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The relationship of circulating testosterone levels with health outcomes in people with chronic obstructive pulmonary disease (COPD) is unknown., Aim: To determine whether serum testosterone levels predict hospitalised acute exacerbations of COPD (H-AECOPD), cardiovascular disease outcome, and mortality in people with COPD., Methods: Separate analyses were carried out on two observational, multicentre COPD cohorts, Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) and Evaluation of the Role of Inflammation in Chronic Airways Disease (ERICA), both of which had serum testosterone measured using a validated liquid chromatography assay at the same laboratory. Data from 1296 male participants in ECLIPSE and 386 male, 239 female participants in ERICA were analysed. All analyses were sex-specific. Multivariate logistic regression was used to determine associations with H-AECOPD during follow-up (3 years ECLIPSE, 4.5 years ERICA), a composite endpoint of cardiovascular hospitalisation and cardiovascular death, and all-cause mortality., Results: Mean (SD) testosterone levels were consistent across cohorts; 459 (197) and 455 (200) ng/dL for males in ECLIPSE and ERICA, respectively, and in ERICA females: 28 (56) ng/dL. Testosterone was not associated with H-AECOPD (ECLIPSE: OR: 0.76, p=0.329, ERICA males: OR (95% CI): 1.06 (0.73 to 1.56), p=0.779, ERICA females: OR: 0.77 (0.52 to 1.12), p=0.178) or cardiovascular hospitalisation and death. Testosterone was associated with all-cause mortality in Global Initiative for Obstructive Lung Disease (GOLD) stage 2 male patients only, in ECLIPSE (OR: 0.25, p=0.007) and ERICA (OR: (95% CI): 0.56 (0.32 to 0.95), p=0.030)., Conclusions: Testosterone levels do not relate to H-AECOPD or cardiovascular outcome in COPD, but are associated with all-cause mortality in GOLD stage 2 COPD male patients, although the clinical significance of this finding is uncertain., Competing Interests: Competing interests: DM is a current shareholder and employee of Genentech/Roche and was an employee of GSK at the time of study planning. IW held research grants with GSK and TSB. RT-S is a GSK retiree and current shareholder. She reports personal fees from COPD Foundation, Immunomet, VOCALIS Health, Teva and ENA Respiratory. She holds share options in ENA Respiratory. JC has received support from GSK, Evelo Biosciences, Astrazeneca, Alexion and Eli Lilly. JC is a full time employee of Cambridge University Hospitals NHS Foundation Trust, but was seconded by the Trust for 50% of his NHS salaried time to work on GSK clinical trials until October 2020. He received no employee benefits or shares/dividends or income from GSK. BEM is a former employee and current shareholder of GSK., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)