No abstract

Previous studies have demonstrated that intravenous testosterone can dilate coronary arteries and increase exercise treadmill time, but the electrocardiographic and hemodynamic effects are unknown. This trial determined the hemodynamic and electrocardiographic effects of dosing intravenous testosterone to achieve a physiologic and a superphysiologic serum testosterone concentration. Twenty men (70.6 +/- 6.2 years) had individualized testosterone bolus and continuous infusions designed to increase the serum testosterone concentration by two (physiologic) and six times baseline (superphysiologic). The men were studied on three occasions when they were randomly allocated to received a placebo, physiologic testosterone regimen, or superphysiologic testosterone regimen. Blood pressures and 12-lead electrocardiograms (ECGs) were taken preinfusion and 28 minutes after initiating the infusion on each visit. The blood pressure (systolic and diastolic) and ECG variables (PR, QRS, QT, QTc, and RR intervals) preinfusion and during the infusion were compared, and the delta changes in the variables were compared between groups. The physiologic testosterone regimen increased the serum testosterone concentration by 2.39 +/- 0.48 times the preinfusion concentration, while the superphysiologic regimen increased it by 6.22 +/- 0.99 times. No significant changes occurred in the blood pressure or ECG variables in any group versus preinfusion values or between the three groups. Exogenously administered intravenous testosterone does not significantly affect the blood pressure or ECG variables when given to achieve physiologic or superphysiologic concentrations.

Cardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the US. 1 State-based antiabortion legislation is associated with maternal mortality, particularly among those with CVD. 2,3 Conditions such as aortopathies, cardiomyopathies, valvular heart disease, and complex congenital heart disease place patients at high risk for complications during pregnancy. 4,5 Shared decision-making regarding pregnancy termination occurs when high maternal risk exists or when pregnancy interferes with medical or surgical treatment. 4 State antiabortion laws limit abortion access, 2,6 impede shared decision-making with patients, and increase racial and socioeconomic disparities in maternal mortality. 2 The pending decision of the Supreme Court of the US (SCOTUS) in Dobbs v Jackson Women's Health Organization could eliminate abortion rights for patients, including those with CVD, further perpetuating unequal pregnancy outcomes.For patients with CVD, abortion access is a critical part of their comprehensive cardiovascular and reproductive care. 4 Pregnancy can exacerbate preexisting cardiovascular conditions, eg, cardiomyopathies and arrythmias, and lead to acquired conditions, including peripartum cardiomyopathy or spontaneous coronary artery dissection. 4 Modified World Health Organization (WHO) class III to IV conditions confer a more immediate cardiovascular morbidity during pregnancy, 4,5 and pregnancy should be discouraged in class IV conditions. 2,5 Sequelae from cardiovascular decompensation during pregnancy can affect patients' functional status, ability to raise children, and future cardiovascular health. 1,4 Barriers to abortion access increase the likelihood of pregnancy continuation, 7 which may be contraindicated in WHO class III to IV conditions. 4,5 Over 500 state antiabortion laws already decrease and delay abortions, increase logistical burdens on patients, and create inequitable access. 6 Restrictive abortion policies are associated with maternal mortality during pregnancy and the postpartum period. 2,3 Midwestern and Southern states with more antiabortion laws have higher rates of total maternal mortality. 2 These regions have concomitantly high CVD burden 7 and the lowest prevalence of favorable prepregnancy cardiometabolic health. 8 Maternal death in restrictive abortion settings is attributable to patients with chronic diseases, such as adult congenital heart diseases and CVD, being unable to access an abortion. 2,8 The COVID-19 pandemic exacerbated existing barriers, including cost, scheduling difficulties, securing childcare, travel distances, and lack of transportation. 4,7 Black and Indigenous patients, individuals in rural areas, and those of lower socioeconomic status (SES) 2

Estradiol USP was extemporaneously compounded for intravenous administration. Eight postmenopausal women were randomized to receive one of four estradiol dosages. Serum estradiol concentrations were determined at frequent intervals after single bolus dosing. The concentration‐time profile was stripped and fit, and pharmacokinetic values were generated. Approximate dosage proportionality was seen with area under the curve, the terminal half‐life was 27.45 ± 5.65 minutes, and volume of distribution was very low (0.082 ± 0.015 L/kg). Estradiol was well tolerated by all study participants.