Testosterone replacement associated with higher risk for adverse cardiovascular events

Despite limited data on cardiovascular safety, rates of testosterone therapy are increasing dramatically. In a retrospective cohort study of 8,709 male Veterans with a low testosterone level, the authors sought to determine the association between use of testosterone therapy following coronary angiography and patient outcomes of all-cause mortality, myocardial infarction and stroke.

Patients initiated on testosterone therapy were younger and had a lower prevalence of co-morbidities. At 3 years after coronary angiography, the cumulative percentage of events from Kaplan-Meier estimates were 19.9% in untreated patients vs 25.7% in patients treated with testosterone. In propensity matched analyses with testosterone therapy modeled as a time-varying covariates, the risk of adverse outcomes was higher among testosterone treated patients (hazard ratio, 1.29; 95% CI, 1.04 to 1.58). The risk for adverse events did not vary by type of testosterone preparation used or the presence of coronary artery disease.


In this observational study, use of testosterone therapy was associated with increased risk for adverse events. However, the impact of this study is limited by its observational design and study population that was limited to Veterans who underwent coronary angiography. Additional randomized studies are needed to better characterize the potential risks of testosterone therapy.

Summarized by Catherine Otto and Supriya Shore

  • Vigen R, O’Donnell CI, Baron AE, Grunwald GK, Maddox TM, Bradley SM, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA : the journal of the American Medical Association 2013;310(17):1829-36.

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