Thromboembolic Risk and Testosterone Replacement Therapy: Debunking Myths and Clarifying Evidence with Recent Systematic Reviews and Meta-Analyses

Abstract Objective: To critically evaluate the relationship between testosterone replacement therapy (TRT) and thromboembolic events, addressing the concerns raised by older studies while focusing on recent robust evidence. This review analyzes the methodological limitations of earlier studies and presents new evidence that refutes these claims. Methods: A systematic review and meta-analysis were conducted, analyzing randomized controlled trials (RCTs) and cohort studies. Both earlier studies that suggested increased risk and newer studies that refute these claims were included. Findings: Recent meta-analyses demonstrate that TRT does not significantly increase the risk of thromboembolic events. The relative risk for major adverse cardiovascular events (MACE) was not statistically significant (RR = 1.08, 95% CI: 0.89–1.31). The inconsistencies in previous studies are addressed, considering patient-specific risk factors, follow-up periods, and methodological quality. Conclusion: TRT is safe when prescribed correctly and monitored closely. Earlier concerns about increased thromboembolic risk are largely unsupported by modern evidence.