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Purpose:

Elevated hematocrit (Hct) can result in increased risk of major adverse cardiovascular events (MACE) in men receiving testosterone therapy (TTh). However, the impact of the magnitude of the change in Hct from baseline after starting TTh has never been assessed.

Materials and Methods:

To assess whether an increase in Hct after initiating TTh is associated with an increased risk of MACE within 3 and 24 months of initiating TTh, we queried the TriNetX Research network database for men over the age of 18 with Hct values obtained within 6 months before starting TTh, and who had follow-up Hct measurements within 3 and 24 months after beginning TTh from 2010 to 2021. Men with and without a subsequent increase in Hct after initiating TTh were propensity matched. MACE was defined as myocardial infarction, stroke, or death.

Results:

After matching, 10,511 men who experienced an any increase in Hct after initiating TTh and an equal number of controls who did have an increase in Hct were included. Compared to controls who did not have an increase in Hct after starting TTh, the men who had an increase in subsequent Hct had a significantly increased risk of MACE compared to men with no change in Hct.

Conclusions:

We demonstrate that increases in Hct from baseline are associated with increased risk of MACE, compared to men whose Hct remains stable while receiving TTh.

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Support: None.

Conflict of Interest Disclosures: R.R. is a consultant for Coloplast, Endo, Aytu Biosciences, and Direx; an investigator for Boston Scientific, Endo, Aytu Biosciences, and Direx; and an advisory board member for Endo and Aytu Biosciences. The other authors have nothing to disclose.

Ethics Statement: In lieu of a formal ethics committee, the principles of the Helsinki Declaration were followed.

Author Contributions: All authors listed have contributed sufficiently to the study to be included as authors, and all those who are qualified to be authors are listed. There are no individuals who have contributed to this manuscript or study who are not authors listed. None of the authors has a potential conflict of interest regarding this paper. All authors have agreed to the submission and changes in the manuscript.

Data Availability: Data regarding any of the subjects in the study have not been previously published. Available data will be made available to the editors of the journal for review or query upon request.

Editor's Note: This article is the fifth of 5 published in this issue forwhich Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 337 and 338.

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