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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Study Finds Increased Risk of CVD from TRT
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<blockquote data-quote="madman" data-source="post: 154529" data-attributes="member: 13851"><p><strong>Cardiovascular and cerebrovascular safety of testosterone replacement therapy among aging men with low testosterone levels: a cohort study </strong></p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Simone Y. Loo, Laurent Azoulay, Rui Nie, Sophie Dell'Aniello, Oriana Hoi Yun Yu, Christel Renoux </span></strong></p><p></p><p></p><p></p><p></p><p></p><p><strong>RESULTS </strong></p><p>After applying all exclusion criteria, <strong><span style="color: rgb(184, 49, 47)">our final cohort comprised 15,401 hypogonadal men (figure 1) with a mean age of 60.4 years (standard deviation (SD) 9.6 years) (table 1).</span></strong> <strong><span style="color: rgb(26, 188, 156)">TRT was prescribed to 4,485 patients (29.1%) on a least one occasion during a mean follow-up time of 4.7 years (SD 3.7 years),</span></strong> <span style="color: rgb(44, 130, 201)"><strong>with a majority of patients initiated on testosterone gels/creams (56.8%) and injections (33.6%). </strong></span></p><p></p><p></p><p></p><p></p><p></p><p></p><p><strong>DISCUSSION </strong></p><p>Our study is notable for specifically evaluating the cardiovascular and cerebrovascular safety of TRT among men with low testosterone levels in the context of aging. Given the recent trends in which these medications are prescribed in the absence of underlying disease, our findings are therefore generalizable to a significant number of aging, but otherwise healthy men who may be considering treatment. Our analyses were also designed to circumvent the biases which may have influenced previous findings. Mainly, a time-varying TRT exposure definition was used to eliminate the potential for immortal time bias, and we further estimated the rate of events as a function of duration of TRT use. <span style="color: rgb(0, 0, 0)"><strong>Despite these strengths, several limitations to our study must also be considered.</strong></span> <span style="color: rgb(184, 49, 47)"><strong>First, while patients with testicular and hypogonadotropic disease were excluded, our cohort may still include a mix of patients with low testosterone levels due to other etiologies that may cause functional hypogonadism including chronic opioid or glucocorticoid use, systemic illness and obesity. However, this heterogeneity reflects the prescribing patterns that have been observed in several countries and our results are still informative with respect to the safety of TRT in this population.</strong></span><span style="color: rgb(26, 188, 156)"><strong> Second, in defining hypogonadism using laboratory test values, we were not able to account for known diurnal fluctuations in endogenous testosterone levels. Nevertheless, we assume that clinicians are adherent to local guidelines for testosterone testing, which recommend blood sampling and testosterone testing in the mornings only and during a fasting state.</strong></span> <span style="color: rgb(147, 101, 184)"><strong>Third, our definition of TRT exposure relied on prescriptions issued by general practitioners, and we were not able to determine patients’ adherence to their prescribed treatment. However, given the consistency of our results using a variety of exposure definitions, we expect the impact of any exposure misclassification to have been minimal.</strong></span> <span style="color: rgb(44, 130, 201)"><strong>Fourth, in the stratified analyses, our study was underpowered to draw a firm conclusion on a potential effect modification by age or prior history of cardiovascular disease. Thus, these prespecified secondary analyses should be interpreted with caution. In addition, it was only possible to examine the risk with all-cause mortality as we did not have information on death from cardiovascular causes. </strong></span><span style="color: rgb(251, 160, 38)"><strong>Finally, although our analyses accounted for numerous potential confounders, including lifestyle habits and timevarying confounders, residual confounding is possible given the observational nature of the study. </strong></span></p><p></p><p></p><p><strong>Our findings suggest that TRT may be associated with an increased risk of ischemic stroke/transient ischemic attack myocardial infarction among aging men with low testosterone levels, <span style="color: rgb(184, 49, 47)">although the overall risk difference was low. </span>Patients may be especially susceptible in the first two years after treatment initiation. <span style="color: rgb(184, 49, 47)">Further large and methodologically sound observational studies should be conducted to reaffirm these results. </span>Until such a time, the potential harms of TRT should be critically weighed against its perceived and expected benefits, and caution is warranted when prescribing these medications to aging but otherwise healthy men. </strong></p></blockquote><p></p>
