This study aimed to evaluate the impact of testosterone replacement therapy (TRT) on clinical outcomes in older men with cirrhosis and hypogonadism, a population frequently characterized by sarcopenia, anemia, and frailty. Using a target trial emulation design, investigators analyzed Medicare data (2008– 2020) to compare outcomes in 282 TRT users and 3517 non-users. A new-user design and inverse probability of treatment weighting were employed within an intention-to-treat framework.
After covariate balancing, the median age was 70 years (IQR, 15) among TRT recipients. The TRT group exhibited significantly reduced risks of mortality or liver transplantation (31.72% vs. 32.83%; subdistribution hazard ratio [sHR], 0.92; 95% CI, 0.85–0.99; P = .049) and liver decompensation (sHR, 0.92; 95% CI, 0.86–0.99; P = .03), particularly ascites requiring paracentesis (sHR, 0.83; P < .0001) and variceal bleeding (sHR, 0.68; P = .0009). However, no significant differences were observed for hepatic encephalopathy, fractures, or hepatocellular carcinoma. Notably, TRT was associated with increased mortality in men with alcohol-related liver disease (sHR, 1.49).
The findings indicate potential mortality and morbidity benefits of TRT in select subgroups. however, limitations include reliance on claims data and lack of biochemical verification. Randomized trials are warranted to confirm these associations.
