{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T01:15:17Z","timestamp":1788311717379,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,3,6]],"date-time":"2018-03-06T00:00:00Z","timestamp":1520294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["5 R01 AG042845"],"award-info":[{"award-number":["5 R01 AG042845"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005539","name":"Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005539","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011082","name":"School of Medicine, University of North Carolina at Chapel Hill","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011082","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Exogenous testosterone administration may affect blood clotting, polycythaemia, and may increase atherosclerosis, though any association with cardiovascular events is unclear. While the literature is inconclusive, some studies have suggested testosterone use may increase short\u2010term risk of cardiovascular events and stroke, and injection testosterone may convey higher risks than other dosage forms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We sought to evaluate the short\u2010term cardiovascular risk of receiving injection testosterone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>We conducted a case\u2010crossover analysis comparing injection testosterone exposure in the 7\u00a0days prior to an outcome event to referent windows in the past to estimate the acute association of cardiovascular outcomes with the receipt of testosterone injections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>We identified adult male testosterone users hospitalized with myocardial infarction (<jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>), stroke or a composite of <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>, stroke or unstable angina in <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> commercial claims (2000\u20102013) or Medicare (2007\u20102010) databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>We identified testosterone use for the patients from pharmacy dispensing claims or in\u2010office procedure codes in the insurance billing data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 2898 commercially insured men with events and recent testosterone use, and 339 from Medicare. Injected testosterone was associated with an increased risk of adverse events (composite outcome of myocardial infarction, stroke or unstable angina) in the immediate postinjection period for the older, Medicare population only: commercial insurance, odds ratios (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>)\u00a0=\u00a00.98 (95% confidence intervals [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]: 0.86\u20101.12); Medicare, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\u00a0=\u00a01.45 (1.07, 1.98). This association was either greatly attenuated or not present when evaluating receipt of any testosterone dosage forms (injection, gel, patch, implant): commercial insurance, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\u00a0=\u00a01.01 (0.92, 1.11); Medicare, <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\u00a0=\u00a01.26 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.98\u20101.63).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Testosterone injections were uniquely associated with short\u2010term risk of acute cardio\u2010 and cerebrovascular events in older adult men following injection receipt.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.13574","type":"journal-article","created":{"date-parts":[[2018,2,15]],"date-time":"2018-02-15T14:26:41Z","timestamp":1518704801000},"page":"719-727","source":"Crossref","is-referenced-by-count":10,"title":["Injection testosterone and adverse cardiovascular events: A\u00a0case\u2010crossover analysis"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0994-5820","authenticated-orcid":false,"given":"J. 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Alan","family":"Brookhart","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of North Carolina at Chapel Hill  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-3570"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1001\/jamainternmed.2013.6895","article-title":"Trends in androgen prescribing in the united states, 2001 to 2011","volume":"173","author":"Baillargeon J","year":"2013","journal-title":"JAMA Intern Med"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.21041"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(16)30215-7"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2016.09.017"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.9546"},{"key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1177\/1060028014539918","article-title":"Risk of myocardial infarction in older men receiving testosterone therapy","volume":"48","author":"\u2010Baillargeon J","year":"2014","journal-title":"Ann Pharmacother"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-11-108"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.280386"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0085805"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.1573"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1534"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1000485"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.21043"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.9540"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-2575"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/smrj.43"},{"key":"e_1_2_7_19_1","unstructured":"U.S. Food and Drug Administration.FDA adding general warning to testosterone products about potential for venous blood clots. 2014.https:\/\/www.fda.gov\/Drugs\/DrugSafety\/ucm401746.htm. 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