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Testosterone and the Heart
Travis Goodale1, Archana Sadhu1, Steven Petak1
1Houston Methodist Hospital, Houston, Texas.
Insights
Testosterone decline in aging men is linked to increased cardiovascular risk. However, testosterone replacement therapy (TRT) shows potential cardiovascular benefits and does not appear to increase risk.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Gerontology
Background:
- Testosterone (T) plays a crucial role in cardiovascular health.
- Declining T levels after age 40 in men correlate with increased mortality and cardiovascular (CV) risk.
- Low T is associated with coronary artery disease (CAD), metabolic syndrome, type 2 diabetes, and poorer prognosis in congestive heart failure (CHF).
Purpose of the Study:
- To review the effects of testosterone and testosterone replacement therapy (TRT) on cardiovascular health in men.
- To evaluate the association between testosterone levels, TRT, and cardiovascular risk factors and outcomes.
Main Methods:
- Review of existing studies on testosterone levels and cardiovascular health.
- Analysis of data on the impact of testosterone replacement therapy (TRT) on cardiovascular risk factors and outcomes.
- Examination of evidence regarding TRT's effect on myocardial ischemia, exercise capacity, and metabolic parameters.
Main Results:
- Higher endogenous testosterone concentrations are linked to reduced CV risk.
- TRT has demonstrated improvements in myocardial ischemia in CAD patients, exercise capacity in CHF patients, and glycemic control in diabetic men.
- No credible evidence suggests TRT increases CV risk; substantial data indicates it may offer benefits.
Conclusions:
- While large-scale, long-term placebo-controlled trials are lacking, current evidence suggests testosterone replacement therapy (TRT) does not increase cardiovascular risk in men.
- Existing data supports the potential for TRT to provide cardiovascular benefits.
- TRT may improve outcomes for men with conditions like CAD, CHF, and diabetes.
Abstract:
Testosterone (T) has a number of important effects on the cardiovascular system. In men, T levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk. Low T levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes. Reduced T levels in men with congestive heart failure (CHF) portends a poor prognosis and is associated with increased mortality. Studies have reported a reduced CV risk with higher endogenous T concentration, improvement of known CV risk factors with T therapy, and reduced mortality in T-deficient men who underwent T replacement therapy versus untreated men. Testosterone replacement therapy (TRT) has been shown to improve myocardial ischemia in men with CAD, improve exercise capacity in patients with CHF, and improve serum glucose levels, HbA1c, and insulin resistance in men with diabetes and prediabetes. There are no large long-term, placebo-controlled, randomized clinical trials to provide definitive conclusions about TRT and CV risk. However, there currently is no credible evidence that T therapy increases CV risk and substantial evidence that it does not. In fact, existing data suggests that T therapy may offer CV benefits to men.
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