In the Journals

Testosterone therapy nearly halves mortality, CV event risks for opioid users

There may be mortality, musculoskeletal and cardiovascular benefits from testosterone therapy among men with low testosterone due to opioid use, according to findings published in JAMA Network Open.

“Little is known about the effects of testosterone treatment on health outcomes in men with opioid-induced androgen deficiency (OPIAD), who often experience marked suppression of testosterone levels,” Guneet K. Jasuja, PhD, investigator at the Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Veterans Administration Medical Center in Bedford, Massachusetts, and colleagues wrote. “The long-term implications of testosterone treatment for major health outcomes in opioid users are unknown to date. Patients who receive opioids experience more severe testosterone deficiency, often have multiple comorbid conditions, use multiple prescription drugs and are at increased risk of mortality, which could influence the benefit-to-risk ratio of testosterone treatment.”

Jasuja and colleagues assessed the risks for all-cause death, major adverse CV events, anemia and fractures at the femur, hip and vertebrae across 6 years in a cohort of 21,272 men using data from the Veteran’s Health Administration. Total testosterone levels less than 300 ng/dL or free testosterone levels less than 70 pg/mL were used as the criteria for low testosterone, which was present in all participants. The researchers also identified prescriptions for testosterone therapy of at least 120 days for 14,121 men (mean age, 52.8 years) and identified no prescriptions for testosterone therapy for 7,151 men(mean age 54.8 years).

Opioids 
There may be mortality, musculoskeletal and cardiovascular benefits from testosterone therapy among men with low testosterone due to opioid use.
Source: Adobe Stock

There was a 49% reduction in all-cause mortality risk among testosterone users vs. nonusers (HR = 0.51; 95% CI, 0.42-0.61). Testosterone users also had a 42% reduction in major adverse CV event risk (HR = 0.58; 95% CI, 0.51-0.67) and a 32% reduction in fracture risk at the femur or hip (HR = 0.68; 95% CI, 0.48-0.96). The researchers also observed an association between testosterone therapy and anemia resolution, with the likelihood of resolution 16% greater for testosterone therapy users vs. nonusers (HR = 1.16; 95% CI, 1.02-1.31). Sensitivity analyses that included considerations for cancer, glucocorticoid medications and propensity score matching did not significantly alter the observations, according to the researchers.

“Men who received opioid plus testosterone therapy had significantly lower all-cause mortality and significantly lower incidence of major adverse CV events, anemia and femoral or hip fractures compared with men who received opioid treatment alone,” the researchers wrote. “This cohort study, a first step toward understanding the association of testosterone treatment with health outcomes in long-term opioid users, has clinical implications because of the high prevalence of opioid use among U.S. military veterans and high rates of androgen deficiency and testosterone use among opioid users. These findings need confirmation in a randomized clinical trial.” – by Phil Neuffer 

Disclosures: Jasuja reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

There may be mortality, musculoskeletal and cardiovascular benefits from testosterone therapy among men with low testosterone due to opioid use, according to findings published in JAMA Network Open.

“Little is known about the effects of testosterone treatment on health outcomes in men with opioid-induced androgen deficiency (OPIAD), who often experience marked suppression of testosterone levels,” Guneet K. Jasuja, PhD, investigator at the Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Veterans Administration Medical Center in Bedford, Massachusetts, and colleagues wrote. “The long-term implications of testosterone treatment for major health outcomes in opioid users are unknown to date. Patients who receive opioids experience more severe testosterone deficiency, often have multiple comorbid conditions, use multiple prescription drugs and are at increased risk of mortality, which could influence the benefit-to-risk ratio of testosterone treatment.”

Jasuja and colleagues assessed the risks for all-cause death, major adverse CV events, anemia and fractures at the femur, hip and vertebrae across 6 years in a cohort of 21,272 men using data from the Veteran’s Health Administration. Total testosterone levels less than 300 ng/dL or free testosterone levels less than 70 pg/mL were used as the criteria for low testosterone, which was present in all participants. The researchers also identified prescriptions for testosterone therapy of at least 120 days for 14,121 men (mean age, 52.8 years) and identified no prescriptions for testosterone therapy for 7,151 men(mean age 54.8 years).

Opioids 
There may be mortality, musculoskeletal and cardiovascular benefits from testosterone therapy among men with low testosterone due to opioid use.
Source: Adobe Stock

There was a 49% reduction in all-cause mortality risk among testosterone users vs. nonusers (HR = 0.51; 95% CI, 0.42-0.61). Testosterone users also had a 42% reduction in major adverse CV event risk (HR = 0.58; 95% CI, 0.51-0.67) and a 32% reduction in fracture risk at the femur or hip (HR = 0.68; 95% CI, 0.48-0.96). The researchers also observed an association between testosterone therapy and anemia resolution, with the likelihood of resolution 16% greater for testosterone therapy users vs. nonusers (HR = 1.16; 95% CI, 1.02-1.31). Sensitivity analyses that included considerations for cancer, glucocorticoid medications and propensity score matching did not significantly alter the observations, according to the researchers.

“Men who received opioid plus testosterone therapy had significantly lower all-cause mortality and significantly lower incidence of major adverse CV events, anemia and femoral or hip fractures compared with men who received opioid treatment alone,” the researchers wrote. “This cohort study, a first step toward understanding the association of testosterone treatment with health outcomes in long-term opioid users, has clinical implications because of the high prevalence of opioid use among U.S. military veterans and high rates of androgen deficiency and testosterone use among opioid users. These findings need confirmation in a randomized clinical trial.” – by Phil Neuffer 

Disclosures: Jasuja reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.