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Aging men looking for a little more zip behind their zippers may want to think twice before turning to testosterone gels. The benefits, according to recent research, may not outweigh the risks.

The results of four new yearlong studies released last month suggest that these gels, also known as androgen replacement therapy, may increase your risk of heart attack while doing little to improve cognitive ability. Testosterone users did see a boost in bone density and a reduced risk of anemia. Earlier tests have shown the hormone to enhance sexual function, but it didn’t produce significant improvements in fitness or vitality.

The verdict, however, is decidedly mixed, said Susan Ellenberg, a biostatistics professor at the University of Pennsylvania and coauthor of the new studies. “There are definitely benefits and potential risks,” she told Reuters. “It’s not an overwhelming conclusion that every man over 65 should be on this or stay away from it.”

Ellenberg and her team joined researchers at 11 other research centers across the country to conduct the studies, which are part of the Testosterone Trials. Scientists focused on men age 65 and older with low testosterone levels. The 790 participants were split into two groups — one used a testosterone gel daily and the other a placebo — for a year, after which researchers measured the effects of the treatment on anemia, bone density and strength, cardiovascular function, and cognitive ability.

Among their findings, published in JAMA: and JAMA Internal Medicine:

“If you’re looking for benefits, you’d like to see it in the other direction,” Ellenberg said of the heart-attack risks.

Though another recent study downplayed these risks, the Testosterone Trials support the findings of other research since 2010 that raised similar alarms, and they mirror concerns the Food and Drug Administration (FDA) expressed in 2015 when it tightened its labeling guidelines for testosterone gels.

Citing the fact that “these medications have not been established for the treatment of low testosterone levels due to aging,” the FDA limited the approved use of the gels to patients suffering from “certain medical conditions.” The move also required manufacturers to explicitly warn consumers of the increased risk of heart attack and stroke.

While the agency is pushing for more transparency from testosterone manufacturers and calling for more research to clarify these risks, it’s currently overlooking other side effects of androgen replacement therapy. The Mayo Clinic warns consumers that testosterone gels can contribute to sleep apnea, trigger the growth of existing cancer cells in the prostate, limit sperm production, enlarge breasts, and lead to blood clots.

Thankfully, there are lifestyle changes you can make to boost your testosterone levels. Check out “How to Increase Testosterone — Naturally” for some practical — and healthier — tips.

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