February 23, 2017
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Testosterone replacement therapy may lower CV risk in androgen deficiency

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The risk for adverse cardiovascular outcomes, including stroke and acute myocardial infarction, may be decreased with the use of testosterone replacement therapy in men with androgen deficiency, according to recent findings.

“We initiated the study because of concerns regarding the CV safety of testosterone replacement therapy,” T. Craig Cheetham, PharmD, MS, of the department of research and evaluation at the Southern California Permanente Medical Group, told Endocrine Today. “[Other] studies, however, selected patients who were either elderly and frail (with restricted mobility) or those with a high frequency of CV risk factors (undergoing coronary angiography). It was our observation that there were many men using testosterone replacement therapy who did not fall into these categories.”

Cheetham and colleagues evaluated data from Kaiser Permanente medical records from 1999 to 2010 on 8,808 men with androgen deficiency to determine the effect of testosterone replacement therapy on CV outcomes. Follow-up was conducted through 2012.

Overall, 19.8% of participants had ever received testosterone replacement therapy.

During a median of 3.4 years of follow-up, composite CV events occurred in 10.2% of participants who never received testosterone therapy (23.9 CV events per 1,000 person-years) compared with 8.2% who did (16.9 events per 1,000 person-years).

In participants who had received testosterone replacement therapy, the adjusted HR for the composite CV outcomes was 0.67 (95% CI, 0.62-0.73), and adjusted HRs were similar for the combined stroke outcome (HR = 0.72; 95%, 0.62-0.84) and the cardiac outcomes (HR = 0.66; 95% CI, 0.6-0.72).

The rates for CV events were slightly higher among participants who received topical testosterone replacement therapy (15.5 per 1,000 person-years) compared with participants who received injectable testosterone replacement therapy (14.5 per 1,000 person-years; adjusted HR = 1.02; 95% CI, 1-1.05).

“For patients with androgen deficiency and their doctors, we hope our findings alleviate the concerns they may have about prescribing testosterone therapy with respect to the risks of adverse CV events,” Cheetham said. – by Amber Cox

For more information:

T. Craig Cheetham, PharmD, MS, can be reached at tcheetham@westernu.edu.

Disclosure: The researchers report no relevant financial disclosures.