Testosterone treatment and coronary artery plaque volume in older men with low testosterone

Matthew J. Budoff, Susan S. Ellenberg, Cora E. Lewis, Emile R. Mohler, Nanette K. Wenger, Shalender Bhasin, Elizabeth Barrett-Connor, Ronald S. Swerdloff, Alisa Stephens-Shields, Jane A. Cauley, Jill P. Crandall, Glenn R. Cunningham, Kristine E. Ensrud, Thomas M. Gill, Alvin M. Matsumoto, Mark E. Molitch, Rine Nakanishi, Negin Nezarat, Suguru Matsumoto, Xiaoling HouShehzad Basaria, Susan J. Diem, Christina Wang, Denise Cifelli, Peter J. Snyder

Research output: Contribution to journalArticlepeer-review

243 Scopus citations


Importance: Recent studies have yielded conflicting results as to whether testosterone treatment increases cardiovascular risk. Objective: To test the hypothesis that testosterone treatment of older men with low testosterone slows progression of noncalcified coronary artery plaque volume. Design, Setting, and Participants: Double-blinded, placebo-controlled trial at 9 academic medical centers in the United States. The participants were 170 of 788 men aged 65 years or older with an average of 2 serum testosterone levels lower than 275 ng/dL (82 men assigned to placebo, 88 to testosterone) and symptoms suggestive of hypogonadism who were enrolled in the Testosterone Trials between June 24, 2010, and June 9, 2014. Intervention: Testosterone gel, with the dose adjusted to maintain the testosterone level in the normal range for young men, or placebo gel for 12 months. Main Outcomes and Measures: The primary outcomewas noncalcified coronary artery plaque volume, as determined by coronary computed tomographic angiography. Secondary outcomes included total coronary artery plaque volume and coronary artery calcium score (range of 0 to >400 Agatston units, with higher values indicating more severe atherosclerosis). Results: Of 170 men who were enrolled, 138 (73 receiving testosterone treatment and 65 receiving placebo) completed the study and were available for the primary analysis. Among the 138 men, the mean (SD) age was 71.2 (5.7) years, and 81%were white. At baseline, 70 men (50.7%) had a coronary artery calcification score higher than 300 Agatston units, reflecting severe atherosclerosis. For the primary outcome, testosterone treatment compared with placebo was associated with a significantly greater increase in noncalcified plaque volume from baseline to 12 months (from median values of 204 mm3 to 232 mm3 vs 317 mm3 to 325 mm3, respectively; estimated difference, 41 mm3; 95%CI, 14 to 67 mm3; P = .003). For the secondary outcomes, the median total plaque volume increased from baseline to 12 months from 272 mm3 to 318 mm3 in the testosterone group vs from 499 mm3 to 541 mm3 in the placebo group (estimated difference, 47 mm3; 95%CI, 13 to 80 mm3; P = .006), and the median coronary artery calcification score changed from 255 to 244 Agatston units in the testosterone group vs 494 to 503 Agatston units in the placebo group (estimated difference, -27 Agatston units; 95%CI, -80 to 26 Agatston units). No major adverse cardiovascular events occurred in either group. Conclusions and Relevance: Among older men with symptomatic hypogonadism, treatment with testosterone gel for 1 year compared with placebo was associated with a significantly greater increase in coronary artery noncalcified plaque volume, as measured by coronary computed tomographic angiography. Larger studies are needed to understand the clinical implications of this finding.

Original languageEnglish (US)
Pages (from-to)708-716
Number of pages9
JournalJAMA - Journal of the American Medical Association
Issue number7
StatePublished - Feb 21 2017

Bibliographical note

Funding Information:
The Testosterone Trials were supported by grant U01 AG030644 from the National Institute on Aging, supplemented by funds from the National Heart, Lung, and Blood Institute. Additional funding was provided by the National Institute of Neurological Diseases and Stroke and the National Institute of Child Health and Human Development. AbbVie provided funding, AndroGel, and placebo gel. Dr Lewis was supported by grant DK079626 from the National Institute of Diabetes and Digestive and Kidney Diseases to the University of Alabama at Birmingham Diabetes Research and Training Center. Dr Gill is the recipient of Academic Leadership Award K07AG043587 from the National Institute on Aging, and the Yale Field Center is supported in part by the Claude D. Pepper Older Americans Independence Centers grant P30-AG021342 from the National Institute on Aging.

Publisher Copyright:
© 2017 American Medical Association. All rights reserved.


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