Testosterone Replacement Therapy and Cardiovascular Disease: Balancing Safety and Risks in Hypogonadal Men.

Hypogonadism is associated with increased mortality in men with cardiovascular disease.

• Low testosterone levels in men with CVD are linked to worse outcomes and increased mortality rates.
• This association supports the clinical rationale for evaluating TRT in hypogonadal men with cardiovascular conditions.
• The review identifies hypogonadism as an independent risk factor relevant to cardiovascular prognosis.

Earlier studies suggesting a link between TRT and adverse cardiovascular events were found to contain methodological flaws.

• A few published studies suggested a link between TRT and CV events, but these studies 'contained flaws.'
• Many other studies reveal a reduction in CV events associated with TRT use.
• The review characterizes the negative studies as outliers in the broader literature base.

TRT in hypogonadal men can improve multiple cardiovascular disease risk factors.

• TRT was found to reduce QT interval prolongation, which is a marker of cardiac arrhythmia risk.
• TRT was associated with better outcomes in heart failure patients.
• TRT was found to slow the progression of atherosclerosis in hypogonadal men.
• Improvements spanned multiple CVD risk domains, suggesting broad cardioprotective mechanisms.

TRT used to achieve physiologic testosterone concentrations does not pose a threat to cardiovascular health and demonstrates a cardioprotective effect.

• The review concludes that achieving physiologic — not supraphysiologic — testosterone levels is key to cardiovascular safety.
• The cardioprotective effect was observed specifically in the context of restoring normal testosterone levels in hypogonadal men.
• This conclusion is drawn from analysis of multiple studies, contrasting with earlier reports of CV harm.