Cardiovascular Safety of Testosterone-Replacement Therapy

TO THE EDITOR: Lincoff et al. (July 13 issue)¹ report the results of the Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE) trial, a noninferiority trial comparing the effect of testosterone-replacement therapy with that of placebo on major adverse cardiac events in men with hypogonadism and preexisting or high cardiovascular risk. Testosterone-replacement therapy was noninferior to placebo, but the testosterone group had a higher incidence of nonfatal arrhythmias, including atrial fibrillation. Atrial fibrillation is known to be an important risk factor for cardiovascular events, and the relationship between testosterone and atrial fibrillation …