[QUOTE="madman, post: 154529, member: 13851"] [B]Cardiovascular and cerebrovascular safety of testosterone replacement therapy among aging men with low testosterone levels: a cohort study [/B] [B][COLOR=rgb(184, 49, 47)]Simone Y. Loo, Laurent Azoulay, Rui Nie, Sophie Dell'Aniello, Oriana Hoi Yun Yu, Christel Renoux [/COLOR][/B] [B]RESULTS [/B] After applying all exclusion criteria, [B][COLOR=rgb(184, 49, 47)]our final cohort comprised 15,401 hypogonadal men (figure 1) with a mean age of 60.4 years (standard deviation (SD) 9.6 years) (table 1).[/COLOR][/B] [B][COLOR=rgb(26, 188, 156)]TRT was prescribed to 4,485 patients (29.1%) on a least one occasion during a mean follow-up time of 4.7 years (SD 3.7 years),[/COLOR][/B] [COLOR=rgb(44, 130, 201)][B]with a majority of patients initiated on testosterone gels/creams (56.8%) and injections (33.6%). [/B][/COLOR] [B]DISCUSSION [/B] Our study is notable for specifically evaluating the cardiovascular and cerebrovascular safety of TRT among men with low testosterone levels in the context of aging. Given the recent trends in which these medications are prescribed in the absence of underlying disease, our findings are therefore generalizable to a significant number of aging, but otherwise healthy men who may be considering treatment. Our analyses were also designed to circumvent the biases which may have influenced previous findings. Mainly, a time-varying TRT exposure definition was used to eliminate the potential for immortal time bias, and we further estimated the rate of events as a function of duration of TRT use. [COLOR=rgb(0, 0, 0)][B]Despite these strengths, several limitations to our study must also be considered.[/B][/COLOR] [COLOR=rgb(184, 49, 47)][B]First, while patients with testicular and hypogonadotropic disease were excluded, our cohort may still include a mix of patients with low testosterone levels due to other etiologies that may cause functional hypogonadism including chronic opioid or glucocorticoid use, systemic illness and obesity. However, this heterogeneity reflects the prescribing patterns that have been observed in several countries and our results are still informative with respect to the safety of TRT in this population.[/B][/COLOR][COLOR=rgb(26, 188, 156)][B] Second, in defining hypogonadism using laboratory test values, we were not able to account for known diurnal fluctuations in endogenous testosterone levels. Nevertheless, we assume that clinicians are adherent to local guidelines for testosterone testing, which recommend blood sampling and testosterone testing in the mornings only and during a fasting state.[/B][/COLOR] [COLOR=rgb(147, 101, 184)][B]Third, our definition of TRT exposure relied on prescriptions issued by general practitioners, and we were not able to determine patients’ adherence to their prescribed treatment. However, given the consistency of our results using a variety of exposure definitions, we expect the impact of any exposure misclassification to have been minimal.[/B][/COLOR] [COLOR=rgb(44, 130, 201)][B]Fourth, in the stratified analyses, our study was underpowered to draw a firm conclusion on a potential effect modification by age or prior history of cardiovascular disease. Thus, these prespecified secondary analyses should be interpreted with caution. In addition, it was only possible to examine the risk with all-cause mortality as we did not have information on death from cardiovascular causes. [/B][/COLOR][COLOR=rgb(251, 160, 38)][B]Finally, although our analyses accounted for numerous potential confounders, including lifestyle habits and timevarying confounders, residual confounding is possible given the observational nature of the study. [/B][/COLOR] [B]Our findings suggest that TRT may be associated with an increased risk of ischemic stroke/transient ischemic attack myocardial infarction among aging men with low testosterone levels, [COLOR=rgb(184, 49, 47)]although the overall risk difference was low. [/COLOR]Patients may be especially susceptible in the first two years after treatment initiation. [COLOR=rgb(184, 49, 47)]Further large and methodologically sound observational studies should be conducted to reaffirm these results. [/COLOR]Until such a time, the potential harms of TRT should be critically weighed against its perceived and expected benefits, and caution is warranted when prescribing these medications to aging but otherwise healthy men. [/B] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Study Finds Increased Risk of CVD from TRT
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