Testosterone for the Management of Traumatic Hemorrhage: A Systematic Review.

BACKGROUND

Testosterone may assist in traumatic hemostasis given its well-established role in erythropoiesis, platelet activation, and vasoconstriction; however, whether exogenous testosterone improves acute outcomes in traumatic hemorrhage is unknown.

METHODS

Following PRISMA 2020, we registered the protocol in PROSPERO (CRD42024617294; 12 October 2024). MEDLINE, EMBASE (both via Ovid), and PubMed were searched from inception to November 2024 for studies that investigated the acute effects of testosterone administration in adults with hemorrhage. Two reviewers independently screened citations and full texts using prespecified eligibility criteria. Independent and duplicate data extraction by two reviewers, and GRADE certainty assessments were prespecified.

RESULTS

Of the 215 records identified, 197 were excluded at title/abstract and 18 underwent full-text review. No study met the inclusion criteria. Consequently, no planned data extraction and GRADE assessments were performed.

CONCLUSIONS

No eligible human studies evaluate exogenous testosterone as an acute intervention in traumatic hemorrhage. The literature gap persists despite a clear clinical rationale and predefined outcome set. High-quality translational and clinical studies using rigorous dosing/timing definitions and standard coagulation and patient-centred endpoints are needed to determine whether testosterone confers benefit or harm in this setting.