To the Editor The retrospective study by Dr Vigen and colleagues1 on the association of testosterone therapy with adverse outcomes was limited by the short duration of therapy and the modest increase in testosterone concentrations following treatment.
The duration of treatment on average was approximately 1 year. In clinical terms, this would probably be considered short-term therapy. Also, 40% of patients did not have a testosterone concentration checked after the initiation of testosterone therapy. Of the 60% who had it checked, the testosterone concentration increased from a baseline of 175.5 ng/dL to 332.2 ng/dL for the first repeat testosterone measurement. Because testosterone therapy is generally titrated to raise testosterone level to approximately 500 ng/dL,2 the study population may have been undertreated. Can the authors clarify if the patients had any further increase in testosterone concentration at subsequent measurements?
Dhindsa S, Batra M, Dandona P. Deaths and Cardiovascular Events in Men Receiving Testosterone. JAMA. 2014;311(9):964. doi:10.1001/jama.2014.389