Testosterone therapy in women may lower risks of MACE, breast cancer

Women on testosterone therapy (TTh) show a lower risk of major adverse cardiac events (MACE) than matched controls, while postmenopausal women have a comparable MACE risk and a similar or significantly reduced risk of breast cancer on age-based subanalysis, reports a study.

The authors used the TriNetX Diamond Network from 2009 to 2022 in this study that involved adult females with three or more systemic testosterone prescriptions within a year. The control cohort excluded those with any testosterone prescriptions, polycystic ovary syndrome, or androgen excess.

Women with prior heart failure, unstable angina, intersex surgery (female to male), personal history of sex reassignment, or gender identity disorders were also excluded from the study. Propensity matching was conducted between the two cohorts. Finally, the authors performed a subanalysis by age (18‒55 and >55 years).

Women with TTh enjoyed a much lower risk of MACE (risk ratio [RR], 0.64, 95 percent confidence interval [CI], 0.51‒0.81), deep vein thrombosis (DVT; RR, 0.61, 95 percent CI, 0.42‒0.90), pulmonary embolism (PE; RR, 0.48, 95 percent CI, 0.28‒0.82), and malignant breast neoplasm (RR, 0.48, 95 percent CI, 0.37‒0.62) than matched controls.

In subanalysis by age, women with TTh aged 18‒55 years also showed a reduced risk of MACE (RR, 0.49, 95 percent CI, 0.28‒0.85) and DVT (RR, 0.48, 95 percent CI, 0.25‒0.93) and a similar risk of malignant breast neoplasm (RR, 0.62, 95 percent CI, 0.34‒1.12).

On the other hand, women with TTh aged 56 years and above had a similar risk of MACE (RR, 0.84, 95 percent CI, 0.64‒1.10), DVT (RR, 0.82, 95 percent CI, 0.50‒1.36), and PE (RR, 0.52, 95 percent CI, 0.26‒1.05) and a significantly lower risk of malignant breast neoplasm (RR, 0.51, 95 percent CI, 0.38‒0.68).

Notably, the risk of hirsutism was consistently greater in women with TTh than in controls.

“Our results contribute to safety data on TTh, a therapy for sexual dysfunction in women,” the authors said.