Observational studies have consistently shown a relationship between low testosterone (T) and a higher cardiovascular (CV) risk profile. However, it is still obscure whether reduced T levels in the elderly play a direct pathogenetic role in the stratification of CV risk, or if CV diseases (CVD) and low T are concomitant conditions, both associated with the aging process. Much evidence supports both of these possibilities. In the meanwhile, recent reports in the scientific and lay press have suggested that T replacement therapy (TRT) is likely to increase CV risk. In a 2015 release, the Food and Drug Administration (FDA) cautioned that prescribing T products is approved only for men who have low T levels due to primary or secondary hypogonadism resulting from specific problems. The FDA emphasized that the benefits and safety of T medications have not been established for the treatment of low T levels due to aging, because it could be associated to a higher CV burden. However, data from randomized controlled studies and information derived from both observational and pharmacoepidemiological investigations do not support this view. In particular, separate meta-analyses of all the available studies do not support any causal role between TRT and adverse CV events. This is especially true when hypogonadism is properly diagnosed and replacement therapy is correctly performed. Elevated hematocrit represents the most common adverse event related to TRT. Hence, it is important to monitor hematocrit at regular intervals in T-treated subjects in order to avoid potentially serious adverse events.
Biographical details: Professor Mario Maggi is Chief of the Sexual Medicine & Andrology Unit at the Department of Experimental and Clinical Biomedical Sciences at the University of Florence, Italy and full Professor of Endocrinology at the same University since September 2000. He got his M.D. from the School of Medicine, University of Florence, Italy in 1981. He served as the secretary of the European Academy of Andrology 20102014, Past President of the Società Italiana di Andrologia e Medicina della Sessualità 20122014 and president of Andrological Sciences Onlus. He is associate Editor for the Journal of Sexual Medicine and for the International Journal of Endocrinology and board member of the Journal of Endocrinological Investigation. Current H index=76. i10 index=326; Total number of citations in peer-reviewed journals =17707. Prof. Maggi is the author of 414 peer-reviewed manuscripts and has written several book chapters and invited reviews in the fields of human reproduction and sexual medicine. For his work in these fields he has received numerous research grants and presented at both national and international meetings. He chaired, together with Jacques Buvat, The Committee for Endocrine Aspects of Male Sexual Dysfunction of the 3rd International Consultation on Sexual Medicine of ISSM.