CiteULike | Further Information

• {"link"=>{"url"=>"http://www.citeulike.org/user/FW_Gibb/article/12944673"}, "post_time"=>"2014-02-02 17:05:50", "tag"=>["cvd", "replacement", "testosterone", "trt"], "linkout"=>{"type"=>"DOI", "url"=>"http://dx.doi.org/10.1371/journal.pone.0085805"}, "username"=>"FW_Gibb", "article_id"=>"12944673"}

Mendeley | Further Information

{"title"=>"TESTOSTERONE PRODUCTS AND CARDIOVASCULAR SAFETY NATIONAL PBM BULLETIN DEPARTMENT OF VETERANS AFFAIRS VETERANS HEALTH ADMINISTRATION (VHA) PHARMACY BENEFITS MANAGEMENT SERVICES (PBM), MEDICAL ADVISORY PANEL (MAP), AND CENTER FOR MEDICATION SAFETY (VA MEDSA", "type"=>"journal", "authors"=>[{"last_name"=>"(VHA)"}, {"first_name"=>"DEPARTMENT OF VETERANS AFFAIRS VETERANS HEALTH", "last_name"=>"ADMINISTRATION"}, {"first_name"=>"PHARMACY BENEFITS MANAGEMENT SERVICES", "last_name"=>"(PBM)"}, {"first_name"=>"AND CENTER FOR MEDICATION SAFETY (VA MEDSAFE)", "last_name"=>"MEDICAL ADVISORY PANEL (MAP)"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"1932-6203", "pmid"=>"24489673", "doi"=>"10.1371/journal.pone.0085805"}, "id"=>"f8b4ab75-92e7-3626-b58d-bce673c804ed", "abstract"=>"I. ISSUE Two recent studies identify a possible risk of increased cardiovascular events in men receiving testosterone therapy. FDA continues to evaluate this association between testosterone treatment and increased risk of stroke, heart attack, or death, but has not yet reached a firm conclusion. 1 II. BACKGROUND Testosterone use is indicated for men with testosterone deficiency associated with a medical condition, such as genetic problems, chemotherapy, or other biochemical disorders affecting the production of testosterone by the testicles. Low testosterone levels in the absence of a medical condition are not an approved indication for testosterone products. FDA-approved testosterone formulations consist of a topical gel, transdermal patch, buccal system (applied to upper gum or inner cheek), and injection. III. DISCUSSION Two publications have prompted FDA to reassess the cardiovascular safety of testosterone therapy. One observational study looking at elderly men in the U.S. Veteran Affairs health system who underwent coronary angiography to assess for coronary artery disease and had a low serum testosterone suggested a 30 percent increase in risk for stroke, heart attack, and death in the group that received testosterone therapy compared to the group that did not receive any testosterone therapy. Many of these patients had underlying cardiovascular disease. 2 Another observational study reported an increased risk of heart attack in older men (two-fold increase in the risk of heart attack among men aged 65 years and older within 90 days after initial prescription), as well as in younger men with pre-existing heart disease (a two-to three-fold increase in the risk of heart attack within 90 days after initial prescription). Younger men with no history of heart disease who received a prescription for testosterone did not demonstrate an increased risk of heart attack.", "link"=>"http://www.mendeley.com/research/testosterone-products-cardiovascular-safety-national-pbm-bulletin-department-veterans-affairs-vetera", "reader_count"=>3, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>1, "Student > Postgraduate"=>1, "Student > Bachelor"=>1}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>1, "Student > Postgraduate"=>1, "Student > Bachelor"=>1}, "reader_count_by_subject_area"=>{"Medicine and Dentistry"=>2, "Chemical Engineering"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>2}, "Chemical Engineering"=>{"Chemical Engineering"=>1}}, "group_count"=>0}

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• http://doi.org/10.1016/j.jsxm.2018.06.012

DataCite

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Europe PMC Database Citations

PubMed Central | Further Information

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Scopus | Further Information

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Web of Science® | Further Information

Article Coverage

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• {"referral"=>"http://www.latimes.com/science/sciencenow/la-sci-sn-testosterone-heart-attack-20140129,0,4339171.story", "language"=>"English", "title"=>"Testosterone prescriptions linked to heart attack", "type"=>"News", "publication"=>"Los Angeles Times", "published_on"=>"2014-01-29T00:00:00Z", "link_state"=>"APPROVED"}
• {"referral"=>"http://www.medscape.com/viewarticle/819968", "language"=>"English", "title"=>"Testosterone Therapy Can Up MI Risk by a Third", "type"=>"News", "publication"=>"", "published_on"=>"2014-02-05T00:00:00Z", "link_state"=>"REJECTED"}
• {"referral"=>"http://www.npr.org/blogs/health/2014/01/29/268427675/popular-testosterone-therapy-may-raise-risk-of-heart-attack", "language"=>"English", "title"=>"Popular Testosterone Therapy May Raise Risk Of Heart Attack ", "type"=>"News", "publication"=>"NPR: Health News", "published_on"=>"2014-01-30T00:00:00Z", "link_state"=>"APPROVED"}
• {"referral"=>"http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/44081", "language"=>"English", "title"=>"FDA to Investigate Testosterone Risk", "type"=>"News", "publication"=>"MedPage Today", "published_on"=>"2014-01-31T00:00:00Z", "link_state"=>"APPROVED"}
• {"referral"=>"http://www.jwatch.org/node/164940", "language"=>"English", "title"=>"Testosterone Therapy Adds MI Risk, Especially in Older Men", "type"=>"Blog", "publication"=>"NEJM Journal Watch", "published_on"=>"2014-01-31T00:00:00Z", "link_state"=>"APPROVED"}
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• {"referral"=>"http://health.yahoo.net/experts/dayinhealth/testosterone-therapy-overhyped", "language"=>"English", "title"=>"Study: 'Low T' Therapy Increases Heart Attack, Stroke Risk in Men", "type"=>"News", "publication"=>"Yahoo Health", "published_on"=>"2014-02-04T00:00:00Z", "link_state"=>"APPROVED"}
• {"referral"=>"http://well.blogs.nytimes.com/2014/01/29/study-adds-to-concern-about-cardiac-risks-for-older-men-taking-testosterone/", "language"=>"English", "title"=>"New Concern About Testosterone and Heart Risks - NYTimes.com", "type"=>"News", "publication"=>"ANAHAD O'CONNOR", "published_on"=>"2014-02-05T00:00:00Z", "link_state"=>"REJECTED"}
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• {"referral"=>"http://articles.latimes.com/2014/jan/29/science/la-sci-sn-testosterone-heart-attack-20140129", "language"=>"English", "title"=>"Testosterone prescriptions linked to heart attack - Los Angeles Times", "type"=>"News", "publication"=>"", "published_on"=>"2014-04-14T00:00:00Z", "link_state"=>"REJECTED"}
• {"referral"=>"http://news.medizin-2000.de/2014/testosteron_therapy_erhoeht_herzinfarkt_risiko.html", "language"=>"German", "title"=>"Testosteron,Testosteron-Therapie,Behandlung,Herzinfarkt-Risiko,Prophylaxe,Vorbeugung,Medizin News,Medizin 2000,Info-Netzwerk Medizin 2000, LaHave Media Services Limited", "type"=>"Discussion board", "publication"=>"Dr. med. Jochen Kubitschek", "published_on"=>"2014-05-12T00:00:00Z", "link_state"=>"REJECTED"}
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Article Coverage Curated

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• {"referral"=>"http://blogs.plos.org/", "language"=>"English", "title"=>"PLOS Blogs Network | Diverse perspectives on science and medicine", "type"=>"News", "publication"=>"PLOS Blogs Network", "published_on"=>"", "link_state"=>"APPROVED"}

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• {"url"=>"http%3A%2F%2Fjournals.plos.org%2Fplosone%2Farticle%3Fid%3D10.1371%252Fjournal.pone.0085805", "share_count"=>10, "like_count"=>2, "comment_count"=>28, "click_count"=>0, "total_count"=>40}

