6 of the 7 meta-analyses of RCTs reviewed did not demonstrate a significant association between serious cardiovascular events and exogenous testosterone, however summary estimates ranged between 1.07 to 1.82 and confidence intervals are imprecise.
The review highlights that given the challenge of adequately powering clinical trials for rare outcomes, rigorous observational studies are needed to clarify the association between testosterone-replacement therapy and major adverse cardiovascular outcomes. Health-care professionals should make patients aware of this possible risk when deciding whether to start or continue a patient on testosterone therapy.