Dear Editor,

We are very grateful for the positive comments from Dr Basaria about our meta-analysis of randomized controlled trials (RCTs) showing that testosterone therapy among men increases the risk of a cardiovascular -related event (1;2). As per the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) guidelines (item 25) (3), we also highlighted the limitations of our review. We are surprised that a comment on compliance with the PRISMA guidelines is followed by the sentence "Therefore, firm conclusions regarding the association between testosterone therapy and CVD cannot be drawn from this study" (1). This line of reasoning would preclude firm conclusions being drawn from all well-conducted meta-analyses of RCTs, which inevitably each have limitations as well as strengths. In a recent update of the Competing Interests statement associated with his commentary, Dr Basaria, and the editor, have clarified a number of potential conflicts of interest including connections with pharmaceutical companies selling or developing testosterone therapy, which may affect readers' interpretation of the commentary. A separate report describes the way pharmaceutical companies have subtly promoted testosterone therapy (4) despite growing evidence of its harmful effects.

References

(1) Basaria S. Need for standardising adverse event reporting in testosterone trials. Evid Based Med 2013.

(2) Xu L, Freeman G, Cowling BJ, et al. Testosterone and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med 2013;11(1):108.

(3) Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6(7):e1000097.

(4) Braun SR. Promoting "Low T": A Medical Writer's Perspective. JAMA Intern Med 2013;173(15):1458-1460.

Conflict of Interest:

None declared