{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T13:22:41Z","timestamp":1788268961286,"version":"build-2803163510"},"reference-count":29,"publisher":"The Endocrine Society","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Historically, low testosterone (T) has been linked to increased atrial fibrillation (AF) risk in men, yet recent evidence suggests that elevated T levels and testosterone replacement therapy (TRT) may also confer risk. This review synthesizes emerging literature to characterize the evolving T\u2013AF relationship and inform clinical practice. A structured literature search of MEDLINE\/PubMed and Embase, supplemented by hand-searching reference lists of relevant publications, was performed, using terms including \u201ctestosterone,\u201d \u201ctestosterone replacement therapy,\u201d and \u201catrial fibrillation.\u201d Findings were heterogeneous. The 2023 TRAVERSE trial reported a higher AF incidence with TRT, contrasting with earlier VA data from Sharma et al. (2017) showing reduced AF risk when T normalized after treatment. A 2024 meta-analysis by Corona et al of 106 randomized placebo-controlled trials found no significant pooled AF signal. Real-world data remained mixed: a TriNetX-based replication did not confirm elevated AF risk, whereas a 5-year cohort study reported a hazard ratio of 1.27 in cisgender hypogonadal men receiving TRT. Population-level studies by Xu et al (2024) and post-hoc ASPREE analyses by Tran et al (2024) demonstrated a nonlinear association in which both low and high T levels increased AF risk. Updated mechanistic data support a U-shaped model: low T disrupts calcium handling, whereas high T alters potassium currents and promotes reentry. Converging evidence thus supports a U-shaped T\u2013AF relationship. Until definitive data emerge, clinicians should prioritize risk-stratified TRT use, mid-physiologic T targets, stable formulations, and structured monitoring.<\/jats:p>","DOI":"10.1210\/jendso\/bvag180","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:17:04Z","timestamp":1786101424000},"source":"Crossref","is-referenced-by-count":0,"title":["Association of testosterone and testosterone replacement therapy with atrial fibrillation: an updated review"],"prefix":"10.1210","volume":"10","author":[{"given":"Anand Reddy","family":"Maligireddy","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, University of Kansas Medical Center , Kansas City, KS 66160, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumedha T","family":"Barua","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Research, Kansas City VA Medical Center , Kansas City, MO 64128, United 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