TRT and the TEAAM Trial: Atherosclerosis and Cognitive Effects

Written by Adam Maggio | Medically reviewed by Dr. Mitchell Ross, MD, ABAARM

The TEAAM trial investigated the effects of three years of testosterone administration on subclinical atherosclerosis and cognitive function in older men with low or low-normal testosterone. It found no significant difference in atherosclerosis progression or cognitive improvement compared to placebo, highlighting that TRT's benefits in these areas are not clearly established for this population.

TRT and the TEAAM Trial: Examining Atherosclerosis and Cognition

For many older men, declining testosterone levels are a reality, often accompanied by concerns about cardiovascular health and cognitive decline. The Testosterone's Effects on Atherosclerosis Progression in Aging Men (TEAAM) trial was a significant study designed to shed light on whether testosterone replacement therapy (TRT) could mitigate these age-related changes. Unlike trials primarily focused on major adverse cardiovascular events (MACE), TEAAM specifically investigated the impact of TRT on subclinical atherosclerosis and cognitive function.

The TEAAM trial was a randomized, double-blind, placebo-controlled study that enrolled 308 older men with low or low-to-normal testosterone levels. Participants received either testosterone administration or placebo for a duration of three years. The primary endpoints were changes in common carotid artery intima-media thickness (CIMT), a marker of subclinical atherosclerosis, and coronary artery calcium (CAC) score, another indicator of atherosclerotic burden. Secondary endpoints included various measures of cognitive function.

Key Findings: Atherosclerosis and Cognition

After three years of treatment, the TEAAM trial found no significant difference between the testosterone and placebo groups in the progression of CIMT or CAC scores (Basaria et al., 2015). This suggests that, in this cohort of older men, TRT did not slow down or reverse the progression of subclinical atherosclerosis. This is an important finding, as it contrasts with some earlier hypotheses that testosterone might have a protective effect on arterial health.

Regarding cognitive function, a prespecified secondary analysis of the TEAAM trial also revealed no improvement. Testosterone administration for 36 months did not enhance multiple domains of cognitive function in older men with low or low-to-normal testosterone concentrations (Huang et al., 2016). This indicates that TRT, at least in the context of this trial, does not offer a clear benefit for cognitive performance in aging men.

Limitations and Nuance

It's crucial to understand the scope and limitations of the TEAAM trial. While it provided valuable data on atherosclerosis and cognition, it was not adequately powered to assess the association between TRT and cardiovascular adverse events, including MACE. Therefore, its findings should not be interpreted as a definitive statement on TRT's overall cardiovascular safety, which was more thoroughly addressed by larger trials like TRAVERSE. The study's focus was on surrogate markers of cardiovascular health rather than hard clinical outcomes.

Furthermore, the trial included men with low-to-normal testosterone levels, which might have attenuated the observed effects compared to a population with more severe hypogonadism. Unlike the TRAVERSE trial, which focused on men with documented hypogonadism and cardiovascular risk, TEAAM's population was broader in terms of testosterone levels.

Practical Takeaway

The TEAAM trial indicates that for older men with low or low-normal testosterone, three years of TRT does not significantly impact the progression of subclinical atherosclerosis or improve cognitive function. This doesn't mean TRT is without benefits for other symptoms of hypogonadism, but it clarifies that you shouldn't expect it to be a preventative measure against atherosclerosis or a cognitive enhancer. Always discuss your individual symptoms and health goals with your doctor to determine if TRT is appropriate for you, understanding its specific benefits and limitations based on robust clinical evidence.