New Study Evaluates CV Safety of Testosterone Treatments

Testosterone injections are associated with greater risk of cardiovascular events, hospitalizations, and death, compared with testosterone patches and gels, according to a new study.

While past research has raised concerns about the cardiovascular safety of testosterone treatment, no study has yet examined the difference in cardiovascular safety associated with each of the various methods of testosterone delivery.

To this end, researchers from the University of North Carolina Chapel Hill conducted a retrospective cohort study using data from insurance claims in the United States and general practitioner records from the United Kingdom. Main outcomes included cardiovascular and cerebrovascular events including stroke, myocardial infarction, and unstable angina.
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Overall, the analysis included 544,115 testosterone uses (37.4% injection, 6.9% patch, 55.8% gel).

Compared with gel and patch use, testosterone injection was associated with a higher risk of cardiovascular events (1.26; 1.18-1.35), hospitalizations (1.16; 1.13-1.19), and death (1.34; 1.15-1.56).

The difference in risk may be explained by the difference in serum testosterone levels between the 3 forms of testosterone treatment. Injections, the researchers explained, cause sudden spikes in serum testosterone, while gels and patches raise serum levels more slowly over time.

The full study is published in JAMA Internal Medicine.

—Michael Potts

Reference:

Layton JB, Meier CR, Sharpless JL, et al. Comparative Safety of Testosterone Dosage Forms. JAMA Internal Medicine. May 2015 [epub ahead of print]. doi:10.1001/jamainternmed.2015.1573