Testosterone Therapy Reduces Cardiovascular Risk among Hypogonadal Men: A Prospective Cohort Study in Germany

Background: Low testosterone level has been associated with predictors of cardiovascular disease (CVD); however, controversies exist regarding the role of testosterone therapy, a treatment to improve testosterone levels, in preventing cardiovascular risk. Longitudinal studies with a large sample size and long follow-up duration are limited. Materials and Methods: We conducted a prospective cohort study using data from 602 hypogonadism men free of CVDs at study baseline from a registry study in Germany who were eligible for testosterone therapy, with an age range of 31-74 years and a follow-up duration of up to 12 years. Receiving testosterone therapy or not was based on the patient's own choice at study entry. Patients who decided to take testosterone therapy were classified as treatment group (n = 325), and the rest were classified as the control group (n = 277). We compared the Framingham Global CVD Risk Score between the treatment and control groups over time and cardiovascular incidence during the follow-up period. We adjusted for baseline characteristics between the treatment and control groups in the mixed-effect model examining the longitudinal effect of testosterone treatment on the risk score, and we applied propensity score matching to control for confounders. Results: We found that the control group had an overall increasing risk score and decreasing testosterone level over time. For the treatment group with improved testosterone level and lipid and glucose profiles, the risk score decreased before 24 months, and it became stable later on. After propensity score matching, there were 0 cardiovascular events in the treatment group and 45 in the control group. Conclusions: Low testosterone level is associated with higher cardiovascular risk. Long-term testosterone therapy reduces cardiovascular events among hypogonadal men. Clinicians should be informed of this association when assessing a male patient's cardiovascular risk and ensure timely treatment if needed.