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Med J Aust 2022; 217 (1): . || doi: 10.5694/mja2.51612
Published online: 4 July 2022

Testosterone replacement therapy appears safe in the short‐to‐medium term to treat hypogonadism, according to an analysis of the treatment, published in The Lancet Healthy Longevity. Researchers from the University of Melbourne and the University of Aberdeen conducted a systematic review identifying 35 eligible clinical trials published since 1992, of which 17 provided individual participant data. A blinded analysis by two independent clinicians enabled the classification of every cardiovascular event, allowing for a more robust analysis of the cardiovascular safety of testosterone treatment. The researchers performed a meta‐analysis using individual participant data from 17 studies and a further meta‐analysis integrating these data with the aggregate data provided by the 18 trials that did not provide individual participant data. Among the 17 trials with individual patient data, 1750 participants received testosterone and 1681 were given a placebo. The average length of testosterone treatment was 9.5 months. The average age of participants was 65 years, and most were white and did not smoke. Participants’ average BMI was 30 kg/m2, which is considered obese. A meta‐analysis showed there were 120/1601 (7.5%) cardiovascular events in the testosterone group and 110/1519 (7.2%) in the placebo group across 13 trials that provided this information. Patient age, smoking or diabetes status did not affect cardiovascular risk. Similarly, there was no significant difference in mortality rate between the testosterone group (6/1621 deaths, 0.4%) and the placebo group (12/1537 deaths, 0.8%) across the 14 trials that provided individual patient data on mortality, but only limited data were available. Testosterone significantly reduced serum total cholesterol, high density lipoprotein, and triglyceride levels compared with placebo. However, there were no significant differences in serum low density lipoprotein, blood pressure, glycaemic parameters, diabetes incidence, and prostate adverse outcomes between the testosterone and placebo groups.



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