Do statins cause testosterone deficiency in men? Systematic review and meta analysis

Abstract

ABSTRACT Introduction Statins are one of the most prescribed classes of drugs worldwide to treat hypercholesterolemia and dyslipidemia. By lowering the level of cholesterol, the precursor of the steroidogenesis pathway, the use of statin could cause a reduction in testosterone levels. Testosterone is essential in biological functions and its reduction can cause negative effects, such as symptoms of hypogonadism. Objective Evaluate whether the continued use of statins causes testosterone deficiency in men. Methods Systematic Review with Meta-analysis, performed in Embase, Medline and Cochrane databases, until April 2021; protocol was submitted to PROSPERO. Selection performed by two independent authors with subsequent conference in stages. There were selected comparative studies, prospective cohorts or clinical trials with comparison of testosterone levels before and after the use of statin. Bias analysis were evaluated with Cochrane Tool. Results Threre found 717 papers on MedLine, 1352 on Embase and 143 on Cochrane. After removal of duplicates, 833 articles remained. Comparative studies, 10 prospective cohorts and 6 randomized clinical trials were selected for meta-analysis. In the forrest plot with the 16 articles, a reduction in the mean testosterone in patients after the use of statins of 13.61 (95% CI=3.99-23.23, I²=41%, p=0.006) was evidenced, demonstrating statistical significance. In the sub-analysis with the Clinical Trials, a reduction in the mean testosterone levels in patients after the use of statins of 27.45 (95% CI=13.85-41.06, I²=14%, p<0.0001) was evidenced, demonstrating statistical significance. On the other hand, in the sub-analysis of the Prospective Cohorts, an increase in the mean testosterone in patients after the use of statins of 0.25 was evidenced, without statistical significance, of 0.25 (95% CI=-13.87-13.36 I²=38%, p=0.97). A reduction in total testosterone was evaluated in all studies after statin use. However, with the exception of Kannat 2009, all studies showed testosterone levels above the normal level (normal up to 300). In the Kannat study, testosterone levels below this value were already presented before the use of the statin. Conclusion Statins cause a decrease in total testosterone, not enough to cause a significant deficiency. Disclosure Work supported by industry: no.