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• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/fae0b926-d091-4954-94a6-02a8dbe3b740", "title"=>"This and the recently VA study point at the need to revise testosterone treatment guidelines ", "body"=>"What this and the previous study at the VA show is that it is WRONG to give testosterone to older men and not provide phlebotomies for lowering hematocrit or anastrozole for lowering estradiol. High hematocrit and estradiol are more common in older men on testosterone since testosterone related aromatization and erythrocytosis are worse in that population. Both variables have been linked to cardiovascular risks in older men. None of these studies manage either.\n\nMany clinics are managing hematocrit by recommending blood donation or phlebotomies to men with hematocrit over 53. They are also recommending treatment with low dose anastrozole for men with estradiol over 50 pg/mL. However, most medical practices follow recommendations for the 4 current guideline groups (neither mentions ways to manage high hematocrit and estradiol). \n\nIt is time to change the current guidelines for testosterone treatment in men to include the management of those two variables.\n\nNelson Vergel\n", "isRemoved"=>false, "created"=>"2014-01-30T14:14:54Z", "lastModified"=>"2014-01-30T14:14:54Z", "creator"=>{"userId"=>"401609"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-01-30T14:14:54Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/867c1f5d-aeb7-4df1-9fe1-8e70fffbd29e", "title"=>"This and the recently VA study point at the need to revise testosterone treatment guidelines ", "body"=>"What this and the previous study at the VA show is that it is WRONG to give testosterone to older men and not provide phlebotomies for lowering hematocrit or anastrozole for lowering estradiol. High hematocrit and estradiol are more common in older men on testosterone since testosterone related aromatization and erythrocytosis are worse in that population. Both variables have been linked to cardiovascular risks in older men. None of these studies manage either.\n\nMany clinics are managing hematocrit by recommending blood donation or phlebotomies to men with hematocrit over 53. They are also recommending treatment with low dose anastrozole for men with estradiol over 50 pg/mL. However, most medical practices follow recommendations of the 4 current guideline groups (neither mentions ways to manage high hematocrit and estradiol). \n\nIt is time to change the current guidelines for testosterone treatment in men to include the management of those two variables.\n\nNelson Vergel\n", "isRemoved"=>false, "created"=>"2014-01-30T14:21:42Z", "lastModified"=>"2014-01-30T14:21:42Z", "creator"=>{"userId"=>"401609"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-01-30T14:21:42Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/618a2836-3b76-4f74-8511-2e11544364de", "title"=>"Study seems to be incomplete", "body"=>"I just read this report. As with some other studies that 'showed' that testosterone therapy might increase risk of heart related problems, there was no data included regarding the level of fitness of the test subjects.\n\nThe doubling of risk for men over 65, quoted without allowing for level of fitness, makes the report useless.\n\nHere is my reasoning.\n\nGiven:\n\na) Men over 65 have been living with increasingly lower testosterone levels for nearly 25 years\n\nb) A lot of men over 65 live fairly sedentary lives. \n\nWhile a) and b) are related, the relationship is not as strong. The on-set of sedentary behavior in seniors has many other causes. However, the significance of sedentary behavior is paramount to fitness levels. Testosterone therapy will increase the desire of the patient to get active as they rapidly begin to feel more vigorous. If they were sedentary before the beginning of the therapy, the suddenly increased physical activity may precipitate dangerous levels stress to the cardiovascular system since fitness does not return quickly to people over 65.\n\nDue to this apparent oversight I am forced to conclude that this study is incomplete. Without that data it is impossible to tell if the increased rate of heart related problems was strictly caused by the testosterone, or from the secondary effect of increased physical activity.\n\nIn my opinion it is premature of the research team to have released this report without that correlation included, as the treatment of the two scenarios is completely different. In the likely event that the heart problems are as a result of a sudden increase in physical activity, the wise treatment would be to include counseling on how to increase physical fitness at a suitable rate or include an appropriate fitness program a part of the testosterone therapy.\n\nMost who will read the news articles related to this report will not bother to read the report, and if they do they are likely not qualified to realize the importance of the missing data. They will make uninformed decisions that will have negative effects on others.\n", "isRemoved"=>false, "created"=>"2014-02-01T17:12:36Z", "lastModified"=>"2014-02-01T17:12:36Z", "creator"=>{"userId"=>"402049"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>3, "mostRecentActivity"=>"2014-02-03T17:38:34Z", "replies"=>[{"type"=>"REPLY", "parentID"=>78273, "annotationUri"=>"info:doi/10.1371/reply/de527399-8092-4fd7-81c5-eb0cf30f4270", "title"=>"RE: Study seems to be incomplete", "body"=>"This is a valid observation and has significant clinical implications. As with events subsequent to the publication of the Women's Health Initiative (WHI) in 2002 incomplete data and premature conclusions can create a domino effect which adversely impact on the health of the very patients who may benefit most.\nThis same phenomenon of increased CV events was seen when Viagra was released.\nWhen initiating any form of medication \"the benefits must outweigh the risks\" and this includes a complete evaluation of the fitness of men prior to the prescribing of testosterone. \nIt may well be that the subjects of this study were in good physical shape, however without this data testosterone's chequered history may well be prolonged.", "isRemoved"=>false, "created"=>"2014-02-03T03:39:29Z", "lastModified"=>"2014-02-03T03:39:29Z", "creator"=>{"userId"=>"402251"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>true, "body"=>"Pharmacist, pharmaceutical industry"}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-02-03T03:39:29Z", "replies"=>[]}, {"type"=>"REPLY", "parentID"=>78273, "annotationUri"=>"info:doi/10.1371/reply/a59a4be2-71b3-4f17-a1f5-99662ee128eb", "title"=>"RE: Study seems to be incomplete", "body"=>"Just started TT 30 days ago and had testicular at age 47 now 65 and some what fit and your observation seems to make sense to a lay person from what I read. \nThank you for your input.", "isRemoved"=>false, "created"=>"2014-02-03T12:57:59Z", "lastModified"=>"2014-02-03T12:57:59Z", "creator"=>{"userId"=>"402355"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-02-03T12:57:59Z", "replies"=>[]}, {"type"=>"REPLY", "parentID"=>78273, "annotationUri"=>"info:doi/10.1371/reply/92160e54-08fc-4cd6-b839-9460e91f5867", "title"=>"RE: Study seems to be incomplete", "body"=>"Your observation is spot on. Correlative data, patient fitness level, and even more importantly quality of care with regard to how their TRT was managed are glaring omissions. This was a far better review that the recent JAMA article was, yet it is no substitute for a quality prospective study. Until data is brought forth from a long-term placebo-controlled study using a representative (not high-risk) cohort, with management and re-evaluation for TRT patients, recommendations against TRT will be highly presumptive at best. As a TRT clinician I am fully ready to admit my bias, but the quality of data here does not match the media weight it carries.", "isRemoved"=>false, "created"=>"2014-02-03T17:38:34Z", "lastModified"=>"2014-02-03T17:38:34Z", "creator"=>{"userId"=>"402437"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>true, "body"=>"I am a clinician specializing in TRT."}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-02-03T17:38:34Z", "replies"=>[]}]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/e3dc9d93-6fb8-4c8a-a0ef-5cecf9cc77ea", "title"=>"Excellent study- should be extended.", "body"=>"The authors are to be congratulated on an elegant and powerful study. If possible, the study should be extended to examine the effect of concomitant primary preventative aspirin, adjunctive aromatase inhibitor therapy, and daily use of tadalafil. Each of these drugs could substantially alter the effect of testosterone on cardiovascular events. Testosterone increases human platelet thromboxane A2 receptor density and aggregation responses (1). The latter effect would likely be attenuated by aspirin's suppression of thromboxane A2 formation. Hence, the reported results may overstate the adverse effects of testosterone for those taking aspirin while understating it for those not taking aspirin. Similarly, patients taking adjunctive aromatase inhibitors may experience a lesser effect on cardiovascular events due to decreased metabolism of exogenous testosterone to estradiol, which has been positively correlated with cardiovascular disease (2). Finally, there is evidence that daily tadalafil may block some potentially deleterious vascular effects of testosterone's metabolite, dihydrotestosterone (DHT). DHT promotes endothelial vascular cell adhesion molecule-1 (VCAM) expression and increases human monocyte adhesion to the vascular endothelium (3,4) whereas daily tadalafil causes a robust and sustained decline in VCAM, endothelin-1, and CRP.(5) With mounting evidence of increased cardiovascular risk with exogenous testosterone administration alone, it is time to look at the effects of these combined regimins - particularly those that are already in common use.\n\n-Woodrow Gandy, MD\n\n(1) Ajayi AA, Mathur R, Halushka PV. Testosterone increases human platelet thromboxane A2 receptor density and aggregation responses. Circulation. 1995 Jun 1;91(11):2742-7.\n\n(2) Coronal G, Giulia R, Matteo M, et al. Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. Eur J Endocrinol November 1, 2011 165 687-701.\n\n(3) Death AK, McGrath KC, Sader MA, et al. Dihydrotestosterone promotes vascular cell adhesion molecule-1 expression in male human endothelial cells via a nuclear factor-kappaB dependent pathway. Endocrinology.2004;145(4):1889-1897.\n\n(4) McCrohon JA, JessupW, Handelsman DJ, Celermajer DS. Androgen exposure increases human monocyte adhesion to vascular endothelium and endothelial cell expression of vascular cell adhesion molecule-1. Circulation.\n1999;99(17):2317-2322.\n\n(5) Aversa A, Greco E, Bruzziches R, et al. Relationship between chronic tadalafil administration and improvement of endothelial function in men with erectile dysfunction: a pilot study. Int J Impot Res. 2007 Mar-Apr;19(2):200-7. Epub 2006 Aug 31.\n", "isRemoved"=>false, "created"=>"2014-02-02T21:21:20Z", "lastModified"=>"2014-02-02T21:21:20Z", "creator"=>{"userId"=>"402173"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-02-02T21:21:20Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/41b4dd58-00f0-4ec3-be72-04e8a2623cd3", "title"=>"Results have to be interpreted with caution", "body"=>"This is a large-scale study comparing the testosterone therapy (TT) group vs the PDE5i group.\n\nAlthough the myocardial infarction risk is raised in the TT group, but the results have to be interpreted with caution, simply because the cohorts being studied may have totally different baseline condition which may interfere with the results.\n\nAs the article has pointed out, \"Testosterone therapy has been used in healthy older men to treat diminished strength and physical function associated an age-related decline in serum testosterone\", patients in the TT group usually have confirmed low level of testosterone level before any replacement is given, i.e. they have low testosterone level to start off with. \n\nOn the other hand, the PDE5i group involved patients presented with erectile dysfunction. The cause of erectile dysfunction in the vast majority will be vascular-related rather than hormonal-related. Even if these patients really have low level of testosterone, then the treatment should involve testosterone replacement rather than PDE5i. I think it would be logical to think that the majority of the patients in the PDE5i group have normal testosterone level to start off with, if not all of them.\n\nIf we look into the literature about the effect of testosterone on myocardial infarction, one of the big areas will be the use of androgen deprivation therapy (ADT) in the treatment of prostate cancer. ADT either in the form of bilateral orchiectomy or gonadotrophin releasing hormone analogue reduces the testosterone level into a castration level. And it has been shown by many studies that this will increase the risk of diabetes, myocardial infarction and stroke. It would therefore be quite unfair to comment that the use of TT will increase the risk of myocardial infarction, given the fact that all these patients have low testosterone level to start off with, which means that they are already predisposed to the risk of myocardial infarction even before starting the treatment. On the other hand, in the PDE5i group, since the majority of the cause of erectile dysfunction is vascular-related, these patients are also predisposed to myocardial infarction. This makes the comparison between the TT group and the PDE5i group even more complicated.