Long-Term Testosterone Shows Cardiovascular Safety in Men With Testosterone Deficiency in Electronic Health Records.

Abstract

Objective: Our objective is to examine the association between cardiovascular (CV) safety and long-term testosterone therapy (TTh) in men with testosterone deficiency (TD) in real-world practice.

Method: We extracted the electronic health records of 2683 adult men with TD from 3 healthcare systems from January 1, 2012, to June 30, 2023. We matched TTh and non-TTh groups in a 1:1 ratio based on age, race, Charlson Comorbidity Index, and serum testosterone level via propensity score. We used intent-to-treat analysis using Kaplan-Meier curves and Cox regressions to examine CV risk for major adverse cardiovascular events (MACE). We also explored the impact of TTh on diabetes and hyperlipidemia development and progression. We compared 928 TTh patients to 928 untreated patients with a median follow-up of 3 years for both groups.

Results: After matching, body mass index, diastolic blood pressure, hyperlipidemia, hypertension, depression, and anxiety were statistically significant different between treatment and control cohorts. The log-rank test for the cumulative MACE incidence was comparable (P > .05). There were no statistically significant associations between TTh use and CV risk hazard ratios (HRs) in the univariate Cox regression (HR [95% CI]: 1.01 [0.75-1.36]) and Cox regressions adjusted by the preexisting MACE (HR [95% CI]: 0.98 [0.72-1.32]) and other baseline covariates (HR [95% CI]: 0.93 [0.68-1.26]). No statistically significant associations were found between TTh and diabetes. For hyperlipidemia, TTh group presented statistically significant improvement on low-density lipoprotein and total cholesterol.

Conclusion: TTh use among men with TD was not associated with increased CV risk in real-world clinical practice.