Testosterone and the heart

Area of Science:

• Endocrinology
• Cardiology
• Metabolic Health

Background:

• Large studies indicate increased cardiovascular mortality in men with low testosterone, especially those with cardiovascular disease and type 2 diabetes.
• Variations in findings may stem from cohort differences in age, obesity, and metabolic syndrome.
• Low testosterone is prevalent in at-risk patient groups but often underdiagnosed and undertreated.

Purpose of the Study:

• To review the association between testosterone levels and cardiovascular outcomes.
• To evaluate the benefits of testosterone replacement therapy (TRT) on cardiovascular risk factors and patient well-being.
• To highlight the underutilization of TRT in at-risk populations.

Main Methods:

• Review of large-scale observational studies and smaller intervention trials.
• Analysis of testosterone levels (total, free, bioavailable) and their correlation with cardiovascular events.
• Assessment of TRT effects on metabolic parameters, body composition, sexual function, and mood.

Main Results:

• Low testosterone is associated with increased cardiovascular mortality, particularly in men with comorbid conditions.
• TRT demonstrates consistent benefits, including reduced insulin resistance, improved lipid profiles (lower LDL-cholesterol, triglycerides), decreased HbA1c, and reduced inflammatory markers.
• TRT leads to significant reductions in visceral and lean fat mass, alongside improvements in sexual function, mood, and quality of life scores.

Conclusions:

• Physiological testosterone replacement shows potential cardiovascular benefits and is associated with reduced cardiovascular mortality in early non-randomized studies.
• The combined effect of TRT on surrogate cardiovascular risk markers is considerable, with significant improvements in patient well-being.
• Underdiagnosis and undertreatment of testosterone deficiency persist due to interdisciplinary challenges and reluctance to manage the condition.