\n\nAlthough this is a large-scale study with significant findings, I would say that the results have to be interpreted with caution and further studies on the effect of testosterone on myocardial infarction will be needed. \n", "isRemoved"=>false, "created"=>"2014-02-05T23:49:45Z", "lastModified"=>"2014-02-05T23:49:45Z", "creator"=>{"userId"=>"403127"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-02-05T23:49:45Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/f7ccded0-8e72-4897-85aa-b0466f460ddb", "title"=>"Improperly drawn casual inferences, unmatched cohorts, lack of biological plausibility", "body"=>"In the January 29, 2014 PLoS One article, “Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men,” the authors improperly draw causal inferences from retrospective, observational connections between testosterone therapy and non-fatal myocardial infarctions in unmatched cohorts [1]. Comparing cardiac risks in a group of men with low testosterone, a known major risk factor for heart disease, to men on Cialis® or Viagra® is incommensurate. This “cohort” study should be considered associative at best. \n\nWhat is disturbing is all the sensationalism surrounding these findings by “medical staff writers” who have reported findings as though definitive. Their lack of medical knowledge and skills to interpret the data is obvious and leads to very subjective and biased reporting. \n\nClearly ignored in these recent “news” articles are the documented benefits of testosterone therapy including cardiac protection as well as a lack of cardiovascular events documented in two well-designed meta-analyses of prospective, controlled trials [2,3]. \n\nFurthermore, over 80% of published epidemiologic studies are later disproven or shown to be false [4]. The known physiologic effects of testosterone at the androgen receptor and the lack of biologic plausibility make this a likely outcome in this case. Most importantly, many higher quality studies and trials have supported the benefits and safety of testosterone therapy in both men and women. \n\nIs there another way to explain the purported ‘finding’ in the unlikely case that is was valid? \n\nAromatization of testosterone to estradiol is rarely addressed in studies on testosterone and was not addressed in this study, even though patients with heart disease have many risk factors for increased aromatase activity: age, obesity, sedentary life style, insulin resistance and medications (statins, cardiac and anti-hypertensive medications) [5]. Side effects from increased local aromatization to estradiol (which is immeasurable in serum), including fluid retention, weight gain and edema, may potentially have adverse cardiovascular effects [6,7,8]. However, these are easily prevented with the use of low dose aromatase inhibitors [9,10]. Interestingly, some, albeit not all, studies in men have shown an increased risk of myocardial infarction with elevated estradiol or a high estradiol/testosterone ratio; this is not necessarily causal and should be approached with caution [11-18]. The confounders (e.g., age, obesity, sedentary life style, insulin resistance and medications), associated with low testosterone and increased aromatization to estradiol, are most likely causative. \n\nAs with many cohort studies there are severe methodical limitations including selection bias and lack of a suitable control group. As physicians and scientists, we should not ignore these results but rather keep them in perspective and, as suggested by the FDA, investigate them further with properly designed studies that also address signs and symptoms of aromatization as well as confounding variables.\n\nReferences\n\n1.\tFinkle WD, Greenland S, Ridgeway GK, Adams… JL. Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men. PLOS ONE. 2014\n2.\tCalof OM, Singh AB, Lee ML et al. Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci. 2005;60:1451-1457.\n3.\tFernández-Balsells MM, Murad MH, Lane M et al. Adverse effects of testosterone therapy in adult men: a systematic review and meta-analysis. Journal of Clinical Endocrinology & Metabolism. 2010;95:2560-2575.\n4.\tIoannidis JPA. Why most published research findings are false. PLoS medicine. 2005;2:e124.\n5.\tCohen PG. Obesity in men: the hypogonadal–estrogen receptor relationship and its effect on glucose homeostasis. Medical hypotheses. 2008;70:358-360.\n6.\tBell J, Bernasochi G, Risbridger… G. Aromatase Overexpression Elicits a Paradoxical Cardiac Response to Ischaemia and Reperfusion Challenge. Heart. 2013\n7.\tBell JR, Mellor KM, Wollermann AC et al. Aromatase deficiency confers paradoxical postischemic cardioprotection. Endocrinology. 2011;152:4937-4947.\n8.\tVermeulen A, Kaufman JM, Goemaere S, Van Pottelberg I. Estradiol in elderly men. The Aging Male. 2002;5:98-102.\n9.\tGlaser R, Dimitrakakis C. 14 Subgroups of patients treated with an aromatase inhibitor (anastrozole) delivered in combination with testosterone. Maturitas. 2012: 71: p.S31\n10.\tde Ronde W, de Jong FH. Aromatase inhibitors in men: effects and therapeutic options. Reproductive Biology and Endocrinology. 2011;9:93.\n11.\tBarrett-Connor E, Khaw K-T. Endogenous sex hormones and cardiovascular disease in men. A prospective population-based study. Circulation. 1988;78:539-545.\n12.\tEntrican JH, Beach C, Carroll D et al. Raised plasma oestradiol and oestrone levels in young survivors of myocardial infarction. The Lancet. 1978;312:487-490.\n13.\tGoldberg RJ, Gore JM, Zive M et al. Serum estradiol and coronary artery disease. The American journal of medicine. 1987;82:1-4.\n14.\tKlaiber EL, Broverman DM, Haffajee CI, Hochman JS, Sacks GM, Dalen JE. Serum estrogen levels in men with acute myocardial infarction. The American journal of medicine. 1982;73:872-881.\n15.\tLuria MH, Johnson MW, Pego R et al. Relationship between sex hormones, myocardial infarction, and occlusive coronary disease. Archives of internal medicine. 1982;142:42.\n16.\tMuller M, van den Beld AW, Bots ML, Grobbee DE, Lamberts SWJ, van der Schouw YT. Endogenous sex hormones and progression of carotid atherosclerosis in elderly men. Circulation. 2004;109:2074-2079.\n17.\tPhillips GB, Jing T, Heymsfield SB. Relationships in men of sex hormones, insulin, adiposity, and risk factors for myocardial infarction. Metabolism. 2003;52:784-790.\n18.\tZehir R, Karabay CY, Kocabay G. Myocardial infarction and spontaneous dissection of coronary artery due to oral contraceptive. Journal of Cardiovascular Medicine. 2011;12:448-450.\n19.\tvan Eickels M, Patten RD, Aronovitz MJ et al. 17-beta-estradiol increases cardiac remodeling and mortality in mice with myocardial infarction. Journal of the American College of Cardiology. 2003;41:2084-2092.\n\n\n", "isRemoved"=>false, "created"=>"2014-02-12T21:29:33Z", "lastModified"=>"2014-02-12T21:29:33Z", "creator"=>{"userId"=>"404825"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-02-12T21:29:33Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/cb6c2817-1595-45e9-a8a3-3e3a305838c2", "title"=>"INCOMPARABLE COHORTS", "body"=>"In this paper, the authors compared the myocardial infarction and mortality rates of men prescribed testosterone for low T versus men prescribed PDE inhibitors. The glaring errors in this study include that the authors did not measure or know the testosterone levels of the men in the PDE-I cohort, nor did they measure or know the baseline or post-treatment T level in the testosterone treated group. The study extracted the data from a review of insurance submitted prescriptions and post-prescriptions insurance ICD diagnosis codes. What the authors compared in this paper was a group of men with presumably low testosterone (who may not have received adequate treatment for low T) against an unrelated cohort of men with unknown but presumed average testosterone. In essence, this PLOS article did not control for the variable they were supposedly studying - testosterone! Clearly, the two groups are not comparable and the study is of no value. Assuming the men given T prescriptions had low T, the authors may have inadvertently lent support to the more established findings across two decades of studies linking men with low testosterone levels to significantly higher levels of myocardial infarctions and mortality from all causes, since the PLOS study’s low testosterone group had higher levels of MIs and mortality for the first 3 months of treatment, but not after that time frame. However, it is hard to draw any conclusion from this paper as they did not have scientifically valid comparable cohort groups or reliable patient data. ", "isRemoved"=>false, "created"=>"2014-02-17T02:55:29Z", "lastModified"=>"2014-02-17T02:55:29Z", "creator"=>{"userId"=>"405555"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>1, "mostRecentActivity"=>"2014-02-20T22:44:09Z", "replies"=>[{"type"=>"REPLY", "parentID"=>78577, "annotationUri"=>"info:doi/10.1371/reply/7f24dec9-42cd-476f-bbd3-ec9e7b0aae76", "title"=>"RE: INCOMPARABLE COHORTS", "body"=>"The commenter is correct that we did not have information on pre or post-treatment levels of testosterone, as well as a number of other potentially interesting variables, and this will surely be of interest for subsequent investigations. However, what we were attempting to do was to document the effects of testosterone therapy as it is currently being used in the U.S. male population. We believe we have accomplished this, and the conclusion is that as it is currently being used, it appears to be related to a substantial increase in the risk of myocardial infarction.\r\nThe commenter is incorrect about our comparison group. The group of men using PDE-I was used only to assess the risk of MI that might be associated with behavioral changes associated with drugs used for related indications. The primary comparison group was the same group of men who were in the testosterone exposed group (in other words, they served as their own controls). Specifically, in the group of men given testosterone, we compared their rate of myocardial infarction in the year prior to their first prescription to their rate in the 90 day period following their first prescription. This resulted in the 2 to 3-fold increased risks reported. We then evaluated the risk of myocardial infarction during the period from 91 to 180 days after the first prescription in the subgroup of men who did not refill their prescription, a time period during which they likely took little or no testosterone. The risk for this group in this time period returned to the rate level observed in the year prior to their first prescription. Using study subjects as their own controls is a powerful study design, and the results appear to be a fairly strong indictment of testosterone therapy. \r\n...", "isRemoved"=>false, "created"=>"2014-02-20T22:44:09Z", "lastModified"=>"2014-02-20T22:44:09Z", "creator"=>{"userId"=>"406643"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-02-20T22:44:09Z", "replies"=>[]}]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/2a5c0b35-e4ad-4b5b-915c-9da34cc1499c", "title"=>"PLOS ONE Misleading", "body"=>"Numerous studies have shown that natural testosterone pellet therapy can reduce the risk of heart disease, type 2 diabetes mellitus, Alzheimer’s disease, osteoporosis, and prostate cancer. A key component of this treatment is an accurate interpretation of a patient’s laboratory values. In the PLOS One study, this data was not considered.\nBio-identical testosterone pellet therapy allows for the optimization of each patient’s hormone levels to achieve a level that is above a discriminatory zone that reduces heart disease and the other diseases noted above. Dosage optimization is not possible with creams and gels.", "isRemoved"=>false, "created"=>"2014-02-25T21:28:45Z", "lastModified"=>"2014-02-25T21:28:45Z", "creator"=>{"userId"=>"407775"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-02-25T21:28:45Z", "replies"=>[]}
• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/bc7937f6-53be-44a2-869d-4c88ea7c7584", "title"=>"Testosterone was administered in an unsafe manner", "body"=>"In the January 29, 2014 PLoS One article, “Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men,” the authors conclude that \"In older men, and in younger men with pre-existing diagnosed heart disease, the risk of MI following initiation of TT prescription is substantially increased.[1]\"\n\nIt is known that for men with systolic chronic heart failure, serum estradiol levels higher or lower than the optimal amount increase the rate of mortality, both in the short term and in the long term[2]. Exogenous testosterone not only raises the level of serum testosterone but also the level of serum estradiol. The failure of the authors to monitor and control estradiol levels is a serious defect in their research.\n\nHigher endogenous levels of estradiol, but not testosterone, are associated with an increased incidence of coronary heart disease in men.[3] Also, for elderly men receiving exogenous testosterone, those who experienced adverse cardiovascular events had serum estradiol levels which were on average more than 1.9 times higher than for those who did not.[4]\n\nTestosterone is known to increase the risk of polycythemia. When hematocrit levels were monitored and kept at a safe level, no increase in adverse cardiovascular events were observed[5]. It is possible that testosterone therapy does in fact increase the risk of adverse cardiovascular events in men, but until researchers monitor both estradiol and hematocrit levels and keep them both at the safest levels possible, it is impossible to come to such a conclusion. \n\nReferences\n\n1. Finkle WD, Greenland S, Ridgeway GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS ONE. 2014;9(1): e85805. doi: 10.1371/journal.pone.0085805\n2. Jankowska EA, Rozentryt P, Ponikowska B, et al. Circulating estradiol and mortality in men with systolic heart failure. JAMA. 2009;301(18):1892-1901.\n3. Phillips GB, Castelli WP, Abbott RD, McNamara PM. Association of hyperestrogenemia and coronary heart disease in men in the Framingham cohort. Am J Med. 1983;74(5):863-869.\n4. Basaria S, Davda MN, Travison TJ, Ulloor J, Singh R, Bhasin S. Risk factors associated with cardiovascular events during testosterone administration in older men with mobility limitation. J Gerontol A Biol Sci Med Sci. 2013;68(2):153-160.\n5. Hajjar RR, Kaiser FE, Morley JE. Outcome of long-term testosterone replacement in older hypogonadal males: A retrospective analysis. JCEM. 1997;82(11):3793-3796.", "isRemoved"=>false, "created"=>"2014-05-09T18:57:19Z", "lastModified"=>"2014-05-09T18:57:19Z", "creator"=>{"userId"=>"433060"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pone.0085805", "state"=>"published", "journals"=>{"PLoSONE"=>{"journalKey"=>"PLoSONE", "eIssn"=>"1932-6203", "title"=>"PLOS ONE"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2014-05-09T18:57:19Z", "replies"=>[]}

