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Background  Atrial fibrillation ( AF ) is the most common cardiac dysrhythmia associated with significant morbidity and mortality. Several small studies have reported that low serum total testosterone ( TT ) levels were associated with a higher incidence of  AF . In contrast, it is also reported that anabolic steroid use is associated with an increase in the risk of  AF . To date, no study has explored the effect of testosterone normalization on new incidence of  AF  after testosterone replacement therapy ( TRT ) in patients with low testosterone.    Methods and Results  Using data from the Veterans Administrations Corporate Data Warehouse, we identified a national cohort of 76 639 veterans with low  TT  levels and divided them into 3 groups. Group 1 had  TRT  resulting in normalization of  TT  levels (normalized  TRT ), group 2 had  TRT  without normalization of  TT  levels (nonnormalized  TRT ), and group 3 did not receive  TRT  (no  TRT ). Propensity score–weighted stabilized inverse probability of treatment weighting Cox proportional hazard methods were used for analysis of the data from these groups to determine the association between post‐ TRT  levels of  TT  and the incidence of  AF . Group 1 (40 856 patients, median age 66 years) had significantly lower risk of  AF  than group 2 (23 939 patients, median age 65 years; hazard ratio 0.90, 95%  CI  0.81–0.99,  P =0.0255) and group 3 (11 853 patients, median age 67 years; hazard ratio 0.79, 95%  CI  0.70–0.89,  P =0.0001). There was no statistical difference between groups 2 and 3 (hazard ratio 0.89, 95%  CI  0.78– 1.0009,  P =0.0675) in incidence of  AF .    Conclusions  These novel results suggest that normalization of  TT  levels after  TRT  is associated with a significant decrease in the incidence of  AF .

Normalization of Testosterone Levels After Testosterone Replacement Therapy Is Associated With Decreased Incidence of Atrial Fibrillation