Current guidelines recommend that there be no clear evidence of cardiovascular risk in any given group of patients treated with TRT. However, its safety in patients with cardiovascular risks and previous cardiovascular events remains doubtful, because recent studies show conflicting results with TRT in patients with adverse cardiovascular risk factors. Therefore, ACC guidelines now recommend avoiding TRT in patients with recent myocardial infarction, revascularization, advanced or severe heart failure, and stroke within the past six months. However, prospective, randomized controlled trials are still needed to follow patients for at least one year or more, including patients with a valid diagnosis of hypogonadism, using two standardized testosterone samples first thing in the morning.
While some clinical trials have reported an association between testosterone insufficiency in older men and an increased risk of death, the exact effects and consequences of testosterone replacement therapy, specifically in older men, remain unclear. The main analysis evaluated mortality in men with low serum testosterone levels compared to men with normal serum testosterone levels.
Testosterone replacement therapy
products should be avoided in patients with testosterone deficiency without an associated medical condition or with testosterone deficiency due to aging. The relationship between testosterone levels and cardiovascular outcomes is difficult and has yielded conflicting results. Congenital or acquired disorders affecting the testicles decrease testosterone levels in primary hypogonadism, while hypothalamic-pituitary disorders are responsible for the decrease in testosterone levels in secondary hypogonadism.Testosterone is an anabolic hormone that, in addition to being responsible for primary sexual characteristics at birth and puberty, is involved in maintaining secondary sexual characteristics throughout life. Previous studies have suggested a possible beneficial effect of testosterone replacement therapy in older men on the cardiovascular system. The benefits and safety of these medications for treating low testosterone levels due to aging have not been established, even if the man's symptoms appear to be related to low testosterone levels. Providers can discuss testosterone therapy and its risks compared to benefits for men over 65 who have symptoms of testosterone deficiency. A larger proportion of men in the testosterone group than in the placebo group reported that they had received a diagnosis of hyperlipidemia or were taking statins.
The literature on clinical trials is inconsistent, limited by the small number of publications and because the sample size is not powerful enough to assess prostate cancer risks in older men receiving testosterone replacement therapy, it indicates that only large clinical trials, in which several thousand patients have been treated for years of treatment, can provide an answer. There are numerous testosterone replacement therapy (TRT) products on the market, which replenish testosterone levels and can resolve the clinical symptoms of testosterone deficiency. Testosterone treatment has also been reported to improve hemoglobin concentrations, which also appears to improve anemia regardless of etiology. Its effectiveness in replacing testosterone in people with nearly low or normal testosterone levels has not yet been proven, and it may not compensate for the risks.
Among American men, direct consumer television advertising has been attributed to the tendency to perform more testosterone tests, to start new tests and to start tests without taking them recently. In that study, subjects taking medications known to affect bones, except over-the-counter calcium and vitamin D, were excluded.