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• {"id"=>"428633859719053312", "text"=>"File under 'no kidding': men < 65 w/history of heart disease who take #testosterone --> 2X more risk of heart attack: http://t.co/C3qx5hzKFJ", "created_at"=>"2014-01-29T21:00:50Z", "user"=>"sxbegle", "user_name"=>"sharon begley", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2602799189/pfqikfot0pbywuygdzfs_normal.jpeg"}
• {"id"=>"428635244850196480", "text"=>"RT @sxbegle: File under 'no kidding': men < 65 w/history of heart disease who take #testosterone --> 2X more risk of heart attack: http://t…", "created_at"=>"2014-01-29T21:06:20Z", "user"=>"KhannaOnHealth", "user_name"=>"Vik Khanna", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1466118047/Vik_March_6_2008_010_small_normal.jpg"}
• {"id"=>"428649611339628544", "text"=>"More evidence for link b/w testosterone therapy & heart risk. From claims database analysis in @PLOSONE \nhttp://t.co/F2PEe9AKnI", "created_at"=>"2014-01-29T22:03:25Z", "user"=>"KristinaMFiore", "user_name"=>"Kristina Fiore", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3167350846/b0457633f51004f5bf9c36b08c7fd9cc_normal.jpeg"}
• {"id"=>"428657023782510592", "text"=>"Tratamientos con testosterona predisponen al infarto en hombres http://t.co/zujY4AkMFo", "created_at"=>"2014-01-29T22:32:53Z", "user"=>"evidenciasmfyc", "user_name"=>"Miguel Angel María", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000651670214/2b8029f35a3fdc7b5d7aa157781951cc_normal.jpeg"}
• {"id"=>"428658400667639808", "text"=>"RT @evidenciasmfyc: Tratamientos con testosterona predisponen al infarto en hombres http://t.co/zujY4AkMFo", "created_at"=>"2014-01-29T22:38:21Z", "user"=>"SEHLELHA140_90", "user_name"=>"SEH-LELHA", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2953468876/3c06403056d198f5bc882dff06e21fe8_normal.jpeg"}
• {"id"=>"428659691741528064", "text"=>"RT @evidenciasmfyc: Tratamientos con testosterona predisponen al infarto en hombres http://t.co/zujY4AkMFo", "created_at"=>"2014-01-29T22:43:29Z", "user"=>"Mitotatu", "user_name"=>"Miguel Angel Prieto", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3592885011/abdfa9189a0cb644bc51ae29deedce2e_normal.jpeg"}
• {"id"=>"428671109274558464", "text"=>"RT @evidenciasmfyc: Tratamientos con testosterona predisponen al infarto en hombres http://t.co/zujY4AkMFo", "created_at"=>"2014-01-29T23:28:51Z", "user"=>"joanpeva", "user_name"=>"JOSE A. PEREZ VARGAS", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1309214003/IMAG0717_normal.jpg"}
• {"id"=>"428677707543506944", "text"=>"In men over age 65, those fancy \"Low T\" drugs double or triple the risk of heart attack http://t.co/UrhHrR7hoG", "created_at"=>"2014-01-29T23:55:04Z", "user"=>"THEHCC", "user_name"=>"Healthcare Channel", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3105949684/9657add73366bda1fef8c68871720771_normal.jpeg"}
• {"id"=>"428678603690106880", "text"=>"Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/pqlrPEyYMK", "created_at"=>"2014-01-29T23:58:38Z", "user"=>"pash22", "user_name"=>"Ash Paul", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3295856896/66ab958422d28c521d0143bddbb90233_normal.jpeg"}
• {"id"=>"428798448997916672", "text"=>"\"Is it Low T\"?\n\nNo, just a death wish. http://t.co/VPgwUl6uHL + http://t.co/zhGsk6uAcQ + http://t.co/IEEfpvNqyK", "created_at"=>"2014-01-30T07:54:51Z", "user"=>"a_picazo", "user_name"=>"Alheli Picazo", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3209865914/5b2be08d1cded8ea14c1e868bdf5ba49_normal.png"}
• {"id"=>"428804833143820288", "text"=>"RT @a_picazo: \"Is it Low T\"?\n\nNo, just a death wish. http://t.co/VPgwUl6uHL + http://t.co/zhGsk6uAcQ + http://t.co/IEEfpvNqyK", "created_at"=>"2014-01-30T08:20:13Z", "user"=>"skippybkroo", "user_name"=>"skippy the bkroo", "user_profile_image"=>"http://pbs.twimg.com/profile_images/84193236/Roo_Logo_from_Lauren_normal.JPG"}
• {"id"=>"428824665130151938", "text"=>"Enn ein grein sem bendir okkur á að ávísun testósteróns gæti haft hættur í för með sér fyrir karla með hjartasjúkdóm. http://t.co/54VH4UNjxu", "created_at"=>"2014-01-30T09:39:02Z", "user"=>"rafn_ben", "user_name"=>"Rafn Benediktsson", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2148030006/tolvukall_normal.png"}
• {"id"=>"428825771746930688", "text"=>"En ein grein sem tengir ávísun testósteróns við hjartasjúkdóma. http://t.co/54VH4UNjxu", "created_at"=>"2014-01-30T09:43:25Z", "user"=>"rafn_ben", "user_name"=>"Rafn Benediktsson", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2148030006/tolvukall_normal.png"}
• {"id"=>"428851437440106497", "text"=>"@ASPCardio @Cardiosmart @NYUDocs New Concern About #Testosterone and #CHDRisk http://t.co/exy5bLRnb9 @PLOSONE http://t.co/xU6gD3WWPl", "created_at"=>"2014-01-30T11:25:25Z", "user"=>"BHLipidclinic", "user_name"=>"Bellevue Hosp Lipid ", "user_profile_image"=>"http://pbs.twimg.com/profile_images/672592177/BHLipidCLinicLogo_normal.jpg"}
• {"id"=>"428851438354440192", "text"=>"@ASPCardio @Cardiosmart @NYUDocs New Concern About #Testosterone and #CHDRisk http://t.co/XCfe7aP6co @PLOSONE http://t.co/vv1kY86ofJ", "created_at"=>"2014-01-30T11:25:25Z", "user"=>"lipiddoc", "user_name"=>"Dr. James Underberg", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2204223638/JAUCasualCompressed_normal.jpg"}
• {"id"=>"428866816421548033", "text"=>"New Study: #Testosterone treatment increased the risk of #heart attacks. http://t.co/OQBOuNH8aB", "created_at"=>"2014-01-30T12:26:31Z", "user"=>"physicianpulse", "user_name"=>"Najeh Ahmad, MD MPH", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1575571246/n1_normal.jpg"}
• {"id"=>"428871829365596160", "text"=>"#Testosterone supplements triple #heartattack risk for men under 65 with history of CVD, says @PLOSONE study - http://t.co/1yan2TjKQD", "created_at"=>"2014-01-30T12:46:26Z", "user"=>"BrJCardiol", "user_name"=>"BJC", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2092352484/BJClogo_normal.jpg"}
• {"id"=>"428873167201775616", "text"=>"RT @BrJCardiol: #Testosterone supplements triple #heartattack risk for men under 65 with history of CVD, says @PLOSONE study - http://t.co/…", "created_at"=>"2014-01-30T12:51:45Z", "user"=>"bushido1900", "user_name"=>"Kenji NAKAI, MD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1279497021/image_normal.jpg"}
• {"id"=>"428876722675515393", "text"=>"In men over age 65, those fancy \"Low T\" drugs double or triple the risk of heart attack http://t.co/UrhHrR7hoG …", "created_at"=>"2014-01-30T13:05:53Z", "user"=>"THEHCC", "user_name"=>"Healthcare Channel", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3105949684/9657add73366bda1fef8c68871720771_normal.jpeg"}
• {"id"=>"428877212994269184", "text"=>"RT @THEHCC: In men over age 65, those fancy \"Low T\" drugs double or triple the risk of heart attack http://t.co/UrhHrR7hoG …", "created_at"=>"2014-01-30T13:07:50Z", "user"=>"rlanzara", "user_name"=>"Richard G. Lanzara", "user_profile_image"=>"http://pbs.twimg.com/profile_images/89594702/MyPict2_normal.jpg"}
• {"id"=>"428885243438043136", "text"=>"RT @evidenciasmfyc: Tratamientos con testosterona predisponen al infarto en hombres http://t.co/zujY4AkMFo", "created_at"=>"2014-01-30T13:39:45Z", "user"=>"chiniffoni", "user_name"=>"Elvira Merlos Tevar", "user_profile_image"=>"http://abs.twimg.com/sticky/default_profile_images/default_profile_2_normal.png"}
• {"id"=>"428913759621775360", "text"=>"RT @THEHCC: In men over age 65, those fancy \"Low T\" drugs double or triple the risk of heart attack http://t.co/UrhHrR7hoG …", "created_at"=>"2014-01-30T15:33:03Z", "user"=>"AlisynGayle", "user_name"=>"Alisyn Gayle", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2620778831/me5vi7j14y78d2iaa5bv_normal.jpeg"}
• {"id"=>"428932937724092416", "text"=>"#PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/gtyOuUglvb", "created_at"=>"2014-01-30T16:49:16Z", "user"=>"Mangold_M", "user_name"=>"Mallory Mangold", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000620653784/5427aa1ec7e6c0aadddb9dfd81f83cac_normal.jpeg"}
• {"id"=>"428973049715888128", "text"=>"#PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/e29rEqx46g #LowT", "created_at"=>"2014-01-30T19:28:39Z", "user"=>"nicoledub1", "user_name"=>"Nicole Dubowitz", "user_profile_image"=>"http://pbs.twimg.com/profile_images/422949726959312897/pEAC_Kiz_normal.jpeg"}
• {"id"=>"428973049720107008", "text"=>"#PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/ZjlLf0JjoY #LowT", "created_at"=>"2014-01-30T19:28:39Z", "user"=>"Pharmed_Out", "user_name"=>"PharmedOut", "user_profile_image"=>"http://pbs.twimg.com/profile_images/413000521641775104/Aj2YSFqt_normal.jpeg"}
• {"id"=>"428977470549663744", "text"=>"In men over age 65, those fancy \"Low T\" drugs double or triple the risk of heart attack http://t.co/UrhHrR7hoG … …", "created_at"=>"2014-01-30T19:46:13Z", "user"=>"THEHCC", "user_name"=>"Healthcare Channel", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3105949684/9657add73366bda1fef8c68871720771_normal.jpeg"}
• {"id"=>"429011182062559233", "text"=>"@roboturoloog Los van prostaat blijft test therapie risicovol: http://t.co/vVrFsHFadM", "created_at"=>"2014-01-30T22:00:11Z", "user"=>"Besnijdenisinfo", "user_name"=>"Besnijdenisinfo.nl", "user_profile_image"=>"http://abs.twimg.com/sticky/default_profile_images/default_profile_2_normal.png"}
• {"id"=>"429155291368660992", "text"=>"Un nuevo estudio vincula el riesgo de infarto con la terapia de testosterona.\nhttp://t.co/npWKPzDl9D)", "created_at"=>"2014-01-31T07:32:49Z", "user"=>"newadvicehealth", "user_name"=>"NEW ADVICE", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000765114131/e376721b17b097a7381d4f22cf7ec69b_normal.jpeg"}
• {"id"=>"429199707471368192", "text"=>"(PLoS One) El tto con testosterona se asocia a un ↑ del riesgo de sufrir un IAM en personas de riesgo http://t.co/SR3QPuKKkA Est Observ", "created_at"=>"2014-01-31T10:29:19Z", "user"=>"rincondesisifo", "user_name"=>"Carlos F. Oropesa", "user_profile_image"=>"http://pbs.twimg.com/profile_images/412688609255256064/e0QO_9cj_normal.jpeg"}
• {"id"=>"429200574262022144", "text"=>"RT @rincondesisifo: (PLoS One) El tto con testosterona se asocia a un ↑ del riesgo de sufrir un IAM en personas de riesgo http://t.co/SR3QP…", "created_at"=>"2014-01-31T10:32:45Z", "user"=>"JuanGrvas", "user_name"=>"Juan Gérvas", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2627753335/IMGP1408_normal.JPG"}
