Injection testosterone and adverse cardiovascular events: A case-crossover analysis.

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Pharmacology

Background:

• Exogenous testosterone administration's cardiovascular effects are debated, with some studies suggesting increased risks.
• Injection testosterone formulations may pose higher risks than other dosage forms.

Purpose of the Study:

• To evaluate the short-term cardiovascular risk associated with receiving testosterone injections.
• To compare risks across different testosterone formulations.

Main Methods:

• A case-crossover analysis was used to compare testosterone exposure within 7 days before an event to referent periods.
• Adult males hospitalized for myocardial infarction (MI), stroke, or unstable angina were identified in US insurance claims and Medicare data.
• Testosterone use was determined via pharmacy dispensing claims or in-office procedure codes.

Main Results:

• Testosterone injections were associated with an increased risk of adverse cardiovascular events (MI, stroke, unstable angina) in older men (Medicare population, OR=1.45).
• This association was not significant in the commercially insured population (OR=0.98).
• When considering all testosterone dosage forms, the increased risk was attenuated or absent across both populations.

Conclusions:

• Testosterone injections are uniquely associated with a short-term risk of acute cardiovascular and cerebrovascular events in older adult men.
• The findings suggest that the risk is specific to the injection method and the immediate post-injection period.