Date of Award


Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)


Physician Assistant Studies

First Advisor

Russ Kauffman


Testosterone; TRT,; Coronary Artery Disease; Hypogonadism; Eugonadal; Hormone replacement therapy


In the United States, males see a decrease in testosterone levels around the age of 40, potentially leading to a condition known as hypogonadism. Testosterone administration is the leading treatment for symptomatic hypogonadism. Testosterone Replacement Therapy (TRT) has increased in popularity amongst practicing healthcare providers. This literature review aims to investigate differences in incidence rates of cardiovascular events in males receiving testosterone therapy compared to untreated males with hypogonadism. Given the conflicting evidence regarding the association between exogenous testosterone and cardiovascular risk, published studies and meta-analysis were reviewed to prove this relationship. A comprehensive literature review was performed using electronic databases such as the American Endocrine Association, Pub-Med, Clinical Key, Cochrane library, and the American Journal of Medicine. A review of the literature shows conflicting data. Various studies showed cardioprotective benefits of TRT, while other studies show an increased incidence of cardiovascular disease. The largest meta-analysis to date revealed no increased cardiovascular risk in men who received testosterone and reduced cardiovascular risk among those with metabolic disease. However, the following studies were limited in duration, dosages, administration routes, and subject population. Because of the inferior quality of evidence, it is challenging to produce a definitive conclusion on cardiovascular disease in males on TRT. Therefore, given the challenge of varied study controls and protocols to assess for rare outcomes, further studies are needed to clarify the association between the duration of TRT and primary adverse cardiovascular effects.