• {"id"=>"429201578566766592", "text"=>"Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men @rincondesisifo \nhttp://t.co/i8dRyqgGj6", "created_at"=>"2014-01-31T10:36:45Z", "user"=>"JuanGrvas", "user_name"=>"Juan Gérvas", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2627753335/IMGP1408_normal.JPG"}
• {"id"=>"429202392517996544", "text"=>"RT @rincondesisifo: (PLoS One) El tto con testosterona se asocia a un ↑ del riesgo de sufrir un IAM en personas de riesgo http://t.co/SR3QP…", "created_at"=>"2014-01-31T10:39:59Z", "user"=>"DOCRAHEM", "user_name"=>"HENRI PINEDA", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000392194842/fd1655e1a4459972a7665ff8069ee28f_normal.jpeg"}
• {"id"=>"429202575460954112", "text"=>"RT @rincondesisifo: (PLoS One) El tto con testosterona se asocia a un ↑ del riesgo de sufrir un IAM en personas de riesgo http://t.co/SR3QP…", "created_at"=>"2014-01-31T10:40:42Z", "user"=>"factam_ss", "user_name"=>"Factam SS", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3176168741/48cada83154df6bf74e26a688bd45186_normal.jpeg"}
• {"id"=>"429206123741454337", "text"=>"RT @JuanGrvas: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men @rincondesisifo \nhttp:/…", "created_at"=>"2014-01-31T10:54:48Z", "user"=>"paolabe25879980", "user_name"=>"paola beltran", "user_profile_image"=>"http://pbs.twimg.com/profile_images/414032790293078016/XCuGnnp-_normal.jpeg"}
• {"id"=>"429206508258484224", "text"=>"RT @rincondesisifo: (PLoS One) El tto con testosterona se asocia a un ↑ del riesgo de sufrir un IAM en personas de riesgo http://t.co/SR3QP…", "created_at"=>"2014-01-31T10:56:20Z", "user"=>"nanivall", "user_name"=>"Nani Vall-llossera", "user_profile_image"=>"http://pbs.twimg.com/profile_images/428187684884848640/XR1sOTP4_normal.jpeg"}
• {"id"=>"429226853325213696", "text"=>"#PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/UaWvujiQs6", "created_at"=>"2014-01-31T12:17:11Z", "user"=>"MargaritaDiVall", "user_name"=>"Margarita DiVall", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2314202853/ru01q2azviok4iq7zzy8_normal.jpeg"}
• {"id"=>"429235268709666817", "text"=>"Risk of myocardial infarction following initiation of testosterone therapy is substantially increased in older men: http://t.co/6PYu36yqb9", "created_at"=>"2014-01-31T12:50:37Z", "user"=>"pulmonary_rehab", "user_name"=>"Martijn A. Spruit ", "user_profile_image"=>"http://pbs.twimg.com/profile_images/428238934091366400/eQ072wa9_normal.jpeg"}
• {"id"=>"429245960439746560", "text"=>"Se incrementa el riesgo de #Infarto con el uso de #Testosterona http://t.co/I4Z7dBoXg1", "created_at"=>"2014-01-31T13:33:06Z", "user"=>"CirujanoUrologo", "user_name"=>"Ricardo Gutfrajnd", "user_profile_image"=>"http://pbs.twimg.com/profile_images/886312572/Dr._Ricardo_Gutfrajnd_normal.jpg"}
• {"id"=>"429264919830089728", "text"=>"#PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/tHEydYKr9v", "created_at"=>"2014-01-31T14:48:26Z", "user"=>"DrLauraDavies", "user_name"=>"Dr. Laura Davies", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3397588895/0700f96fe3578df739e985dda035567c_normal.jpeg"}
• {"id"=>"429269052721074176", "text"=>"Risk for heart attack increases significantly in the months after starting testosterone therapy. Uh oh.\nhttp://t.co/jaIFJWVwpP", "created_at"=>"2014-01-31T15:04:52Z", "user"=>"DrShlain", "user_name"=>"Jordan Shlain MD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3366835571/0ba576e7455b5d6019d6cfcc8e45316c_normal.jpeg"}
• {"id"=>"429333957914947584", "text"=>"RT @rincondesisifo: (PLoS One) El tto con testosterona se asocia a un ↑ del riesgo de sufrir un IAM en personas de riesgo http://t.co/SR3QP…", "created_at"=>"2014-01-31T19:22:46Z", "user"=>"gineblog", "user_name"=>"Gineblog", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2711872512/18892054712cc6f96fcf898eff9462f5_normal.jpeg"}
• {"id"=>"429334595558195200", "text"=>"RT @rincondesisifo: (PLoS One) El tto con testosterona se asocia a un ↑ del riesgo de sufrir un IAM en personas de riesgo http://t.co/SR3QP…", "created_at"=>"2014-01-31T19:25:18Z", "user"=>"ruralsud", "user_name"=>"job", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2251747163/escuela_1967_1__normal.jpg"}
• {"id"=>"429357006332649473", "text"=>"T1E1A1 Trat con #tetosterona aumenta riesgo #IAM en >65a y tb en jóvenes con enf cardíaca previa. Vía @rincondesisifo http://t.co/qkss697CQV", "created_at"=>"2014-01-31T20:54:22Z", "user"=>"pontealdiaAP", "user_name"=>"@pontealdiaAP SAMFyC", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000683174275/0527ee5f7d9b41b2c81fdb5de06a1916_normal.jpeg"}
• {"id"=>"429368944362004480", "text"=>"RT @pontealdiaAP: T1E1A1 Trat con #tetosterona aumenta riesgo #IAM en >65a y tb en jóvenes con enf cardíaca previa. Vía @rincondesisifo htt…", "created_at"=>"2014-01-31T21:41:48Z", "user"=>"Omidhakami", "user_name"=>"Omid Hakami Hakami", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1241042039/161715_1624267671_391833_q_normal.jpg"}
• {"id"=>"429372177259847680", "text"=>"FDA to Investigate Testosterone Risk http://t.co/yKCpmnBSoW related article: http://t.co/Eqrx0XvI7T", "created_at"=>"2014-01-31T21:54:39Z", "user"=>"PLOSONE", "user_name"=>"PLOS ONE", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2429958559/mzjl6as5u2m09r2erof6_normal.jpeg"}
• {"id"=>"429373132106104832", "text"=>"\"@PLOSONE: FDA to Investigate Testosterone Risk http://t.co/6JVf8Vsa2r related article: http://t.co/fPEBmW9MXk\"", "created_at"=>"2014-01-31T21:58:26Z", "user"=>"MiamiDevils", "user_name"=>"H.Erturk Williams", "user_profile_image"=>"http://pbs.twimg.com/profile_images/426160860181319680/VYYj2-3O_normal.jpeg"}
• {"id"=>"429374870372106240", "text"=>"RT @PLOSONE: FDA to Investigate Testosterone Risk http://t.co/yKCpmnBSoW related article: http://t.co/Eqrx0XvI7T", "created_at"=>"2014-01-31T22:05:21Z", "user"=>"DrBronquio", "user_name"=>"Andrea Salgado", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1538534016/CameraFunSnap_normal.jpg"}
• {"id"=>"429380777424347136", "text"=>"RT @PLOSONE: FDA to Investigate Testosterone Risk http://t.co/yKCpmnBSoW related article: http://t.co/Eqrx0XvI7T", "created_at"=>"2014-01-31T22:28:49Z", "user"=>"PLOS", "user_name"=>"PLOS", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2424363764/2etoq0zjwxicokm1woge_normal.jpeg"}
• {"id"=>"429381668676591619", "text"=>"RT @PLOSONE: FDA to Investigate Testosterone Risk http://t.co/yKCpmnBSoW related article: http://t.co/Eqrx0XvI7T", "created_at"=>"2014-01-31T22:32:22Z", "user"=>"Hixgrid", "user_name"=>"Science Network", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1190589259/Hixgrid_avatar_normal.png"}
• {"id"=>"429382143153029120", "text"=>"RT @PLOSONE: FDA to Investigate Testosterone Risk http://t.co/yKCpmnBSoW related article: http://t.co/Eqrx0XvI7T", "created_at"=>"2014-01-31T22:34:15Z", "user"=>"biodanilo", "user_name"=>"Danilo Fernandez ", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1359775506/DNA_Strand_by_melonhead_emotion_normal.gif"}
• {"id"=>"429392537531727872", "text"=>"RT @pontealdiaAP: T1E1A1 Trat con #tetosterona aumenta riesgo #IAM en >65a y tb en jóvenes con enf cardíaca previa. Vía @rincondesisifo htt…", "created_at"=>"2014-01-31T23:15:33Z", "user"=>"juanprj1", "user_name"=>"Juan M Parras Rejano", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000701910179/6d4a1c4c75fe59078d8b24a5430257d3_normal.jpeg"}
• {"id"=>"429399348141498368", "text"=>"\"Low T\"? Considering #testosterone? Buy the hype & you could 'buy the farm' http://t.co/2qQpUeec1Q via @PLOSONE. @AAFP", "created_at"=>"2014-01-31T23:42:37Z", "user"=>"SeanLucan", "user_name"=>"Sean C. Lucan, MD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2329558269/207sytude25xsoz0y3is_normal.jpeg"}
• {"id"=>"429419079342882816", "text"=>"【Medpage TODAY】\nTestosterone Tx Tied to Heart Attack Risk http://t.co/ECxSfkrMP1\n【PLoS ONE】\nhttp://t.co/jjBFrHexB6", "created_at"=>"2014-02-01T01:01:01Z", "user"=>"kojima_aponet", "user_name"=>"小嶋 慎二＠アポネット", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1864221167/aponet_profile_normal.jpg"}
• {"id"=>"429443921899307009", "text"=>"@Reynolds2305 Might refer this to 1100 personnel who flog T therapy so unquestioningly: http://t.co/fRmDNnrk3S", "created_at"=>"2014-02-01T02:39:44Z", "user"=>"dansteves1", "user_name"=>"dan steves", "user_profile_image"=>"http://abs.twimg.com/sticky/default_profile_images/default_profile_4_normal.png"}
• {"id"=>"429449137075924992", "text"=>"RT @PLOSONE: FDA to Investigate Testosterone Risk http://t.co/yKCpmnBSoW related article: http://t.co/Eqrx0XvI7T", "created_at"=>"2014-02-01T03:00:27Z", "user"=>"Mangold_M", "user_name"=>"Mallory Mangold", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000620653784/5427aa1ec7e6c0aadddb9dfd81f83cac_normal.jpeg"}
• {"id"=>"429451046797447169", "text"=>"RT @rincondesisifo: (PLoS One) El tto con testosterona se asocia a un ↑ del riesgo de sufrir un IAM en personas de riesgo http://t.co/SR3QP…", "created_at"=>"2014-02-01T03:08:03Z", "user"=>"rubenroa", "user_name"=>"Ruben Roa", "user_profile_image"=>"http://pbs.twimg.com/profile_images/428849770891710464/kgRmDYTd_normal.png"}
• {"id"=>"429497020236464128", "text"=>"\"@PLOSONE: FDA to Investigate Testosterone Risk http://t.co/2TN6LVIyYo related article: http://t.co/7iYQLFywii\"", "created_at"=>"2014-02-01T06:10:43Z", "user"=>"Ayo_Toye", "user_name"=>"Dr Ayo A. Toye", "user_profile_image"=>"http://abs.twimg.com/sticky/default_profile_images/default_profile_4_normal.png"}
• {"id"=>"429534110516654081", "text"=>"Testosteron behandling knyttet til hjerteinfarkt (spes menn > 65 år ). Potensiell risiko ved å behandle \" low T \"?. http://t.co/oj9a8QoQKA", "created_at"=>"2014-02-01T08:38:06Z", "user"=>"tvalderhaug", "user_name"=>"Tone Valderhaug", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1840936704/TGV_sv_hvi_normal.jpg"}
• {"id"=>"429558890427326464", "text"=>"Em homens >65a, o risco de IAM é 2x maior nos 90 dias após início de terapia com testosterona-PLOS One, 2014 http://t.co/GkkK7LlgpW", "created_at"=>"2014-02-01T10:16:34Z", "user"=>"Afonso_Th", "user_name"=>"Thiago Afonso", "user_profile_image"=>"http://pbs.twimg.com/profile_images/427650480630931456/YIc0Ag3J_normal.jpeg"}
• {"id"=>"429676935656902657", "text"=>"#PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/RrJ9K9ik3k", "created_at"=>"2014-02-01T18:05:39Z", "user"=>"AllThingsGero", "user_name"=>"Pamela Pitman Brown", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3107311562/09a6c28050823faf594de32b64e9bb2c_normal.jpeg"}
