Does Testosterone Therapy Increase Risk of Atrial Fibrillation? Appraisal of the Contemporary Scientific and Clinical Evidence.

Here we review the evidence whether "testosterone" (T) therapy in hypogonadal men contributes to onset and increases the incidence of atrial fibrillation (AF). A MEDLINE review of the literature was performed, and relevant studies were analyzed and discussed. The effect of T therapy (TTh) on the incidence of AF is a controversial clinical issue that remains hotly debated. Few studies have purported that TTh increases the incidence of AF. However, a closer look at these studied suggest that several confounding factors may have contributed to the authors' conclusion that T increases the incidence of AF. On the contrary, a much larger number of studies have demonstrated that T deficiency contributes to incidence of AF and TTh does not increase the incidence of AF. Because this clinical issue is of critical importance in management of men with hypogonadism, it is critical that more clinical studies with AF as the primary outcome measure need to be considered. However, to date, none of the clinical trials have focused on AF as the primary outcome and in most of the reported studies AF was a secondary or tertiary outcome measure. Thus, lack of accurate clinical data on this issue will remain in the helm of debate, until new clinical trial data becomes available. We conclude that the findings of numerous studies suggest that low circulating levels (T deficiency) are associated with greater incidence of AF and higher endogenous T levels or TTh in hypogonadal men are associated with lower incidence of AF.