Testosterone Replacement Therapy is use to treat low testosterone (T) levels. But is it actually safe for the cardiovascular health?

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Is Testosterone Safe for Your Heart?! Things You Should Know

there is some big news I'm about to share with you today about testosterone replacement therapy I'm Dr Vena Malek urologist and pelvic surgeon and today I'm going to talk about the newest trial that was just published looking at the risk of cardiovascular or heart effects of testosterone replacement therapy now this is really really important so make sure you listen to the entire video and soak it all in first let's talk about the controversy surrounding testosterone therapy for a couple of decades research indicated that low testosterone levels were associated with greater cardiovascular disease risks meaning that if you had low testosterone you were more likely to have heart disease and other problems in fact obesity and diabetes were also known to be major risk factors for cardiovascular disease and we're also linked to having low testosterone levels and several observational studies even showed that testosterone therapy might actually even reduce the risk of but why then all of a sudden was testosterone therapy shown as this horrible thing that might kill you in 2013 the Journal of American Medical Association or Jama published a observational study that did report a higher absolute risk of heart attack stroke and death in men who received testosterone therapy compared to those who did not however here's the catch the authors of the study actually misreported their data in reality the absolute risk was actually lower in the group that received testosterone therapy compared to the untreated group but it was too late the media already picked it up and blasted everywhere that testosterone replacement had a higher risk and the authors and the journal still corrected the article but it was too late now to understand the true effects of testosterone therapy it's important to look at well-designed studies and several controlled trials have demonstrated that the use of testosterone in men offers various benefits including Improvement in sexual function increasing bone mineral density and helping with unexplained anemia and even maybe reducing some depressive symptoms so very recently the results of the Traverse trial were published and this was published in the New England Journal of Medicine which is the most impactful and respected medical journal arguably in the world and it wanted to provide more clarity on the cardiovascular safety of testosterone replacement therapy so the study involved over 5200 men between the ages of 45 and 80 who had pre-existing cardiovascular disease or were at high risk for cardiovascular disease and they had symptoms of low testosterone or hypogonadism and these symptoms could be decreased sexual desire fatigue low or depressed mood a loss of hair in the pubic or axillary area or hot flashes these men also had two you fasting early morning blood tests to test their total testosterone and their levels were less than 300 nanograms per deciliter and they were considered to be of high cardiovascular risk if they had three or more risk factors and these included high blood pressure and abnormal lipid profiling they had some abnormalities in their cholesterol they were current smokers they have stage three kidney disease diabetes or elevated CRP which is a blood test if they were age 65 or older or if they had what's called an agastin coronary calcium score and that had to be above the 75th percentile for age and race and what that is it's a score that looks at how much calcification you have in your arteries based on Imaging so these participants were then randomly assigned to get either daily transdermal 1.62 percent testosterone gel or get a placebo gel and their testosterone levels were adjusted throughout the trial to maintain a specific Civic rage and because this was blinded meaning that both the doctors and the providers giving the testosterone didn't know and the patients didn't know they actually had a centralized group looking at the testosterone levels and making sure they were changing the dosing appropriately so people still remained blinded throughout I think it's important to be transparent and this trial was funded by a bunch of testosterone manufacturers led by Avi which is a major testosterone manufacturer as well so the men received treatment for an average of almost 22 months and they were followed for almost three years and at the end of the trial they saw heart attacks or cardiovascular events in seven percent of the patients in the testosterone group and 7.3 percent in the placebo group which means there was really no difference in those who received testosterone replacement and those who didn't bottom line testosterone replacement therapy does not increase your cardiac risk even if you're at a high risk of cardiovascular disease now this does mean that trt is completely safe there were some small increases in other abnormalities in the testosterone group like a higher risk of pulmonary embolism or blood clot in the lungs they also saw a slight increase in prostate specific antigen or PSA blood tests now they didn't see a difference in prostate cancer and PSA tests is a specific screening test for prostate cancer they also saw slight increases in blood pressure and arrhythmias which were not life-threatening atrial fibrillation and acute kidney injury so ultimately I think this is wonderful news for anyone who's considering taking testosterone replacement or is taking it already now it's important to realize that you should only be taking testosterone replacement if you have clinical hypogonadism that means you have symptoms and your blood work shows a low testosterone level and if you're getting testosterone replacement you need to be monitored by a health care professional with regular blood work to make sure testosterone levels remain in the physiologic range meaning it should not go too high and you should actually be seeing a benefit meaning your symptoms should be improving I think this study is so exciting because there's also some new data looking at sexual satisfaction fracture risk and these lower rates of anemia which might change the way we even look at testosterone replacement in the future super exciting stuff I hope you guys enjoyed this video if you did make sure you check out my other video looking at testosterone levels by age because I think that's a really interesting area that we don't talk about enough and also please if you like this video subscribe and share this Channel with your friends as always you want to take care of yourself because you are worth it

Dr.

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