Dr. Harry Fisch, who wasn’t involved in the study, was not surprised. First of all, he said, men with cardiovascular disease tend to have lower testosterone levels. In addition, people with heart disease are often overweight and “people who are heavier tend to have lower testosterone,” said Fisch, a clinical professor of urology and reproductive medicine at Weill Cornell Medical College in New York City. “The bigger the belly, the lower the testosterone.”
A better solution for these men would be “diet and exercise,” said Fisch. “That will lower the belly fat.”
Fisch said he never prescribes testosterone off-label for low hormone levels. Beyond safety issues, “there is not a study showing what symptoms are improved with testosterone,” Fisch said.
A large, ongoing randomized trial - the Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men - should be completed in 2022, said Dr. Erin Michos of the Ciccarone Center for the Prevention of Heart Disease at the Johns Hopkins School of Medicine in Baltimore, Maryland. “The results of that trial could be the tipping point that changes practice patterns.”
Low testosterone “may be a marker of a poorer health state, so it’s not surprising that many men with coronary artery disease have low testosterone,” said Michos, who wasn’t involved in the current study. “Men with diabetes and (coronary artery disease) frequently have vascular erectile dysfunction, stemming from atherosclerosis and endothelial dysfunction. Blaming low testosterone levels may seem like an easy solution when actually the problem stems from a more complicated underlying vascular disorder,” she said in an email.
“Additionally,” Michos said, “there might be a tendency to blame a lot of nonspecific symptoms such as fatigue or lack of fitness on the low testosterone level whereas there might be other modifiable etiologies for those symptoms, such as obesity and sedentary behavior.”