Effects of testosterone deficiency and therapy on the cardiometabolic syndrome in men

Testosterone (T) is a metabolic, sexual, and vascular hormone that has an important metabolic function in many tissues and organs and plays a key role in maintaining human physiology and health. A deficiency of T has detrimental effects on men's health and negatively impacts quality of life. T regulates differentiation, growth and function of muscle tissue and inhibits differentiation into adipocytes and fat accumulation; therefore, it regulates body composition. Thus, T deficiency (TD) may contribute to development of adiposity and metabolic syndrome (MetS). It should be noted that over the past 80 years, only 4 randomized clinical trials with a duration of three years or longer were reported. Hence, understanding the effects of long-term T therapy (TTh) on amelioration of MetS and its components would be attained mostly from observational and registry studies.

A comprehensive review of the current literature utilizing the NCBI library and PubMed were utilized using the key words "metabolic syndrome; testosterone deficiency; testosterone therapy". Relevant articles were retrieved and a summary of the potential relationship between TD and TTh and MetS were synthesized.

The contemporary findings in the medical literature strongly suggest that TD is a predictor of onset of MetS and TTh ameliorates MetS components. Long-term data from several registry studies on the impact of TTh on MetS in men with TD demonstrated unequivocally that long-term TTh (up to 11 years) resulted in reductions in waist circumference (WC), fasting blood glucose, triglycerides (TGs), systolic and diastolic blood pressure and increased high-density lipoprotein cholesterol (HDL). In summary, long-term TTh in men with TD: 1) produces substantial and sustained weight loss; 2) prevents the progression from prediabetes to type 2 diabetes; 3) may result in remission of type 2 diabetes; 4) reduces fasting blood glucose; and 5) reduces cardiovascular events and mortality.

In this narrative review, we summarize the available contemporary literature on the potential relationship between TD and development of MetS and discuss the findings of long-term TTh on amelioration of MetS components in men.