Men who started testosterone therapy (TT) without evidence of hypogonadism had significantly higher long-term risks of major adverse cardiovascular events (MACE), all-cause mortality, ischaemic stroke, cardiac arrest, and heart failure than men with documented hypogonadism. In this global retrospective real-world study of 358,957 men aged 30–75 years initiating TT, 35.4% had no evidence of hypogonadism. After 1:1 propensity-score matching, 113,554 matched pairs were followed for up to 10 years. Compared with men treated for hypogonadism, those receiving TT without evidence of hypogonadism had a 51% higher risk of MACE (HR 1.51) and a 90% higher risk of all-cause mortality (HR 1.90), along with increased risks of ischaemic stroke, cardiac arrest, and heart failure. Although the magnitude of risk varied across racial and ethnic groups, the overall pattern was consistent. These findings suggest that the cardiovascular safety of testosterone therapy depends on the clinical indication, supporting careful prescribing and ongoing cardiovascular risk monitoring, particularly when TT is initiated without evidence of hypogonadism. Source: https://www.thelancet.com/
