Association of Testosterone Replacement Therapy and the Incidence of a Composite of Postoperative In-hospital Mortality and Cardiovascular Events in Men Undergoing Noncardiac Surgery

2017 ◽  
Vol 127 (3) ◽  
pp. 457-465 ◽  
Author(s):  
Maged Y. Argalious ◽  
Jing You ◽  
Guangmei Mao ◽  
Daniel Ramos ◽  
Sandeep Khanna ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Replacement Therapy ◽  
Odds Ratio ◽  
Cardiovascular Events ◽  
Noncardiac Surgery ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Abstract Background Whether patients on testosterone replacement therapy undergoing noncardiac surgery have an increased risk of postoperative in-hospital mortality and cardiovascular events remains unknown. We therefore sought to identify the impact of testosterone replacement on the incidence of a composite of postoperative in-hospital mortality and cardiovascular events in men undergoing noncardiac surgery. Methods Data from male American Society of Anesthesiologists I through IV patients 40 yr or older who underwent noncardiac surgery between May 2005 and December 2015 at the Cleveland Clinic (Cleveland, Ohio) main campus were included. The primary exposure was preoperative testosterone use. The primary outcome was a composite of postoperative in-hospital mortality and cardiovascular events. We compared patients who received testosterone and those who did not using propensity score matching within surgical procedure matches. Results Among 49,273 patients who met inclusion and exclusion criteria, 947 patients on testosterone were matched to 4,598 nontestosterone patients. The incidence of in-hospital mortality was 1.3% in the testosterone group and 1.1% in the nontestosterone group, giving an odds ratio of 1.17 (99% CI, 0.51 to 2.68; P = 0.63). The incidence of myocardial infarction was 0.2% in the testosterone group and 0.6% in the nontestosterone group (odds ratio = 0.34; 99% CI, 0.05 to 2.28; P = 0.15). Similarly, no significant difference was found in stroke (testosterone vs. nontestosterone: 2.0% vs. 2.1%), pulmonary embolism (0.5% vs. 0.7%), or deep venous thrombosis (2.0% vs. 1.7%). Conclusions Preoperative testosterone is not associated with an increased incidence of a composite of postoperative in-hospital mortality and cardiovascular events.

scholarly journals Testosterone Replacement Therapy and the Risk of Prostate Cancer in Men With Late-Onset Hypogonadism

2019 ◽  
Vol 188 (9) ◽  
pp. 1666-1673 ◽  
Author(s):  
Christina Santella ◽  
Christel Renoux ◽  
Hui Yin ◽  
Oriana H Y Yu ◽  
Laurent Azoulay
Keyword(s):  
Prostate Cancer ◽  
Replacement Therapy ◽  
Late Onset ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Newly Diagnosed ◽  
Increased Risk ◽  
Late Onset Hypogonadism ◽  
The Impact

Abstract The association between the use of testosterone replacement therapy (TRT) and prostate cancer remains uncertain. Thus, we investigated whether TRT is associated with an increased risk of prostate cancer in men with late-onset hypogonadism. We used the UK Clinical Practice Research Datalink to assemble a cohort of 12,779 men who were newly diagnosed with hypogonadism between January 1, 1995, and August 31, 2016, with follow-up until August 31, 2017. Exposure to TRT was treated as a time-varying variable and lagged by 1 year to account for cancer latency, with nonuse as the reference category. During 58,224 person-years of follow-up, a total of 215 patients were newly diagnosed with prostate cancer, generating an incidence rate of 3.7 per 1,000 person-years. In time-dependent Cox proportional hazards models, use of TRT was not associated with an overall increased risk of prostate cancer (hazard ratio = 0.97; 95% confidence interval: 0.71, 1.32) compared with nonuse. Results remained consistent in secondary and sensitivity analyses, as well as in a propensity score–matched cohort analysis that further assessed the impact of residual confounding. Overall, the use of TRT was not associated with an increased risk of prostate cancer in men with late-onset hypogonadism.

scholarly journals Therapeutic Phlebotomy for Testosterone-Induced Polycythemia

2020 ◽  
Vol 154 (1) ◽  
pp. 33-37
Author(s):  
Nancy L Van Buren ◽  
Anita J Hove ◽  
Tracy A French ◽  
Jed B Gorlin
Keyword(s):  
Replacement Therapy ◽  
Blood Donors ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Blood Center ◽  
The Impact

Abstract Objectives To evaluate therapeutic phlebotomy (TP) requests for testosterone replacement therapy (TRT) and to highlight the impact to a blood center (BC) or service that provides TP for individuals on TRT. Methods Review of TP requests for individuals on TRT at our BC over a 3-year period from 2014 through 2016, as well as the total number of TP collections. Results Total TPs during 2014, 2015, and 2016 were 475, 500, and 569, respectively. Annual TP collections for patients on TRT were 193, 212, and 239, respectively. TRT patients with TP orders increased 71.4% during this period. After discontinuation of TP services for TRT at our BC, 32% continued to donate as volunteer blood donors at our BC. Conclusions Our BC observed increased TP requests for patients on TRT from 2014 through 2016. Our findings suggest that individuals on TRT may be presenting to BCs as volunteer blood donors to avoid charges for TP.

