As the average age in our country rises over time, so does the complaint of loss of libido, or sex drive, and erectile dysfunction (ED). While men do suffer a gradual decline in testosterone levels, they do not experience the acute drop in the sex hormone as women do in their 50s. Rather, men have a more gradual decline in testosterone as they age, and so men fathering children well past the age of 50 is not uncommon.

Due to the gradual rise in the human life span, there is a call for therapy to address the decline in testosterone. This increasing demand has resulted in the availability of multiple forms of therapy and multiple brands of topical testosterone gels. In recent years, multiple small studies suggest a correlation between the use of testosterone therapy and nonfatal heart attacks.

A recent study supported by the Intramural Research Program of the National Cancer Institute suggests there may be a link between the onset of use of testosterone therapy and the risk of nonfatal heart attack in men. Involving 55,593 men, the study found the risk of having a heart attack more than doubled in the first three months following the start of therapy in men ages 65 or older. The risk of heart attack was also elevated in men younger than 65 if they also had a pre-existing history of heart disease.

The data also suggests that the risk of heart attack could decline if older men stopped testosterone therapy after the first 90 days. The mechanism for the observed increased risk is not precisely known, but it is speculated that physiologic changes while on testosterone therapy, such as an increase in red blood cells, a thicker blood viscosity, or a drop in HDL cholesterol may be involved. It should also be noted that while the study was large and included both older and younger men, it was an observational study. It did not involve a blinded-crossover trial, which is a more rigorous approach.  Such a study needs further corroboration with additional studies for a stronger confirmation of its validity. It should also be noted that using the class of drugs known as phosphodiesterase inhibitors, known more commonly as Viagra and Levitra, did not show the increased risk of heart attack.

For now, testosterone therapy remains a valid therapy for hypogonadal men. However, more research is needed on the risk of heart attacks and the use of testosterone. A candid discussion between physicians and patients regarding the risks and benefits remains essential before starting therapy.