There are no large, long-term, placebo controlled randomized clinical trials in the field of Testosterone (T) therapy to provide definitive conclusions about Cardiovascular (CV) risk. Nonetheless, there exists a rich literature spanning many decades that provides valuable information.

Established benefits of testosterone therapy in hypo-gonadal men include improved sexual desire and function, improved energy, mood, and vitality, increased lean mass, decreased waist circumference, reduced total body fat mass, and increased bone mineral density. Promising new data reveal that T therapy improves insulin sensitivity and reduces blood glucose and hemoglobin A1c(HbA1c) levels in men with type 2 diabetes or obesity*.

The largest meta-analysis to date was published in the Mayo Clinic Proceedings in February 2015 and the following is their conclusion:

“In the absence of large, prospective, placebo controlled studies of several years’ duration, it is impossible to provide any definitive comment on the absolute safety or risk of T therapy with regard to CV outcomes. However, review of the literature clearly reveals a strong relationship between higher serum T concentrations, endogenous or via T therapy, as beneficial for reduction of CV disease and CV risk factors. Public health may be harmed not only by inadequate appreciation of an actual risk but also by the failure to offer beneficial treatment for a medical condition because of false claims of risk concerns. On the basis of the current state of evidence, placing restrictions on the appropriate use of T therapy for T-deficient men is likely to result in compromise of public health and a substantially increased future financial burden on the US health care system. In summary, we find no scientific basis for the suggestion that T therapy increases CV risk. In fact, as of this date, we are unaware of any compelling evidence that T therapy is associated with increased CV risk. On the contrary, the weight of evidence accumulated by researchers around the world over several decades clearly indicates that higher levels of T are associated with amelioration of CV risk factors and reduced risk of mortality.”