Busted: Legal Q & A; The “Risk” of Testosterone to Your Heart

Q: What’s the deal with the new study about testosterone therapy increasing your risk for a heart attack?

A: The Internet is on fire with advertisements from hungry class action lawyers urging “victims of testosterone” to sue, trolling for clients with the claim that a “Study finds testosterone supplementation can triple your risk of death” (1). The study, by Finkle and colleagues and published in January in the journal Plos One (2), follows other recent studies claiming to link testosterone (“T”) with heart problems. Both the methodology and conclusions of these studies have been challenged by medical authorities (3), including our own Dan Gwartney, MD, in past issues of this magazine. Harvard testosterone expert Abraham Morgentaler, MD, assured MedPage Today that the new studies “run contrary to 40 years’ worth of research on testosterone” (4).

But rather than cite specific flaws in the studies, I’m going to discuss a bigger issue. It’s about what “risk” means. So, just for this purpose, let’s accept the Finkle study findings as totally reliable. The authors say that for men aged 65 and over, there was “double the risk” of a non-fatal cardiovascular event (CVE) in the first 90 days after filling a T prescription. Among men under age 65 with a history of heart disease, the authors say the “risk” nearly tripled.

“Double” or “triple” the risk sounds frightening indeed. But you need to understand two kinds of risk. The “absolute” risk of something happening is its chance of taking place. The “relative” risk is the chance of something happening in one set of circumstances compared to another. For example, we might find that speeding drivers are twice as likely to get into a car accident as slow drivers. But we need to know about both kinds of risks for the finding to have real meaning for us. Our relative risk may “triple” – a 300% increase – but what then is our absolute risk? One in 10? Or one in a million?

Here’s what the Finkle study found about T and the heart:

Men 65 and over: Without a prescription for T, 5 or 6 per 1,000 men had a CVE. After filling a T prescription, it was 11 or 12 per 1,000. Yes, the relative risk doubled. But the absolute risk of a CVE for older men prescribed T was only about 1 per 100. In other words, nearly 99 per 100 did not have a CVE.

Men under 65 with heart disease: Without a T prescription, 5 per 1,000 men had a CVE. After filling a T prescription, it was 15 per 1,000. Yes, the relative risk tripled. But the absolute risk of a CVE for these men with previous heart problems was still only 1.5 per 100. In other words, more than 98 per 100 did not have a CVE.

Men under 65 with NO history of heart disease. For those not on T, 3 per 1,000 had a CVE. After filling a T prescription, it was the exact same 3 per 1,000. So, the absolute risk either way is wellunder 1%. And the relative risk increase from T was ZERO. Testosterone does NOT increase the risk of a CVE in what is probably the largest population of potential patients and the group most likely to be reading this magazine! So, every single man in this group presumably enjoyed the documented benefits of T therapy without any increased risk.

A little different than the way it’s been presented, huh? If the findings are valid – a contested point – old men and younger men with prior heart disease might be concerned about initially filling a prescription (even though 98-99% will be okay). But the rest of the men on T should feel reassured. The researchers or covering journalists could have headlined the findings: “Study finds testosterone supplementation safe for the heart in the vast majority of men.” They didn’t. They all selectively highlighted the negative findings and showcased the relative risks, not the absolute risks. That’s not surprising. Most news reports about risk never talk about the absolute risk of the thing of concern actually happening, misleading the public into false risk perceptions .

So, remember what you’ve learned here about absolute and relative risk the next time you’re watching TV or reading the news about anything. Unless they tell you the absolute risk, you’re only hearing half the story.

(1)   The study actually reported on non-fatal heart events, not fatalities.

(2)   Finkle WD, Greenland S, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One 2014;9:e85805 (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0085805).

(3)   See, for example, Landa J. Testosterone therapy does not cause heart attacks. Huffington Post. February 4, 2014. http://www.huffingtonpost.com/jen-landa-md/testosterone-therapy_b_4709168.html.

(4)   http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/44952.


Rick Collins, JD, CSCS [www.rickcollins.com] is the lawyer that members of the bodybuilding community and nutritional supplement industry turn to when they need legal help or representation. [© Rick Collins, 2014. All rights reserved. For informational purposes only, not to be construed as legal or medical advice. Reprinted with permission from a column in Muscular Development magazine. To read Rick’s monthly column as soon as it’s published, please subscribe to MD!]