Safety of Testosterone-Replacement Therapy in Older Men

This editorial discusses the safety of testosterone-replacement therapy (TRT) in older men with hypogonadism, focusing on results from the TRAVERSE trial a randomized, placebo controlled study involving 5,246 men aged 45–80 at high cardiovascular risk. TRT did not increase major adverse cardiac events (hazard ratio 0.96) over 22 months, supporting its noninferiority to placebo. However, TRT was associated with higher incidences of pulmonary embolism (0.9% vs. 0.5%), atrial fibrillation (3.5% vs. 2.4%), and acute kidney injury (2.3% vs. 1.5%). While the trial addresses short term cardiovascular safety, questions remain about long term effects, optimal testosterone levels, and the role of elevated estradiol. The findings provide critical guidance for TRT use in high risk populations but underscore the need for further research on extended therapy and broader applicability.

This editorial discusses the safety of testosterone-replacement therapy (TRT) in older men with hypogonadism, focusing on results from the TRAVERSE trial a randomized, placebo controlled study involving 5,246 men aged 45–80 at high cardiovascular risk. TRT did not increase major adverse cardiac events (hazard ratio 0.96) over 22 months, supporting its noninferiority to placebo. However, TRT was associated with higher incidences of pulmonary embolism (0.9% vs. 0.5%), atrial fibrillation (3.5% vs. 2.4%), and acute kidney injury (2.3% vs. 1.5%). While the trial addresses short term cardiovascular safety, questions remain about long term effects, optimal testosterone levels, and the role of elevated estradiol. The findings provide critical guidance for TRT use in high risk populations but underscore the need for further research on extended therapy and broader applicability.