• {"id"=>"429960357218902016", "text"=>"RT @BrJCardiol: #Testosterone supplements triple #heartattack risk for men under 65 with history of CVD, says @PLOSONE study - http://t.co/…", "created_at"=>"2014-02-02T12:51:52Z", "user"=>"TeamCPR", "user_name"=>"CPR U READY", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3609321504/a25bd33648464a003a816db9a9e968be_normal.jpeg"}
• {"id"=>"430052536872353792", "text"=>"RT @PLOSONE: FDA to Investigate Testosterone Risk http://t.co/yKCpmnBSoW related article: http://t.co/Eqrx0XvI7T", "created_at"=>"2014-02-02T18:58:09Z", "user"=>"MEDIANA_FILTER", "user_name"=>"MEDIANA-FILTER", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000632432123/93ac7556f53e7d2929a7fd731128e5b2_normal.jpeg"}
• {"id"=>"430189203289161728", "text"=>"Using testosterone treatment in old age can increase risks of heart attacks. http://t.co/cMn8HxQhc7)", "created_at"=>"2014-02-03T04:01:13Z", "user"=>"Unnikri", "user_name"=>"Unnikrishnan AG", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000361733180/0a27b594f30d03c5161df496102f73b7_normal.jpeg"}
• {"id"=>"430259824031326209", "text"=>"@cecilicp @JuanGrvas Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone therapy in Men http://t.co/EPLgj1KOal", "created_at"=>"2014-02-03T08:41:50Z", "user"=>"enriquegavilan", "user_name"=>"Enrique Gavilán", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000623793757/91c0240c9da67a514e6711768ea3156a_normal.jpeg"}
• {"id"=>"430311821179109377", "text"=>"RT @pontealdiaAP: T1E1A1 Trat con #tetosterona aumenta riesgo #IAM en >65a y tb en jóvenes con enf cardíaca previa. Vía @rincondesisifo htt…", "created_at"=>"2014-02-03T12:08:27Z", "user"=>"SAMFyC", "user_name"=>"SAMFyC", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2108567859/LOGO_SAMFyC_Color_normal.jpg"}
• {"id"=>"430472822335733760", "text"=>"RT @pontealdiaAP: T1E1A1 Trat con #tetosterona aumenta riesgo #IAM en >65a y tb en jóvenes con enf cardíaca previa. Vía @rincondesisifo htt…", "created_at"=>"2014-02-03T22:48:13Z", "user"=>"InmaMesa", "user_name"=>"Inmaculada Mesa", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3673638864/03de958fae426a35e29ca49e1b51005e_normal.jpeg"}
• {"id"=>"430811936151056384", "text"=>"Ojo con la terapia de reemplazo hormonal con #testosterona: aumenta el riesgo de #infartos @PLOSONE http://t.co/ib1t1e5fEz", "created_at"=>"2014-02-04T21:15:44Z", "user"=>"SAGRADA_BSAS", "user_name"=>"La Sagrada Familia", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1722082577/Captura_de_pantalla_2011-12-29_a_la_s__15.37.02_normal.png"}
• {"id"=>"430871716894482432", "text"=>"Is that the sound of brakes being hit? Probably not a bad thing. Increased Risk of Non-Fatal MI Following TRT http://t.co/TTCFLRduvW", "created_at"=>"2014-02-05T01:13:17Z", "user"=>"DrDrewDylewski", "user_name"=>"Drew Dylewski", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2614560659/8p6sy8jgpghskw5vwr4f_normal.jpeg"}
• {"id"=>"430910970815209472", "text"=>"Men who start taking testosterone supplements double their risk of heart attack http://t.co/gbd8iZMD8p", "created_at"=>"2014-02-05T03:49:16Z", "user"=>"mpwoodhead", "user_name"=>"Michael Woodhead", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000542376944/a659edf84cc9c61cd71a3c952cc928dc_normal.jpeg"}
• {"id"=>"430941419310546945", "text"=>"Brief but good statement by @nytimes on the ridiculous \"Low T\" trend -- http://t.co/4p3mTXDiIb + study from @PLOS http://t.co/ny96KYO4Mi", "created_at"=>"2014-02-05T05:50:15Z", "user"=>"dgermain21", "user_name"=>"D. Russler-Germain", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000424636218/8c294f7ea1800f3b6362a0ff074f5212_normal.png"}
• {"id"=>"431028358269644800", "text"=>"RT @BrJCardiol: #Testosterone supplements triple #heartattack risk for men under 65 with history of CVD, says @PLOSONE study - http://t.co/…", "created_at"=>"2014-02-05T11:35:43Z", "user"=>"CardiacConsult", "user_name"=>"Jordan Safirstein MD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000675932213/8631304bb219311bb51b216be18e8929_normal.jpeg"}
• {"id"=>"431032101736284162", "text"=>"RT @BrJCardiol: #Testosterone supplements triple #heartattack risk for men under 65 with history of CVD, says @PLOSONE study - http://t.co/…", "created_at"=>"2014-02-05T11:50:35Z", "user"=>"DrJennHaythe", "user_name"=>"Jennifer Haythe MD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000150977381/1b2315eee6e7a6e53f6704e05db44203_normal.jpeg"}
• {"id"=>"431100805567897600", "text"=>"RT @dgermain21: Brief but good statement by @nytimes on the ridiculous \"Low T\" trend -- http://t.co/4p3mTXDiIb + study from @PLOS http://t.…", "created_at"=>"2014-02-05T16:23:36Z", "user"=>"mattjhodgkinson", "user_name"=>"Matt Hodgkinson", "user_profile_image"=>"http://pbs.twimg.com/profile_images/423543051471323136/WmIo5YF8_normal.png"}
• {"id"=>"431102939688480768", "text"=>"Exogenous testosterone doubles risk of non-fatal myocardial infarction in first three months of therapy http://t.co/ZcLQgxVyef", "created_at"=>"2014-02-05T16:32:04Z", "user"=>"drwburdick", "user_name"=>"Bill Burdick", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1589687006/ETR_7012-1_normal.JPG"}
• {"id"=>"431172307684691968", "text"=>"Low dose Testosterone therapy in men increases stroke & MI PLoS ONE http://t.co/AbT7Z9uLKZ JAMA http://t.co/wnOYMDCCud HRT again?", "created_at"=>"2014-02-05T21:07:43Z", "user"=>"EricRawsonPhD", "user_name"=>"Eric Rawson, Ph.D.", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000716936058/d98de493fb24a132ff5b54b0f1fc39e8_normal.jpeg"}
• {"id"=>"431449264263548928", "text"=>"#PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/FsqrL281hw", "created_at"=>"2014-02-06T15:28:15Z", "user"=>"BrainsNeedSleep", "user_name"=>"Si Baker-Goodwin EdD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/424372088418226176/BwSuyIVP_normal.jpeg"}
• {"id"=>"431455083599908864", "text"=>"RT @BrainsNeedSleep: #PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://…", "created_at"=>"2014-02-06T15:51:22Z", "user"=>"masterofsleep", "user_name"=>"MDso♚me", "user_profile_image"=>"http://pbs.twimg.com/profile_images/428361194341031937/uH04ZRJ-_normal.jpeg"}
• {"id"=>"433221053104795648", "text"=>"There is an association between #testosterone therapy & #heart #disease according to this study. Bad news. http://t.co/Elr13Nsakk", "created_at"=>"2014-02-11T12:48:42Z", "user"=>"TheFitDr", "user_name"=>"Dr. Stuart Fischer", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3158137503/812ea0ada2403291f505aa5a16131913_normal.png"}
• {"id"=>"433228368146743296", "text"=>"RT @TheFitDr: There is an association between #testosterone therapy & #heart #disease according to this study. Bad news. http://t.co/Elr13N…", "created_at"=>"2014-02-11T13:17:46Z", "user"=>"garden4u_wa", "user_name"=>"Donna Maher", "user_profile_image"=>"http://abs.twimg.com/sticky/default_profile_images/default_profile_0_normal.png"}
• {"id"=>"433245338682806272", "text"=>"RT @TheFitDr: There is an association between #testosterone therapy & #heart #disease according to this study. Bad news. http://t.co/Elr13N…", "created_at"=>"2014-02-11T14:25:12Z", "user"=>"crask1", "user_name"=>"Bill Craske", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3198445180/60c38cd8314100b6458255d8feeb452b_normal.jpeg"}
• {"id"=>"433353313812107265", "text"=>"RT @TheFitDr: There is an association between #testosterone therapy & #heart #disease according to this study. Bad news. http://t.co/Elr13N…", "created_at"=>"2014-02-11T21:34:16Z", "user"=>"robalero", "user_name"=>"Luis Franco™", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000855053912/5a78948a353d56a53d45b87366b9541d_normal.jpeg"}
• {"id"=>"436693001604452352", "text"=>"men with pre-existing heart disease, the risk of MI after starting testosterone prescription is increased. http://t.co/eTZwBYizcy", "created_at"=>"2014-02-21T02:44:59Z", "user"=>"MarwaDabbagh", "user_name"=>"Marwa Dabbagh", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000145249588/67378b801227434fa6d891bcb17e0e05_normal.jpeg"}
• {"id"=>"436870764651098112", "text"=>"Men treated with testosterone more likely to have heart attack w/in 90 days of starting treatment. http://t.co/eHREa2XAhm", "created_at"=>"2014-02-21T14:31:21Z", "user"=>"DocCarnahan", "user_name"=>"Jill Carnahan, MD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1780184917/carnahan0609-004_2_normal.jpg"}
• {"id"=>"436877053183270912", "text"=>"In older men & younger men w/heart disease risk of heart attacks greatly increased on starting Testosterone Rx. #lowT\nhttp://t.co/mPbTtlukji", "created_at"=>"2014-02-21T14:56:20Z", "user"=>"praanamd", "user_name"=>"Dr. Manisha Ghei, ", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000458760663/c25ab64779b8ded6df145a742ded4aad_normal.jpeg"}
• {"id"=>"439187395414458368", "text"=>"#PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men~> http://t.co/Nnw3wxcEFx", "created_at"=>"2014-02-27T23:56:49Z", "user"=>"glenlerner", "user_name"=>"Glen Lerner", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2631507783/5867d119b6d366778f285a81eb21021c_normal.png"}
• {"id"=>"441989249215115264", "text"=>"#PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/Qf4gwuFHPi", "created_at"=>"2014-03-07T17:30:23Z", "user"=>"PintoHealthcare", "user_name"=>"Dr. Marc Pinto", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1476062418/Snapshot_20110728_6_normal.jpg"}
• {"id"=>"448414271290880000", "text"=>"#testosterone and #CVrisk http://t.co/z1QNK6PiTr", "created_at"=>"2014-03-25T11:01:08Z", "user"=>"GregoryWallinMD", "user_name"=>"Gregory Wallin M.D.", "user_profile_image"=>"http://pbs.twimg.com/profile_images/444914015110565888/iF30DXC6_normal.jpeg"}
• {"id"=>"469278169086717952", "text"=>"Increased Risk of Non-Fatal #MyocardialInfarction Following #Testosterone #Therapy Prescription in Men http://t.co/qv9sHwwOpl - 2014 study", "created_at"=>"2014-05-22T00:46:48Z", "user"=>"rylan7", "user_name"=>"W R", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1363571261/TwitAvatar_Pic_from_Silver_normal.jpg"}
• {"id"=>"522151507580309504", "text"=>"#PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/GVIReCV6di", "created_at"=>"2014-10-14T22:26:35Z", "user"=>"DrBenKoh", "user_name"=>"Sports-Medicine-Law", "user_profile_image"=>"http://pbs.twimg.com/profile_images/419770396980674560/xsG7eCW__normal.jpeg"}
• {"id"=>"522159954699251713", "text"=>"RT @DrBenKoh: #PLOSONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men http://t.co/GV…", "created_at"=>"2014-10-14T23:00:09Z", "user"=>"FitnessLawyer", "user_name"=>"Tammy Thomas, JD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/431126639523540992/n7nGQR_U_normal.jpeg"}

