Testosterone therapy and the risk of atrial fibrillation, venous thromboembolism and cardiovascular events in cis men with hypogonadism and trans men.

Testosterone therapy in cis men with hypogonadism was associated with a lower risk of myocardial infarction over 5 years of follow-up.

• 117,908 cis men with hypogonadism treated with testosterone were compared to 1:1 propensity score matched cis men not treated.
• HR for myocardial infarction: 0.94 (95% CI 0.89–0.99), P = .01.
• No significant difference was observed for stroke or mortality between treated and untreated cis men.
• Follow-up duration was 5 years.

Testosterone therapy in cis men with hypogonadism was associated with a higher risk of atrial fibrillation.

• HR for atrial fibrillation: 1.27 (95% CI 1.22–1.32), P < .0001.
• This finding was based on the comparison of 117,908 testosterone-treated cis men with propensity score matched untreated cis men.
• The increased risk was observed over a 5-year follow-up period.

Testosterone therapy in cis men with hypogonadism was associated with a higher risk of acute pulmonary embolism and deep vein thrombosis.

• HR for acute pulmonary embolism/deep vein thrombosis: 1.26 (95% CI 1.18–1.34), P < .0001.
• This was assessed in the propensity score matched cohort of 117,908 treated vs. untreated cis men with hypogonadism.
• The increased risk was observed over a 5-year follow-up period.

Trans men treated with testosterone had no significant increase in cardiovascular outcomes compared to both untreated trans men and untreated cis men.

• 6,251 trans men treated with testosterone were compared to 6,251 untreated trans men using 1:1 propensity score matching.
• 6,986 trans men treated with testosterone were also compared to 6,986 untreated cis men.
• No significant increase was observed in the rate of cardiovascular outcomes in either comparison.
• Follow-up duration was 5 years.

Trans men treated with testosterone had a significantly lower rate of suicide attempts compared to untreated trans men.

• HR for suicide attempts in treated vs. untreated trans men: 0.52 (95% CI 0.35–0.78), P = .001.
• There were no significant differences in suicide attempt rates when treated trans men were compared to untreated cis men.
• This finding was based on the comparison of 6,251 testosterone-treated trans men vs. 6,251 propensity score matched untreated trans men.

The study utilized the TriNetX Research network for participant recruitment and propensity score matching for comparisons.

• Participants were recruited from the TriNetX Research network.
• Three comparison groups were established: cis men with hypogonadism treated vs. untreated (117,908 per group), trans men treated vs. untreated (6,251 per group), and trans men treated vs. untreated cis men (6,986 per group).
• 1:1 propensity score matching was applied in all comparisons.
• Follow-up was conducted over 5 years.