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Adult Male Hypogonadism: A Review.

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Endogenous Testosterone, Testosterone Treatment, and Cardiovascular Health Outcomes in Men.

Bu B Yeap1,2, Bradley D Anawalt3

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Lower testosterone levels in aging men may link to higher mortality risk, but not necessarily cardiovascular disease. Testosterone therapy showed no increased cardiovascular risk in trials, with potential benefits needing further study.

Keywords:
cardiovascular diseasemalemortalitymyocardial infarctionobesitysex hormone–binding globulinstroketestosterone

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Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Gerontology

Background:

  • The link between low testosterone and adverse health outcomes in aging men, particularly cardiovascular disease (CVD), is debated.
  • Observational studies suggest associations, but confounding factors like age and comorbidities are significant.

Purpose of the Study:

  • To review the relationship between testosterone concentrations and cardiovascular health in aging men.
  • To evaluate the cardiovascular safety and potential benefits of testosterone therapy.

Main Methods:

  • Narrative review of observational and interventional studies.
  • Analysis of large prospective cohort studies (UK Biobank).
  • Meta-analysis of individual participant data from cohort studies.
  • Review of randomized controlled trials (T4DM, TRAVERSE).

Main Results:

  • Lower endogenous testosterone is associated with CVD but influenced more by age, BMI, and comorbidities.
  • UK Biobank data showed lower testosterone linked to higher all-cause mortality, not incident CVD events.
  • Meta-analysis revealed non-linear associations between testosterone levels and mortality risk below specific thresholds.
  • T4DM trial: Testosterone therapy reduced type 2 diabetes risk in men with dysglycemia.
  • TRAVERSE trial: Testosterone treatment did not increase major adverse cardiovascular events in high-risk men.

Conclusions:

  • While low testosterone may correlate with mortality, its direct causal role in CVD requires further investigation.
  • Testosterone therapy appears safe regarding major cardiovascular events in the short-to-medium term.
  • Further research is needed to confirm long-term cardiovascular safety and explore potential benefits on body composition and cardiometabolic risk.