Wikipedia | Further Information

• {"title"=>"Hypogonadism", "url"=>"http://en.wikipedia.org/wiki/Hypogonadism", "timestamp"=>"2019-03-06T16:27:16Z"}
• {"title"=>"Testosterone and the cardiovascular system", "url"=>"http://en.wikipedia.org/wiki/Testosterone_and_the_cardiovascular_system", "timestamp"=>"2019-02-14T19:45:39Z"}
• {"title"=>"Androgen replacement therapy", "url"=>"http://en.wikipedia.org/wiki/Androgen_replacement_therapy", "timestamp"=>"2019-02-20T04:17:22Z"}
• {"title"=>"Sarcopenia", "url"=>"http://en.wikipedia.org/wiki/Sarcopenia", "timestamp"=>"2019-02-09T23:28:40Z"}
• {"title"=>"Testosterone (medication)", "url"=>"http://en.wikipedia.org/wiki/Testosterone_(medication)", "timestamp"=>"2019-03-01T13:26:12Z"}
• {"title"=>"Testosteronikorvaushoito", "url"=>"http://fi.wikipedia.org/wiki/Testosteronikorvaushoito", "timestamp"=>"2018-04-24T04:12:09Z"}
• {"title"=>"علاج بديل بالأندروجين", "url"=>"http://ar.wikipedia.org/wiki/علاج_بديل_بالأندروجين", "timestamp"=>"2018-12-24T12:51:53Z"}
• {"title"=>"تستوستيرون (دواء)", "url"=>"http://ar.wikipedia.org/wiki/تستوستيرون_(دواء)", "timestamp"=>"2019-02-18T05:27:56Z"}

