Hypogonadism is a common endocrine disorder in aging men, and testosterone therapy is frequently used to improve symptoms and metabolic health. A study published in the Journal of the Endocrine Society evaluated the relationship between long-term testosterone therapy and cardiovascular outcomes in older men.

This retrospective cohort study included 440 testosterone-exposed men and 136,051 unexposed men from the National Health Service (NHS) Greater Glasgow and Clyde population. Testosterone exposure was defined as a minimum 2-year interval between the first and last prescription within a 5-year window from 2012 to 2016. Participants were followed from January 1, 2017, to December 31, 2022. The primary outcome was time to first major adverse cardiovascular event (MACE), defined as acute myocardial infarction, unstable angina, stroke, heart failure, or cardiovascular death. Cox proportional hazards models were used to estimate associations, adjusting for age, ethnicity, socioeconomic deprivation, and comorbidities.

Testosterone therapy was associated with a higher risk of major adverse cardiovascular events, with an adjusted hazard ratio (HR) of 1.55 (95% CI, 1.19–2.01). The unadjusted hazard ratio was 1.54 (95% CI, 1.18–2.00).

These findings indicate that prolonged testosterone therapy may increase cardiovascular risk in older men. Further long-term studies are required to clarify the cardiovascular safety profile of testosterone therapy.