Testosterone Replacement Therapy

The landmark TRAVERSE trial (Lincoff et al., NEJM 2023; 5,198 men aged 45–80 with hypogonadism and elevated cardiovascular risk, median follow-up 33 months) established cardiovascular non-inferiority: major adverse cardiac events occurred in 7.0% of the testosterone group versus 7.3% of placebo (hazard ratio 0.96, 95% CI 0.78–1.17). This resolved a long-standing safety question, showing testosterone did not increase overall cardiovascular risk when used for documented hypogonadism. Prespecified secondary analyses did, however, show higher rates of atrial fibrillation (3.5% vs 2.4%, P=0.02), pulmonary embolism / venous thromboembolism (1.7% vs 1.2%), and acute kidney injury in the testosterone group. A dedicated fracture sub-study (Snyder et al., NEJM 2024) unexpectedly found more clinical fractures with testosterone (3.5% vs 2.5%; hazard ratio 1.43, 95% CI 1.04–1.97), so testosterone should not be used to prevent fractures. 2024–2026 systematic reviews and position statements from the Androgen Society and the European Expert Panel for Testosterone Research concur: in properly selected, symptomatic hypogonadal men, testosterone therapy has a reassuring cardiovascular profile alongside meaningful benefits for body composition, sexual function, mood, and bone density — provided hematocrit, PSA, and cardiac rhythm are monitored. This is educational information, not medical advice.

Evidence Scale