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Testosterone Therapy in Veterans Causing Adverse Outcomes

Treating low levels of testosterone is associated with increased risk of adverse outcomes….

In a retrospective cohort study, researchers found that testosterone therapy in veterans was associated with an increased risk of mortality, myocardial infarction, and ischemic stroke. The study included 8,709 veterans who underwent angiography between 2005 and 2011. These patients had a total testosterone level of lower than 300 ng/dL. Of the 8,709 men, 1,223 initiated testosterone therapy after their angiography and 7,486 did not.

There was no significant difference in the effect size of testosterone therapy between patients with coronary artery disease and patients without it. The rate of events was 25.7% in patients that did receive testosterone and 19.9% in patients who did not receive testosterone therapy.

When compared to a previous retrospective study, the results differ because testosterone therapy caused a 39% reduction in mortality risk. But the study had patients who had a lower incidence of heart disease and did not account for the differences in time from the study and initiation of testosterone therapy.

Previous clinical trials have found testosterone therapy to be beneficial but most of those studies were small and was not observed over a long period of time. Other studies such as the Testosterone Trial in Older Men study included 209 older men with low testosterone levels was stopped early due to a high rate of cardiovascular events.

Since this was an observational study, confounding factors or hidden bias are possible limitations to this study. The time of day when testosterone levels were drawn were not known. It is hard to generalize the results because men in the VA system tend to have more comorbidities and health problems than the normal general population.

Practice Pearls:
  • Testosterone therapy in veterans associated with an increased risk of mortality, myocardial infarction, and ischemic stroke.
  • No significant difference in the effect size of testosterone therapy between patents with CAD and patients without it.
  • Increased of more than five-fold from 2000 to 2011 in annual prescriptions for testosterone           

JAMA Nov. 2013