Debate: Testosterone Therapy Reduces Cardiovascular Risk in Men with Diabetes. Against the Motion

Abstract

© 2015, Springer Science+Business Media New York. Observationally, men with low testosterone are more vulnerable to type 2 diabetes (T2DM). In meta-analysis of, albeit small, randomized controlled trials (RCTs) giving men testosterone improves glucose metabolism. T2DM predicts cardiovascular disease; improving glucose metabolism could be expected to reduce cardiovascular disease risk. Taken together, trials have not shown clearly that commonly used agents for glucose reduction also reduce cardiovascular risk substantially, although some treatments for T2DM, such as insulin and sulfonylureas may raise testosterone. Testosterone has never been tested as a strategy for cardiovascular disease prevention or treatment in men with T2DM. Meta-analysis of RCTs in men suggests that testosterone administration has no effect on cardiovascular events or increases cardiovascular-related events, perhaps because testosterone promotes coagulability. Regulators have warned of cardiovascular risk on testosterone and/or suggested prescription of testosterone be restricted. As such, testosterone is unlikely to be an effective means of reducing cardiovascular risk in men with T2DM.