Aim: To assess side effects of testosterone (TRT).
Introduction: TRT in men with hypogonadism helps improve libido, erectile dysfunction, energy levels and bone density. However the risks/benefits of TRT in terms of ischemic heart disease (IHD), stroke and venous thromboembolism (VTE) is controversial no definitive answers from current evidence. We evaluated the side effects of TRT in patients attending endocrinology outpatient clinic between 2009 to 2019.
Methods: A retrospective analysis for 106 patients with data collected from electronic clinic letters, blood results and radiology reporting including age, reason for TRT, duration of treatment, past medical history, side effects, time interval between starting TRT and onset of side effects with emphasis on cardio/cerebrovascular outcomes was conducted.
Results: Mean age was 57 years (1889) and mean duration of TRT was 6 years (134). Of 106 patients, 27 had primary, 44 secondary and 38 mixed hypogonadism. Before initiation of TRT, 34 (32.1%) patients had pre-existing diabetes, 43 (40.6%) hypertension, 9 (8.4%) IHD, 6 (5.6%) hyperlipidemia and 2 (1.9%) VTE. During the study period, 8 (7.5%) patients were diagnosed with IHD, 3 (2.8%) with diabetes and 2(1.9%) each with hypertension, VTE and prostate cancer. Raised haematocrit was observed in 10(9.4%). Average time lag for diagnosis of a new medical condition or a side effect was 3.7 years (range 113) after starting TRT while cardiac symptoms had an average time lag of 1.9 years(range 0.55). Of 6 patients with pre-existing IHD 4 (50%) showed increased cardiac symptoms.
Conclusion: In our study, very small percentage of patients developed IHD and VTE and none developed stroke after starting TRT. While cardiac symptoms worsened in 50% men with preexisting cardiac disease, no major cardiovascular events occurred. So we feel it is safe to prescribe TRT irrespective of age or pre-existing IHD with cautious monitoring.