Testosterone supplementation and stroke in young adults: a review of the literature

Abstract

Testosterone supplementation has increased in recent years for both treatment of hypogonadism and recreational use. Strokes in young adults have similarly increased with a larger proportion of patients in this age group having a stroke due to early onset of cardiovascular risk factors or unrelated to conventional risks. Hormonal treatments are associated with increased stroke risk amongst women, with some studies indicating an increase in stroke risk as high as 40% when compared to non-users. However, less is known about male sex hormones and risks associated with increased stroke. Limited data evaluates the relationship between testosterone supplementation and stroke in young adults. In this review, we analyze the literature and plausible underlying pathophysiological mechanisms associated with increased risks in patients using exogenous testosterone. Furthermore, we highlight the gaps in research about safety and long-term effects on young patients.

Keywords: hormone replacement therapy; ischemic stroke; male enhancement drugs; stroke in young adults; testosterone.

Figure 1

(A) Testosterone use among men aged 18–45 years over the period 2003–2013 in the United States (2). (B) Average testosterone prescription claims per provider from 2016 to 2019 (6). (C) Testosterone market growth in million USD from 2018 to 2028 (7). (A) Shows the increasing use of testosterone in men aged 18–45 years from 2003 to 2013 based on outpatient drug claims. Horizontal axis represents years from 2003 to 2013. Vertical axis represents the rate of testosterone use per 10,000-person year. (B) Shows increasing average testosterone claim per provider from 2016 to 2018. Horizontal axis represents years from 2016–2019. Vertical axis represents average claim per provider. (C) Shows the growth of testosterone market in US, UK, Canada, China, Germany from 2018 to 2028. Horizontal axis represents years from 2018 to 2028. Vertical axis represents market size in million USD.

Figure 2

Possible mechanisms of stroke in young adults with supratherapeutic testosterone use. This illustration highlights potential mechanisms of stroke in young adults related to testosterone use.