Yesterday’s TRAVERSE paper has instantly changed clinical practice and scientific concepts. Hugely impactful. Kudos to @DrMohitKhera and the other investigators. My thoughts- A 🧵: 1/n The study- >5000 enrolled in multi-year RCT of T gel vs placebo gel mandated originally by FDA to investigate CV risks. Results of CV study previously reported- no increased MACE with T therapy (TTh). Yesterday’s paper reported on prostate outcomes. 2/n

Long-awaited Traverse Trial shows no difference in MACE between testosterone and placebo groups in 5246 men treated for mean 22 months. Reassuring, not surprising.

Indeed, the surprise is that CVD was ever raised as a concern! A thread. For a couple of decades research showed low T levels were associated with greater CVD risks. Obesity and DM were also clearly assoc. with low T levels, and are themselves major risk factors for CVD. Several observational studies suggested T therapy might even REDUCE mortality.

Writing guidelines is hard, since evidence often lacking for key items. AUA recommendations re T thresholds is excellent example. No data exist re who responds to TTh based on total T levels. So recommended threshold of <300 is ARBITRARY, not evidence-based. 1/ While I congratulate AUA for establishing #testosterone guidelines, 1st rule should be to avoid making AUA members who practice good medicine WRONG. Experienced clinicians know there are MANY men with total T >300 who benefit from TTh, esp if have low free T. 2/