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Research ArticleOriginal Research

Benefits of Testosterone Replacement Therapy in Hypogonadal Males

Kelli M. Blackwell, Hannah Buckingham, Krishna K. Paul, Hamza Uddin, Dietrich von Kuenssberg Jehle and Thomas A. Blackwell
The Journal of the American Board of Family Medicine September 2024, 37 (5) 816-825; DOI: https://doi.org/10.3122/jabfm.2024.240025R1
Kelli M. Blackwell
From the John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (KMB); John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (HB); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (KKP); Department of Surgery, University of Texas Medical Branch, Galveston, Texas (HU); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (DVKJ); Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas (TAB).
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Hannah Buckingham
From the John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (KMB); John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (HB); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (KKP); Department of Surgery, University of Texas Medical Branch, Galveston, Texas (HU); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (DVKJ); Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas (TAB).
BS
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Krishna K. Paul
From the John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (KMB); John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (HB); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (KKP); Department of Surgery, University of Texas Medical Branch, Galveston, Texas (HU); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (DVKJ); Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas (TAB).
BS
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Hamza Uddin
From the John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (KMB); John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (HB); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (KKP); Department of Surgery, University of Texas Medical Branch, Galveston, Texas (HU); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (DVKJ); Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas (TAB).
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Dietrich von Kuenssberg Jehle
From the John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (KMB); John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (HB); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (KKP); Department of Surgery, University of Texas Medical Branch, Galveston, Texas (HU); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (DVKJ); Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas (TAB).
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Thomas A. Blackwell
From the John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (KMB); John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas (HB); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (KKP); Department of Surgery, University of Texas Medical Branch, Galveston, Texas (HU); Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas (DVKJ); Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas (TAB).
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  • Article
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Article Figures & Data

Tables

    • View popup
    Table 1.

    Patient Demographics Before and After Propensity Matching

    Before Propensity MatchingAfter Propensity Matching
    CohortDemographicsMean ± SDPatients% of CohortP-valueMean ± SDPatients% of CohortP-value
    1Male sex68,448100–66,792100–
    295,00810066,792100
    1Age at index56.6 ± 9.868,448100<0.00156.7 ± 9.866,7921000.013
    257.4 ± 10.395,00810056.8 ± 10.066,792100
    1White54,32679.4<0.00152,77779.00.809
    271,72475.552,74179.0
    1Not Hispanic or Latino48,28570.5<0.00146,79770.10.862
    262,40765.746,82670.1
    1Unknown ethnicity17,36425.4<0.00117,20825.80.535
    227,73529.217,10925.6
    1Unknown race7,81911.4<0.0017,77011.60.308
    213,09913.87,65111.5
    1Black or African American5,0627.4<0.0015,0247.50.010
    28,0778.55,2747.9
    1Hispanic or Latin2,7994.1<0.0012,7874.20.341
    24,8665.12,8574.3
    1Asian8941.3<0.0018941.30.030
    21,6531.78051.2
    1American Indian or Alaska Native1900.30.0051710.30.785
    21980.21660.2
    1Native Hawaiian or Other Pacific Islander1570.20.1031560.20.955
    22570.31550.2
    • Abbreviation: SD, Standard deviation.

    • View popup
    Table 2.

    Preexisting Conditions Associated with Mortality Before and After Propensity Matching

    Before Propensity MatchingAfter Propensity Matching
    CohortI-10ConditionPatients% of CohortP-valuePatients% of CohortP-value
    1I10-I16Hypertensive diseases31,52746.1<0.00129,94144.80.010
    234,73636.630,40945.5
    1E08-E13Diabetes mellitus15,13722.1<0.00114,30421.40.009
    217,22018.114,69722.0
    1E66Overweight & obesity13,76820.1<0.00112,36718.50.366
    212,80413.512,23918.3
    1I20-I25Ischemic heart diseases8,08111.8<0.0017,81511.70.037
    210,08610.68,06212.1
    1N17-N19Acute kidney failure & chronic kidney disease5,6898.3<0.0015,3198.00.992
    26,0986.44,3208.0
    1I50Heart failure2,7654.0<0.0012,6393.90.544
    23,2093.42,5953.9
    1C34Malignant neoplasm of bronchus & lung2800.40.0802800.40.439
    22620.42620.4
    1I46Cardiac arrest1370.2<0.0011100.20.405
    21070.1980.1
    • Abbreviation: ICD-10, International Statistical Classification of Diseases, Tenth Revision.

