madman
Super Moderator
Abstract
This review assesses the evidence of the physiological effects of testosterone on cardiovascular health, the association between male hypogonadism and cardiovascular health, and the effects of testosterone therapy on cardiovascular health in male hypogonadism. Preclinical studies suggest complex effects of testosterone on cardiovascular risk by acting on skeletal muscle, cardiomyocytes, vasculature, adipocytes, insulin action, and erythropoiesis. Furthermore, low testosterone has a bi-directional association with cardiometabolic risk. Observational studies have reported worse metabolic profiles in men with organic hypogonadism. However, a consistent association between major cardiovascular events and male hypogonadism has not been established. Hematocrit increases with testosterone therapy; however, most studies do not report an increase in venous thromboembolism risk. Although some observational studies anda small randomized controlled study reported an increased risk of cardiovascular disease, recent data confirm the medium-term cardiovascular safety of testosterone therapy in middle-aged and older men with low testosterone.
PHYSIOLOGICAL EFFECTS OF TESTOSTERONE ON THE CARDIOVASCULAR SYSTEM AND CARDIOVASCULAR RISK FACTORS
ASSOCIATIONS OF MALE HYPOGONADISM WITH CARDIOVASCULAR DISEASE AND RISK FACTORS
-Cardiovascular risk factors
-Cardiovascular disease and mortality
EFFECTS OF TESTOSTERONE THERAPY ON CARDIOVASCULAR DISEASE AND CARDIOVASCULAR RISK FACTORS
-Cardiovascular risk factors
-Cardiovascular disease and mortality
CONCLUSIONS
Testosterone has multiple physiological effects on the cardiovascular system. Although male hypogonadism seems to be associated with an adverse metabolic profile, there is no consistent evidence for increased cardiovascular risk in men with low testosterone. Similarly, testosterone therapy has not consistently improved cardiovascular risk factors or outcomes in men with hypogonadism. On the other hand, recent data suggest medium-term cardiovascular safety of testosterone therapy in middle-aged and older men with low testosterone; long-term cardiovascular safety is yet to be established.
In men with hypogonadism, baseline assessments for pre-existing cardiovascular disease and risk factors (e.g., obesity, diabetes, dyslipidemia, hypertension, and smoking) and optimization of these risk factors are vital and independent of testosterone therapy to improve overall cardiovascular outcomes. In middle-aged and older men with low testosterone, lifestyle modifications (weight loss, exercise, and smoking cessation) and optimization of risk factors would take precedence over testosterone therapy for improved cardiovascular outcomes. Apart from hematocrit, any additional monitoring for cardiovascular risk reduction would not be routinely required during testosterone therapy.
This review assesses the evidence of the physiological effects of testosterone on cardiovascular health, the association between male hypogonadism and cardiovascular health, and the effects of testosterone therapy on cardiovascular health in male hypogonadism. Preclinical studies suggest complex effects of testosterone on cardiovascular risk by acting on skeletal muscle, cardiomyocytes, vasculature, adipocytes, insulin action, and erythropoiesis. Furthermore, low testosterone has a bi-directional association with cardiometabolic risk. Observational studies have reported worse metabolic profiles in men with organic hypogonadism. However, a consistent association between major cardiovascular events and male hypogonadism has not been established. Hematocrit increases with testosterone therapy; however, most studies do not report an increase in venous thromboembolism risk. Although some observational studies anda small randomized controlled study reported an increased risk of cardiovascular disease, recent data confirm the medium-term cardiovascular safety of testosterone therapy in middle-aged and older men with low testosterone.
PHYSIOLOGICAL EFFECTS OF TESTOSTERONE ON THE CARDIOVASCULAR SYSTEM AND CARDIOVASCULAR RISK FACTORS
ASSOCIATIONS OF MALE HYPOGONADISM WITH CARDIOVASCULAR DISEASE AND RISK FACTORS
-Cardiovascular risk factors
-Cardiovascular disease and mortality
EFFECTS OF TESTOSTERONE THERAPY ON CARDIOVASCULAR DISEASE AND CARDIOVASCULAR RISK FACTORS
-Cardiovascular risk factors
-Cardiovascular disease and mortality
CONCLUSIONS
Testosterone has multiple physiological effects on the cardiovascular system. Although male hypogonadism seems to be associated with an adverse metabolic profile, there is no consistent evidence for increased cardiovascular risk in men with low testosterone. Similarly, testosterone therapy has not consistently improved cardiovascular risk factors or outcomes in men with hypogonadism. On the other hand, recent data suggest medium-term cardiovascular safety of testosterone therapy in middle-aged and older men with low testosterone; long-term cardiovascular safety is yet to be established.
In men with hypogonadism, baseline assessments for pre-existing cardiovascular disease and risk factors (e.g., obesity, diabetes, dyslipidemia, hypertension, and smoking) and optimization of these risk factors are vital and independent of testosterone therapy to improve overall cardiovascular outcomes. In middle-aged and older men with low testosterone, lifestyle modifications (weight loss, exercise, and smoking cessation) and optimization of risk factors would take precedence over testosterone therapy for improved cardiovascular outcomes. Apart from hematocrit, any additional monitoring for cardiovascular risk reduction would not be routinely required during testosterone therapy.
