SOURCE: Eisenberg ML, et al. Int J Impot Res 2014;27:46-48.

The number of men receiving treatment for hypogonadism has increased dramatically over the past decade. At the same time, some clinical trials have suggested that there are safety issues with testosterone. For instance, one trial of frail seniors was stopped early because of an increased mortality signal. Other clinical trials have not demonstrated similar risk. Ultimately, the only way the question about testosterone safety can be convincingly answered is by performance of a large randomized, prospective trial, similar to the Women’s Health Initiative (WHI).

In the meantime, other trial data may inform clinician choices about testosterone replacement. For instance, Eisenberg et al published their results of a retrospective analysis of the andrology database at Baylor College of Medicine (Houston, Texas), which included 509 hypogonadal men, approximately half of whom were treated with testosterone replacement (injectable or transdermal).

In a 10-year follow-up interval, the mortality rate trended lower in men receiving testosterone replacement than controls, but the difference was not statistically significant. Although such results cannot provide a definitive answer to the question of the relationship between testosterone replacement and mortality, they are reassuring for hypogonadal men who are enjoying symptomatic improvement through testosterone replacement.