In Reply: We appreciate the point of view expressed by Dr Schooling and agree that given widespread use of testosterone products, a thorough investigation of its cardiovascular safety is crucial. Understanding whether testosterone treatment (in any form) contributes to an increased risk of cardiovascular events, stroke, and/or death is of great interest to multiple stakeholders, including patients, physicians, and regulators. Dr Schooling is correct to point out that our recently published study did not attempt to answer those questions. Assessing the safety of testosterone relative to nonuse is methodologically challenging in a nonexperimental study but is a line of research that is being actively pursued by our group and others.
