharmaceutical advertising” is legal.

So if you've watched television lately, you've probably heard something about the many men who suffer from “low T,” or low testosterone, which can be treated with various topical gels or patches so talk to your doctor if you have any of the symptoms mentioned in this commercial.

If you are taking any of these testosterone treatments then you should talk to your doctor (again) because he might not know that various forms of FDA-approved testosterone replacement therapies seem to increase patients' risk of heart attack, stroke or other problems. Not that your doctor is being lax; the studies suggesting this correlation are only a few months old, and word hasn't fully got out yet.

If you've purchased testosterone supplements by responding to one of those last-night commercials, talk to your doctor before you start or continue taking them. Low testosterone is not something you can self-diagnose.

On January 31, 2014, the FDA announced that it was “evaluating risk of stroke, heart attack and death with FDA-approved testosterone products” though it also specified that “At this time, FDA has not concluded that FDA-approved testosterone treatment increases the risk of stroke, heart attack, or death. Patients should not stop taking prescribed testosterone products without first discussing any questions or concerns with their health care professionals.”

FDA investigating

But the FDA is still investigating the possibility, after a November 2013 report in the Journal of the American Medical Association:

The men included in this study had low serum testosterone and were undergoing imaging of the blood vessels of the heart, called coronary angiography, to assess for coronary artery disease. Some of the men received testosterone treatment while others did not. On average, the men who entered the study were about 60 years old, and many had underlying cardiovascular disease. This study suggested a 30% increased risk of stroke, heart attack, and death in the group that had been prescribed testosterone therapy.

How was that 30% increased risk determined? Researchers followed up with the men about two and a half years after the men had their angiography. Among the men who had received testosterone therapy, 26% of them either had a heart attack, suffered a stroke, or died from any cause; this number dropped to 20% among the men who did not have testosterone replacement therapy.

The November 2013 AMA study wasn't the first to suggest a correlation between testosterone therapy and heart problems, though. In 2010, the New England Journal of Medicine mentioned an aborted clinical trial intended to test testosterone gel on patients over 65; researchers halted the study early after subjects showed an increased number of heart attacks and other heart-related problems.

That 2010 study, meanwhile, inspired another study which the online journal PLOS One published in January 2014, noting that “An association between testosterone therapy (TT) and cardiovascular disease has been reported and TT use is increasing rapidly.”

Remember: “increased risk of heart disease” is not remotely synonymous with “guaranteed to cause a heart attack.” However, if you are undergoing testosterone replacement therapy — and especially if you or any of your genetic relatives have a history of heart problems — talk to your doctor and decide whether the risks of testosterone therapy might outweigh the benefits, for you.


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