Abstract Body (Do not enter title and authors here): Background:
Available data on the effects of testosterone replacement therapy (TRT) on cardiovascular (CV) events and all-cause mortality have yielded conflicting results. There is scarcity of data from large prospective randomized controlled trials in this regard. The objective of this meta-analysis is to compare all-cause mortality and cardiovascular outcomes in patients with and without TRT.

Methods:
PubMed database and Google Scholars was searched through May 2024 for articles meeting the eligibility criteria. We included randomized controlled trials (RCTs) with a sample size of at least 100 patients and a follow-up of more than 12 months. The end points were all-cause mortality, CV mortality, myocardial infarction (MI), stroke, and any CV event. The Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI) was computed with Random Effects model and p<0.05 was considered as a level of significance. RevMan 5.4 software was used for the analysis.

Results:
There were twelve studies (n=8,636) comparing CV outcomes and all-cause mortality among patients with hypogonadism treated with TRT (n=4,336) vs control groups (n=4300). There was no significant heterogeneity observed with the outcomes. There was no significant difference in MI (OR 1.11; CI 0.79-1.55), stroke (OR 1.02; CI 0.67-1.53), any CV events (OR 0.94; CI 0.62-1.43), CV mortality (OR 0.88; CI 0.0.66-1.16), and all-cause mortality (OR 0.86; CI 0.49-1.49) between TRT and control groups. Forest plots (Figure 1 and Figure 2) showed MI and any cardiovascular events, respectively.

Conclusion:
There was no significant difference in CV outcomes and all-cause mortality in patients treated with TRT as compared to controls. However, large RCTs with a long-term follow-up are needed to evaluate these findings.