Testosterone and cardiovascular disease risk
1School of Medicine and Pharmacology, University of Western Australia and Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Perth, Western Australia, Australia.
Insights
Low testosterone in aging men may be linked to cardiovascular health. While observational studies suggest benefits, more research is needed to confirm testosterone therapy
Area of Science:
- Endocrinology
- Geriatrics
- Cardiovascular Medicine
Background:
- Aging is associated with declining testosterone levels and increased comorbidities.
- The relationship between low testosterone and ill-health is debated: cause or biomarker?
- Testosterone prescriptions are increasing amidst concerns about adverse effects.
Purpose of the Study:
- To review the evidence linking androgens to cardiovascular risk in older men.
- To examine the role of testosterone in the health of aging males.
Main Methods:
- Review of observational studies.
- Analysis of randomized controlled trials (RCTs) of testosterone supplementation.
- Examination of meta-analyses and retrospective prescription database studies.
Main Results:
- Observational studies indicate a lower cardiovascular event risk with higher testosterone.
- Higher dihydrotestosterone concentrations correlate with lower ischemic heart disease mortality.
- RCTs are underpowered for cardiovascular outcomes; meta-analyses show conflicting results on adverse events.
- Retrospective studies yield controversial findings on testosterone therapy and cardiovascular risk.
Conclusions:
- Further RCTs are necessary to clarify testosterone supplementation's role in non-diseased older men.
- Testosterone therapy may be considered for androgen-deficient men, balancing potential benefits and risks pending further evidence.
Purpose Of Review:
Ageing is accompanied by a reduction in circulating testosterone and progressive accumulation of medical morbidities. There is an intense debate whether low testosterone contributes to ill-health as opposed to being a biomarker for its presence. Prescriptions for testosterone are rising on a background of concern over potential adverse effects. This review examines evidence relating androgens to cardiovascular risk in older men.
Recent Findings:
Observational studies show lower risk of cardiovascular events in older men with higher testosterone, and lower mortality from ischaemic heart disease in men with higher concentrations of its more potent androgenic metabolite dihydrotestosterone. However, randomized controlled trials of testosterone supplementation have been underpowered for the outcome of cardiovascular events. Recent meta-analyses have reached contrasting conclusions regarding cardiovascular adverse events associated with testosterone therapy. Retrospective studies of prescription databases have produced controversial and conflicting results.
Summary:
Additional randomized controlled trials are required to clarify the role of testosterone supplementation in older men in the absence of pituitary or gonadal disease. Pending such studies, testosterone therapy should be considered in androgen-deficient men, with evaluation of potential benefits and risks.
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