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Testosterone replacement therapy carries increased risk of urolithiasis

10 Jul 2019

Men undergoing testosterone replacement therapy (TRT) are at increased risk of developing stones, a recent study suggests.

The population-based matched cohort study sourced data from a large military database that includes beneficiaries of the TRICARE programme. Analysis included 26,586 men who received continuous TRT for hypogonadism and 26,586 matched controls who did not receive therapy. The mean age of the cohort was 52.03 years, and none of the participants had prior history of urolithiasis.

A total of 1,853 stone events occurred during a median follow-up of 36 months: 1,059 in the TRT group vs 794 in the control group. The 2-year absolute risk of a stone-related event, the primary study outcome, was significantly higher in TRT-treated patients (659 vs 482; p<0.0001).

The increased urolithiasis risk associated with TRT was consistent in topical therapy type (p<0.0001) and injection therapy type (p=0.004) subgroups, although not in the pellet therapy type subgroup (p=0.27).

On further analysis, stone episodes did not significantly differ based on secondary polycythaemia diagnosis, which was used as an indirect indicator of higher on-treatment testosterone levels (5.27 percent in the polycythaemia group vs 3.97 percent in the no-polycythaemia group; p=0.14).

The findings should be considered alongside other known risks and benefits as clinicians select appropriate patients for TRT treatment, given that the current study is the first to specifically examine the relationship between TRT and stone events, according to the researchers.

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