Debate: Testosterone Therapy Reduces Cardiovascular Risk in Men with Diabetes. Against the Motion
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DIABETES AND INSULIN RESISTANCE (M RUTTER, SECTION EDITOR)
Debate: Testosterone Therapy Reduces Cardiovascular Risk in Men with Diabetes. Against the Motion C. Mary Schooling & Lin Xu & Jie Zhao
Published online: 22 March 2015 # Springer Science+Business Media New York 2015
Abstract Observationally, men with low testosterone are more vulnerable to type 2 diabetes (T2DM). In metaanalysis 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.
This article is part of the Topical Collection on Diabetes and Insulin Resistance C. M. Schooling (*) CUNY School of Public Health and Hunter College, C Mary Schooling, 2180 Third Avenue, New York, NY 10035, USA e-mail: [email protected] C. M. Schooling : L. Xu : J. Zhao School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, People’s Republic of China L. Xu e-mail: [email protected] J. Zhao e-mail: [email protected]
Keywords Diabetes . Testosterone . Cardiovascular disease . Coagulation . Men . Obesity . Lipids . Blood pressure
Introduction Testosterone is an appealing product for men and has been promoted to create a climate of opinion where it is seen in favorable light [1]. Testosterone is also recommended for symptomatic testosterone deficiency by the Endocrine Society [2], albeit largely based on observational rather than experimental evidence. However, regulators highlighted concerns about the cardiovascular safety of testosterone treatment in 2014 and 2015. Specifically, the Food and Drug Administration (FDA) in the USA warned about venous thromboembolism on testosterone in June 2014 [3]. Health Canada warned about Bheart attack, stroke, blood clot in the lungs or legs; and increased or irregular heart rate with the use of testosterone replacement products^ in July 2014 [4]. The FDA required manufacturers to "add information to the labeling [for testosterone] about a possible increased risk of heart attacks and strokes" in March 2015 and recommended more restricted prescription of testosterone [5]. The European Medicines Agency was more equivocal, but emphasized th
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