    • View popup
    Table 3.

    Mortality, Cardiovascular, and Prostate Cancer 3-Year Outcomes After Propensity Score Matching

    OutcomeICD-10Cohort 1 (Prescribed T)Cohort 2 (Not Prescribed T)Risk Ratio95% CIP-value
    Mortality–0.0310.0360.886(0.836, 0.939)<0.001
    AFI480.0360.0400.900(0.851, 0.951)<0.001
    StrokeI630.0160.0180.898(0.826, 0.975)0.011
    MII210.0180.0190.977(0.903, 1.057)0.559
    PCC610.0190.0290.648(0.603, 0.695)<0.001
    • Abbreviations: ICD-10, International Statistical Classification of Diseases, Tenth Revision; T, testosterone; AF, atrial fibrillation; MI, myocardial infarction; PC, prostate cancer.

    • View popup
    Table 4.

    Mortality, Cardiovascular, and Prostate Cancer 3-Year Outcomes Before Propensity Score Matching

    OutcomeICD-10 Cohort 1 (Prescribed T)Cohort 2 (Not Prescribed T)Risk Ratio95% CIP-value
    Mortality–0.0320.0340.940(0.890, 0.991)0.023
    AFI480.0360.0420.873(0.830, 0.918)<0.001
    StrokeI630.0160.0170.915(0.848, 0.988)0.023
    MII210.0190.0181.032(0.960, 1.110)0.392
    PCC610.0190.0330.575(0.539, 0.614)<0.001
    • Abbreviations: ICD-10, International Statistical Classification of Diseases, Tenth Revision; T, testosterone; AF, atrial fibrillation; MI, myocardial infarction; PC, prostate cancer; CI, Class interval.

    • View popup
    Table 5.

    Patients Excluded If the Outcome Occurred Before the 3-Year Time Frame Evaluated

    OutcomeCohort 1 ExclusionCohort 2 Exclusion
    Mortality277272
    AF3,1363,236
    Stroke1,0861,210
    MI1,3211,352
    PC1,8373,425
    • Abbreviations: AF, atrial fibrillation; MI, myocardial infarction; PC, prostate cancer.

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The Journal of the American Board of Family     Medicine: 37 (5)
The Journal of the American Board of Family Medicine
Vol. 37, Issue 5
September-October 2024
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Benefits of Testosterone Replacement Therapy in Hypogonadal Males
Kelli M. Blackwell, Hannah Buckingham, Krishna K. Paul, Hamza Uddin, Dietrich von Kuenssberg Jehle, Thomas A. Blackwell
The Journal of the American Board of Family Medicine Sep 2024, 37 (5) 816-825; DOI: 10.3122/jabfm.2024.240025R1

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Benefits of Testosterone Replacement Therapy in Hypogonadal Males
Kelli M. Blackwell, Hannah Buckingham, Krishna K. Paul, Hamza Uddin, Dietrich von Kuenssberg Jehle, Thomas A. Blackwell
The Journal of the American Board of Family Medicine Sep 2024, 37 (5) 816-825; DOI: 10.3122/jabfm.2024.240025R1
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Keywords

  • Cardiovascular Diseases
  • Chronic Disease
  • Hormone Replacement Therapy
  • Hypogonadism
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  • Preventive Medicine
  • Primary Health Care
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  • Testosterone

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