Testosterone replacement therapy and vascular thromboembolic events: a systematic review and meta-analysis.

TRT did not significantly influence the risk of arterial thrombosis based on RCT-derived data.

• OR = 1.27, 95% CI: 0.47–3.43, P = 0.64
• Analysis based on 14 randomized controlled trials with 4027 hypotestosteronemic male patients
• Population restricted to men with pre-treatment total testosterone <12 nmol l-1 or clear mention of hypogonadism in inclusion criteria

TRT did not significantly influence the risk of stroke based on RCT-derived data.

• OR = 1.34, 95% CI: 0.09–18.97, P = 0.83
• Wide confidence interval reflects limited RCT data on this specific outcome
• Analyzed as a component of the broader arterial thrombotic events outcome

TRT did not significantly influence the risk of myocardial infarction based on RCT-derived data.

• OR = 0.51, 95% CI: 0.11–2.31, P = 0.39
• Point estimate suggests a possible reduction in MI risk, but this did not reach statistical significance
• Derived from RCT data including 4027 hypotestosteronemic male patients

TRT did not significantly influence the risk of venous thromboembolism (VTE) based on RCT-derived data.

• OR = 1.42, 95% CI: 0.22–9.03, P = 0.71
• Pulmonary embolism specifically: OR = 1.38, 95% CI: 0.27–7.04, P = 0.70
• The risk for DVT was described as uncertain due to paucity of RCT-based data

TRT did not significantly influence all-cause mortality based on RCT-derived data.

• OR = 0.70, 95% CI: 0.20–2.38, P = 0.56
• Point estimate trended toward a reduction in mortality but did not reach statistical significance
• Analyzed among 4027 patients from 14 RCTs

Observational studies showed a significant reduction in arterial thrombotic events, MI, VTE, and mortality associated with TRT.

• Observational studies included a total of 310,288 hypotestosteronemic male patients
• Results contrasted with RCT findings, which showed no significant effects
• Authors noted this discrepancy between RCT-derived and observational study-derived data
• 24 total studies were included, of which 14 were RCTs and the remainder were observational studies

A total of 2423 abstracts were assessed for eligibility, with 24 studies ultimately included in the meta-analysis.

• 14 of the 24 included studies were randomized controlled trials (RCTs)
• RCTs contributed data from 4027 hypotestosteronemic male patients
• Observational studies contributed data from 310,288 hypotestosteronemic male patients
• Outcomes assessed included stroke, MI, upper and lower limb arterial events, DVT, portal vein thrombosis, splenic thrombosis, pulmonary embolism, and mortality

The risk of deep vein thrombosis (DVT) with TRT remains uncertain due to insufficient RCT-based data.

• Authors explicitly called for further studies specifically assessing the risk of DVT in men on TRT
• DVT was listed as one of the VTE outcomes of interest but lacked adequate RCT data for a definitive conclusion
• This was identified as a key gap in the existing literature