The Intersection of Androgens and Cardiovascular Disease in Postmenopausal Women

To summarize the current understanding of the relationships between endogenous and exogenous androgens and cardiovascular disease in postmenopausal women.

Endogenous testosterone and dehydroepiandrosterone exhibit a J-shaped relationship with cardiovascular mortality. The association of exogenous testosterone with adverse cardiovascular outcomes is highly dependent on dose and route of administration. Non-oral testosterone administration is associated with neutral risks, but close monitoring of total testosterone levels is obligatory. Estrogen, progesterone, and androgens levels shift during menopause transition, and the ratios between levels have a greater impact on cardiometabolic and cardiovascular outcomes than absolute levels. While exogenous testosterone modestly improves hypoactive sexual desire, it is unknown if restoring testosterone levels to premenopausal physiologic conditions can also mitigate other age-related physical changes. Future studies addressing the timing, dose, route of administration, treatment duration, and combination therapy with estrogen in postmenopausal women of all racial and ethnicities are needed.