Male hypogonadism: The unrecognized cardiovascular risk factor

Normal levels of male sex hormones are essential to men's health. Many studies demonstrate that hypogonadal men are at higher risk for developing a host of metabolic derangements, including dyslipidemia, type 2 diabetes mellitus, obesity, and hypertension. We examined the most recent studies supporting this notion of hypogonadism as a cardiac risk factor by reviewing all relevant PubMed data. Most studies showed an increase in metabolic disorders and cardiac events in hypogonadal men compared to their eugonadal counterparts. Mechanisms explaining this increased risk include adverse cytokine profiles produced by excess adipose tissue, abnormal lipid metabolism by understimulated hormone-sensitive lipase, and abnormal cellular respiration leading to insulin resistance. In contrast, some studies have not demonstrated such an increased cardiac risk. Conflicting data between studies is expected, given the complexity of testosterone and its metabolic effects. Additionally, the interaction of testosterone with the androgen receptor differs based on an individual genome. Hypogonadism will affect individual men differently because of this genomic variance. The literature points toward true hypogonadism as a major cardiac risk factor. Men at risk of being hypogonadal should be screened and brought back to eugonadism with hormone replacement.