Abstract TP152: Exogenous Testosterone Is Associated with Lower Odds of Stroke in Young Men: An Exploratory Analysis of the Colorado Claims Database

Introduction: Low testosterone levels are associated with increased risk for cardiovascular disease, including ischemic stroke. The relationship between supratherapeutic testosterone use and stroke risk in young men remains unexplored. We present an exploratory analysis evaluating the stroke risk with exogenous testosterone use in men using Colorado claims data Hypothesis: Stroke risk is increased at low and supratherapeutic testosterone levels but reduced at optimal levels Methodology: We conducted a secondary analysis of retrospective case–control data from Colorado’s All Payer Claims Database (2012–2019). Exogenous testosterone exposure was defined as a prescription within 1 year before index stroke in male sex aged 18–55. Stroke cases were matched to controls (without stroke) by age, sex, prestroke period, and insurance. Conditional logistic regression assessed stroke odds by testosterone exposure compard to no exposure, controlling for socioeconomic status, language, and sum of cardiovascular&non-cardiovascular risk factors Results: Our model consisted of 1,238 cases and 3,694 matched controls. Median age was 48.5 years (range 18.6-55.9) for cases and 48.6 years (18.4-57) for controls with similar age distribution for both groups. The presence of > 3 traditional and non-traditional risk factors was higher in cases than controls.(Table 1)Among cases, 74.4% had ischemic stroke, 14.2% had hemorrhagic stroke, and 11.4% had subarachnoid hemorrhage. 67 participants were exposed to testosterone—15 case and 52 control groups—while the proportion of men with hypogonadism was comparable between groups. Exposure to testosterone was associated with statistically significant reduced stroke odds. (OR 0.47, 95% CI: 0.25–0.91; p < 0.02) Conclusion: In young men, testosterone prescription was linked to lower stroke odds, despite cases having more with > 3 risk factors. However, among men with hypogonadism, only a small fraction received testosterone in both groups, suggesting careful selection of patients for exogenous testosterone. The model captured only prescription testosterone, without distinguishing therapeutic versus supratherapeutic. The model did not account for off-label use. Baseline levels, dose, route, preparation, and indication were not available. Small number of testosterone-exposed individuals limits the strength and generalizability of this finding. Prospective studies are needed to clarify the relationship between testosterone exposure and stroke risk