Testosterone and cardiovascular risk in men
1Department of Human Metabolism, Medical School, The University of Sheffield, Sheffield, UK.
Insights
Testosterone deficiency is common in men with cardiovascular disease (CVD) and linked to higher mortality. Optimizing testosterone levels may improve cardiovascular health, but careful monitoring is crucial to avoid risks.
Area of Science:
- Endocrinology
- Cardiology
- Men's Health
Background:
- Testosterone deficiency is prevalent in men with cardiovascular disease (CVD), correlating with increased mortality.
- Low testosterone negatively impacts cardiovascular risk factors like insulin resistance, diabetes, dyslipidemia, central obesity, and endothelial dysfunction.
- The role of testosterone deficiency in atherogenesis versus being a biomarker of poor health is debated.
Purpose of the Study:
- To investigate the relationship between testosterone levels and cardiovascular disease (CVD) outcomes.
- To evaluate the impact of testosterone replacement therapy (TRT) on cardiovascular risk factors and mortality in hypogonadal men.
- To determine the optimal testosterone level for cardiovascular health and the risks associated with undertreatment or overtreatment.
Main Methods:
- Review of animal studies, cell experiments, and epidemiological data on testosterone and cardiovascular health.
- Analysis of studies on testosterone replacement in hypogonadal men, examining effects on risk factors, exercise capacity, and mortality.
- Comparison of cardiovascular events and mortality across different endogenous testosterone level ranges.
Main Results:
- Animal and cell studies suggest testosterone beneficially modulates atherosclerotic mechanisms.
- Epidemiological data indicate reduced cardiovascular events and mortality in men with mid-to-upper normal testosterone levels.
- TRT achieving mid-normal levels shows benefits for cardiovascular risk factors, ischemia, exercise capacity, and mortality; however, undertreatment or high-dose TRT is linked to increased cardiovascular events.
Conclusions:
- Testosterone plays a role in cardiovascular health, with mid-normal levels associated with better outcomes.
- Testosterone replacement therapy can be beneficial for hypogonadal men, improving cardiovascular risk factors and mortality.
- Precise clinical monitoring and dose titration of testosterone are essential to maximize benefits and minimize cardiovascular risks.
Abstract:
Testosterone deficiency is highly prevalent in men with cardiovascular disease (CVD) and is associated with an increased mortality. Low testosterone also has an adverse effect on several cardiovascular risk factors, which include insulin resistance, diabetes, dyslipidaemia, central adiposity and endothelial dysfunction. Male gender is a well-recognised risk factor for premature CVD and mortality. The question of whether or not testosterone deficiency is a contributory factor to atherogenesis or merely a biomarker of ill health arises. Animal studies and experiments on isolated cells indicate that many of the mechanisms intimate to the atherosclerotic process are beneficially modulated by testosterone. Epidemiological studies have shown that men with endogenous testosterone levels in the mid-upper normal range have reduced cardiovascular events and mortality compared to those with low or lower range, and with high range testosterone. Testosterone replacement in men diagnosed with hypogonadism where mid-normal range levels are achieved have shown a beneficial effect on several cardiovascular risk factors, cardiac ischaemia, functional exercise capacity and improved mortality. Yet studies where patients were either undertreated or given high-dose testosterone have been associated with an increased risk of cardiovascular-related events. Clinical monitoring and titration of testosterone dose is therefore of paramount importance.
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