Testosterone replacement therapy with testosterone undecanoate was associated with lower mortality in men with adult-onset testosterone deficiency, with this association evident only in men with greater cardio-metabolic risk factors who demonstrated greater benefit.
Key Findings
Results
Testosterone undecanoate (TU) treatment was associated with significantly lower mortality compared to non-treatment in men with adult-onset testosterone deficiency.
Hazard ratio for TU (ref: non-treatment) was 0.23, 95% confidence intervals = 0.14–0.40
Registry database of 737 men with adult-onset testosterone deficiency defined as serum total testosterone ≤12.1 nmol/L with associated symptoms
94 of the 737 men died during the follow-up period
Median follow-up interquartile range (IQR) of 114 (84–132) months (near 10-year follow-up)
Results
The association between TU treatment and reduced mortality was independent of multiple baseline cardio-metabolic risk factors.
Cox regression models showed the association between TU and mortality was independent of baseline age, waist circumference, hemoglobin A1c, lipids, blood pressure, smoking, and type 2 diabetes
The cardio-metabolic risk factor variables themselves remained independently associated with mortality in these models
Non-parametric statistics were used prior to Cox regression models
Results
The association between TU treatment and lower mortality was only evident in men stratified into higher cardio-metabolic risk subgroups.
Men were stratified by high-risk baseline variables to examine the association between TU and mortality
No significant association between TU and mortality was observed in men with lower cardio-metabolic risk
The authors attributed this pattern to the 'law of initial value,' where greater improvements are evident following treatment in patients with worse baseline values
Methods
The study population consisted of men with adult-onset testosterone deficiency followed for a near 10-year period in a registry database.
737 men were included in the registry database
Testosterone deficiency was defined as presenting with low serum total testosterone (TT) levels ≤12.1 nmol/L and associated symptoms
Median follow-up IQR of 114 (84–132) months
Comparisons were made between TU-treated and non-treated men using both non-parametric statistics and Cox regression models
Mann A, Strange R, König C, Hackett G, Haider A, Haider K, et al.. (2024). Testosterone replacement therapy: association with mortality in high-risk patient subgroups.. Andrology. https://doi.org/10.1111/andr.13582