Abstract 17765: Mild Preoperative Anemia is an Independent Predictor of Mortality and Cardiovascular Events in Patients Undergoing Elective Major Noncardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jesús álvarez-García ◽  
Miquel Vives-Borrás ◽  
Joan I Llao ◽  
Andreu Ferrero-Gregori ◽  
Marc Bausili ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cardiovascular Events ◽  
Postoperative Mortality ◽  
Postoperative Outcome ◽  
Primary Outcome Measure ◽  
Noncardiac Surgery ◽  
Concomitant Treatment ◽  
Preoperative Anemia ◽  
Increased Risk ◽  
The Impact

Background: Preoperative anemia has been recognized as an important risk factor for perioperative red blood cell transfusions and adverse events in patients undergoing noncardiac surgery. Mild anemia has not unequivocally shown to be a risk factor for death, unless cardiac disease is present or major blood loss occurs. Objective: To evaluate the prevalence of preoperative anemia and its effect on 30-day postoperative outcome in subjects undergoing elective major noncardiac surgery. Methods: A retrospective cohort study was performed in 1630 patients, 40 years and older, who underwent major noncardiac surgery.Based on preoperative hemoglobin levels and gender, we stratified patients into the next categories of anemia: mild (11-12 g/dl), moderate (10-11 g/dl) and severe (<10 g/dl) for female; mild (12-13 g/dl), moderate (11-12 g/dl) and severe (<11 g/dl) for male. Age, risk factors, previous chronic heart or lung disease, renal function and concomitant treatment were used in a binary logistic regression to determine the impact of anemia in prognosis. The primary outcome measure was a composite of 30-day postoperative mortality or cardiovascular events (cardiac arrest, myocardial infarction, stroke or pulmonary embolism). Results: The overall prevalence of anemia was 18.8%. Thirty-day mortality and cardiac event rate increased with the presence of anemia (table). Mild, moderate and severe anemia were associated with a two-fold (OR 2.07; CI 95%: 1.04-4.11), three-fold (OR 2.93; CI 95%: 1.45-5.94) and four-fold (OR 4.09; CI 95%:1.87-8.95) increases in the risk of MACCE respectively. Conclusions: Anemia is a prevalent risk factor in patients undergoing major noncardiac surgery. Even mild degrees of preoperative anemia are associated with an increased risk of 30-day postoperative mortality and cardiovascular events. Further studies are needed in order to evaluate whether treatment of preoperative anemia could reduce postoperative mortality.

scholarly journals Testosterone Replacement Therapy in Hypogonadal Men Following Prostate Cancer Treatment: A Questionnaire-Based Retrospective Study among Urologists in Bavaria, Germany

2015 ◽  
Vol 95 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Charlotte Marie Kühn ◽  
Hans Strasser ◽  
Alexander Romming ◽  
Bernd Wullich ◽  
Peter J. Goebell
Keyword(s):  
Prostate Cancer ◽  
Replacement Therapy ◽  
High Intensity Focused Ultrasound ◽  
Testosterone Replacement ◽  
External Beam Radiation ◽  
Curative Treatment ◽  
High Dose ◽  
Testosterone Replacement Therapy ◽  
Beam Radiation ◽  
Increased Risk

Background: Several reports suggest testosterone replacement therapy (TRT) may be an option in selected hypogonadal patients with a history of prostate cancer (PCa) and no evidence of disease after curative treatment. Our aim was to assess TRT experience and patient management among urologists in Bavaria. Materials and Methods: Questionnaires were developed and mailed to all registered urologists in Bavaria (n = 420) regarding their experience with TRT in patients with treated PCa. Results: One hundred and ninety-three (46%) urologists returned the questionnaire and reported their experience with TRT in hypogonadal patients after curative treatment for PCa. Complete data was available for 32 men. Twenty-six patients (81%) received TRT after prostatectomy, 1 patient after external beam radiation, 3 patients after high-dose brachytherapy and 2 patients after high-intensity focused ultrasound. Of the PCa cases, 88.5% (23/26) were organ confined (pT2a-c), and 3 were pT3 tumors. All patients were pN0/cN0, and only 1 patient (pT3a) had a positive surgical margin status postoperatively. After a mean follow-up of 39.8 months, no biochemical relapse was observed. Conclusion: To date, there is no clear evidence to withhold TRT from hypogonadal men after curative PCa treatment. Our findings, although with limitations, fit in with the available data showing that TRT does not put patients at an increased risk after curative treatment of PCa.

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