The American Association of Clinical Endocrinologists recently issued a position statement, published in Endocrine Practice, citing lack of evidence linking testosterone replacement therapy with cardiovascular events.

Neil Goodman, MD, FACE, of the University of Miami Miller School of Medicine, and colleagues for the AACE Reproductive Endocrinology Scientific Committee are calling for larger studies that will focus on the impact of testosterone replacement therapy on risk for CVD.

The association of low testosterone concentrations with CV problems, especially among older men, has been supported by recently published studies, but the position statement notes that low testosterone is often a marker of CV illness and not a causal factor.

Testosterone replacement therapy has been shown to have benefits in men with hypogonadism, including decreased insulin resistance, waist circumference and fat mass. Metabolic syndrome has also been reversed in some men following testosterone replacement therapy.

According to the committee, a thorough diagnostic work up should be performed on any man being considered for testosterone replacement therapy. The patients’ signs, symptoms and testosterone concentrations should guide the decision for the therapy rather than the underlying cause.

The committee added that the risk/benefit ratio of testosterone replacement therapy is still not completely clear.

“It needs to be emphasized that low testosterone is often a marker for chronic disease, and the underlying CVD risk factors should be addressed,” the researchers wrote. “In patients with vascular and minor symptoms of hypogonadism, a more cautious approach towards testosterone therapy is prudent. Physicians should have a detailed discussion with such patients … before embarking on testosterone replacement.” – by Amber Cox