Cardiovascular aspects of androgens in women

A review of the literature of androgen actions affecting the circulatory system indicates early enthusiasm for use of testosterone in cardiac patients, subsequent disenchantment with androgens due to negative effects on lipid metabolism, and recent renewed interest as new technologies and understandings of the cardio-protective effects of estrogens has led to re-examination of the beneficial and adverse effects of androgens. Ovarian steroids, including androgens, have effects on lipid metabolism in the liver and direct effects in the arterial wall, which influence the development and progress of atherosclerosis. Androgens lower total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides but also decrease high-density lipoprotein (HDL) cholesterol levels. Androgen arterial-wall effects help maintain the mechanisms involved in vasodilation. Androgens alone appear to promote atherosclerosis but when administered with estrogens have the opposite effect in the arterial wall. Recognition of the cellular actions of androgens and the decrease in androgen production as women age after the menopause has led to increased use of androgen replacement therapy for postmenopausal women. Preliminary clinical findings in women using postmenopausal estrogen/androgen treatment indicate a good safety profile. However, in comparison to the many years and experience in evaluating the effects of estrogens, studies of androgen effects must be considered to be at a preliminary stage.