Wordpress.com | Further Information

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Figshare

• {"files"=>["https://ndownloader.figshare.com/files/1366182"], "description"=>"*<p>Adjusted for age and pre-existing medical conditions and medication use associated with MI or its risk factors.</p>†<p>Effective sample size of PDE5 inhibitor cohort after weighting.</p><p>Under 65 with heart disease history: 9,003.</p><p>Under 65 without a history of heart disease: 112,588.</p><p>65 and older with heart disease history: 4,190.</p><p>65 and older without a history of heart disease: 15,718.</p>‡<p>RRR = RR TT cohort/RR PDE5I cohort.</p>", "links"=>[], "tags"=>["cardiovascular", "Myocardial infarction", "Clinical research design", "Cohort studies", "epidemiology", "Drugs and devices", "Pharmacoepidemiology", "Endocrinology", "Endocrine physiology", "hormones", "Cardiovascular disease epidemiology", "oncology", "Cancer treatment", "Hormonal therapy", "myocardial", "infarction", "men", "65", "older", "pre-", "post-prescription", "intervals", "tt", "pde5", "ratios", "limits"], "article_id"=>917850, "categories"=>["Medicine"], "users"=>["William D. Finkle", "Sander Greenland", "Gregory K. Ridgeway", "John L. Adams", "Melissa A. Frasco", "Michael B. Cook", "Joseph F. Fraumeni Jr", "Robert N. Hoover"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0085805.t004", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Rates_of_myocardial_infarction_in_men_under_and_65_and_those_65_and_older_per_1_000_PY_in_pre_and_post_prescription_intervals_for_an_initial_prescription_for_TT_or_PDE5_inhibitors_with_adjusted_rate_ratios_RR_ratio_of_rate_ratios_RRR_and_95_confidence_li/917850", "title"=>"Rates of myocardial infarction in men under and 65 and those 65 and older per 1,000(PY) in pre- and post-prescription intervals for an initial prescription for TT or PDE5 inhibitors, with adjusted^* rate ratios (RR), ratio of rate ratios (RRR) and 95% confidence limits (CL) by history of heart disease.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-01-29 03:39:49"}
• {"files"=>["https://ndownloader.figshare.com/files/1366183"], "description"=>"<p>The TT prescription patients were unweighted and the PDE5I patients were weighted to match the TT prescription cohort based on odds of TT prescription.</p><p>These descriptive tabulations are restricted to exposures that occur in at least 2% or more of individuals. Please see the <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0085805#pone.0085805.s001\" target=\"_blank\">Tables S1</a> and <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0085805#pone.0085805.s002\" target=\"_blank\">S2</a> for a full list.</p>", "links"=>[], "tags"=>["cardiovascular", "Myocardial infarction", "Clinical research design", "Cohort studies", "epidemiology", "Drugs and devices", "Pharmacoepidemiology", "Endocrinology", "Endocrine physiology", "hormones", "Cardiovascular disease epidemiology", "oncology", "Cancer treatment", "Hormonal therapy", "baseline", "covariates", "medicare", "enrollees", "tt", "pde5i", "cohorts"], "article_id"=>917851, "categories"=>["Medicine"], "users"=>["William D. Finkle", "Sander Greenland", "Gregory K. Ridgeway", "John L. Adams", "Melissa A. Frasco", "Michael B. Cook", "Joseph F. Fraumeni Jr", "Robert N. Hoover"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0085805.t002", "stats"=>{"downloads"=>9, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Distribution_of_baseline_covariates_for_all_Medicare_and_commercial_insurance_enrollees_in_the_TT_prescription_and_PDE5I_cohorts_before_and_after_weighting_/917851", "title"=>"Distribution of baseline covariates for all Medicare and commercial insurance enrollees in the TT prescription and PDE5I cohorts before and after weighting.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-01-29 03:39:49"}
• {"files"=>["https://ndownloader.figshare.com/files/1366184"], "description"=>"*<p>Adjusted for age and pre-existing medical conditions and medication use associated with MI or its risk factors (<a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0085805#pone-0085805-t001\" target=\"_blank\">Table 1</a> and Supplemental Tables).</p>†<p>Effective sample sizes of PDE5I cohorts after weighting:</p><p>All Ages: 141,671.</p><p>Age <65: Years 121,696.</p><p>Age ≥65: Years 19,505.</p>", "links"=>[], "tags"=>["cardiovascular", "Myocardial infarction", "Clinical research design", "Cohort studies", "epidemiology", "Drugs and devices", "Pharmacoepidemiology", "Endocrinology", "Endocrine physiology", "hormones", "Cardiovascular disease epidemiology", "oncology", "Cancer treatment", "Hormonal therapy", "myocardial", "infarction", "persons", "men", "65", "years", "pre-", "post-prescription", "intervals", "pde5i", "ratios"], "article_id"=>917852, "categories"=>["Medicine"], "users"=>["William D. Finkle", "Sander Greenland", "Gregory K. Ridgeway", "John L. Adams", "Melissa A. Frasco", "Michael B. Cook", "Joseph F. Fraumeni Jr", "Robert N. Hoover"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0085805.t003", "stats"=>{"downloads"=>2, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Rates_of_myocardial_infarction_per_1_000_persons_per_year_PY_in_men_under_age_65_years_and_those_age_65_years_and_older_in_pre_and_post_prescription_intervals_for_an_initial_prescription_for_PDE5I_with_adjusted_rate_ratios_RR_and_95_confidence_intervals_/917852", "title"=>"Rates of myocardial infarction per 1,000 persons per year (PY) in men under age 65 years and those age 65 years and older, in pre- and post-prescription intervals for an initial prescription for PDE5I with adjusted^* rate ratios (RR), and 95% confidence intervals (CI).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-01-29 03:39:49"}
• {"files"=>["https://ndownloader.figshare.com/files/1366185"], "description"=>"_", "links"=>[], "tags"=>["cardiovascular", "Myocardial infarction", "Clinical research design", "Cohort studies", "epidemiology", "Drugs and devices", "Pharmacoepidemiology", "Endocrinology", "Endocrine physiology", "hormones", "Cardiovascular disease epidemiology", "oncology", "Cancer treatment", "Hormonal therapy", "myocardial", "infarction", "persons", "men", "65", "years", "pre-", "post-prescription", "intervals", "testosterone", "ratios"], "article_id"=>917853, "categories"=>["Medicine"], "users"=>["William D. Finkle", "Sander Greenland", "Gregory K. Ridgeway", "John L. Adams", "Melissa A. Frasco", "Michael B. Cook", "Joseph F. Fraumeni Jr", "Robert N. Hoover"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0085805.t001", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Rates_of_myocardial_infarction_per_1_000_persons_per_year_PY_in_men_under_age_65_years_and_those_age_65_years_and_older_in_pre_and_post_prescription_intervals_for_an_initial_prescription_for_testosterone_therapy_rate_ratios_RR_and_95_confidence_intervals/917853", "title"=>"Rates of myocardial infarction per 1,000 persons per year (PY) in men under age 65 years and those age 65 years and older, in pre- and post-prescription intervals for an initial prescription for testosterone therapy rate ratios (RR) and 95% confidence intervals (CI).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-01-29 03:39:49"}
• {"files"=>["https://ndownloader.figshare.com/files/1366186", "https://ndownloader.figshare.com/files/1366187"], "description"=>"<div><p>Background</p><p>An association between testosterone therapy (TT) and cardiovascular disease has been reported and TT use is increasing rapidly.</p><p>Methods</p><p>We conducted a cohort study of the risk of acute non-fatal myocardial infarction (MI) following an initial TT prescription (N = 55,593) in a large health-care database. We compared the incidence rate of MI in the 90 days following the initial prescription (post-prescription interval) with the rate in the one year prior to the initial prescription (pre-prescription interval) (post/pre). We also compared post/pre rates in a cohort of men prescribed phosphodiesterase type 5 inhibitors (PDE5I; sildenafil or tadalafil, N = 167,279), and compared TT prescription post/pre rates with the PDE5I post/pre rates, adjusting for potential confounders using doubly robust estimation.</p><p>Results</p><p>In all subjects, the post/pre-prescription rate ratio (RR) for TT prescription was 1.36 (1.03, 1.81). In men aged 65 years and older, the RR was 2.19 (1.27, 3.77) for TT prescription and 1.15 (0.83, 1.59) for PDE5I, and the ratio of the rate ratios (RRR) for TT prescription relative to PDE5I was 1.90 (1.04, 3.49). The RR for TT prescription increased with age from 0.95 (0.54, 1.67) for men under age 55 years to 3.43 (1.54, 7.56) for those aged ≥75 years (p_trend = 0.03), while no trend was seen for PDE5I (p_trend = 0.18). In men under age 65 years, excess risk was confined to those with a prior history of heart disease, with RRs of 2.90 (1.49, 5.62) for TT prescription and 1.40 (0.91, 2.14) for PDE5I, and a RRR of 2.07 (1.05, 4.11).</p><p>Discussion</p><p>In older men, and in younger men with pre-existing diagnosed heart disease, the risk of MI following initiation of TT prescription is substantially increased.</p></div>", "links"=>[], "tags"=>["cardiovascular", "Myocardial infarction", "Clinical research design", "Cohort studies", "epidemiology", "Drugs and devices", "Pharmacoepidemiology", "Endocrinology", "Endocrine physiology", "hormones", "Cardiovascular disease epidemiology", "oncology", "Cancer treatment", "Hormonal therapy", "non-fatal", "myocardial", "infarction", "testosterone"], "article_id"=>917854, "categories"=>["Medicine"], "users"=>["William D. Finkle", "Sander Greenland", "Gregory K. Ridgeway", "John L. Adams", "Melissa A. Frasco", "Michael B. Cook", "Joseph F. Fraumeni Jr", "Robert N. Hoover"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0085805.s001", "https://dx.doi.org/10.1371/journal.pone.0085805.s002"], "stats"=>{"downloads"=>18, "page_views"=>26, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Increased_Risk_of_Non_Fatal_Myocardial_Infarction_Following_Testosterone_Therapy_Prescription_in_Men_/917854", "title"=>"Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-01-29 03:39:49"}

PMC Usage Stats | Further Information

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Relative Metric

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F1000Prime