Discontinuation of Testosterone Replacement Therapy in Aortic Dissection Management

Primary Medical Management of Aortic Dissection

Target a systolic blood pressure < 120 mm Hg (or the lowest pressure that maintains end‑organ perfusion) and a heart rate of 60–80 bpm to minimize aortic wall stress. 1, 2
Beta‑blockers are recommended as first‑line agents for all patients with acute aortic syndrome unless contraindicated, because they lower both heart rate and blood pressure. 1, 2, 3
Additional antihypertensive drugs—particularly angiotensin‑receptor blockers or ACE inhibitors—should be added when beta‑blockade alone does not achieve the blood‑pressure target. 3

Testosterone replacement can affect blood‑pressure regulation, with studies showing variable (both hypertensive and normotensive) effects on cardiovascular parameters. 4
The therapy exerts mixed pro‑thrombotic and anti‑thrombotic influences; any potential increase in thrombotic risk is undesirable in the setting of an aortic dissection. 4
Long‑term cardiovascular safety of testosterone replacement has not been definitively established in large prospective trials, limiting confidence in its use for patients at high vascular risk. 4

Lifelong beta‑blocker therapy is associated with a reduction in late aortic‑related adverse events. 3
Regular imaging surveillance (computed tomography, magnetic resonance angiography, or ultrasound) every 6–12 months is recommended to detect aneurysm formation or progression. 5

Discontinue testosterone replacement therapy in patients with an aortic dissection. 4
Optimize beta‑blocker dosing to achieve the target heart rate of 60–80 bpm. 1, 2
Verify that systolic blood pressure is maintained below 120 mm Hg. 1, 2
Continue statin therapy and low‑dose aspirin as part of the cardiovascular risk‑reduction regimen. 6

Perform imaging at 1 month, 6 months, and 12 months after diagnosis, then annually if the disease remains stable. 5