In this Century Cardiovascular Disease (CVD) is the most common isolated cause of death in developed countries. Many studies have suggested that men with low testosterone levels present higher incidence of components of metabolic syndrome and are at a greater risk of developing CVD. Testosterone can affect the development of atherosclerosis in the coronary arteries. While this androgen seems to have a cardioprotective effect by benefiting endothelial function, inducing vasodilation, and reducing fat mass, insulin resistance and chronic inflammation, it also appears to increase endothelin, thromboxane A2 and reactive oxygen species and renal smooth muscle cells. The relation between testosterone and coronary disease in men has been the focus of study of many authors. Most studies point to a neutral and/or protective effect of endogenous testosterone in male cardiovascular health. Unfortunately, many intervention studies have not been able to confirm this effect with testosterone therapy. More studies are needed to elucidate the pathogenic mechanisms of testosterone in cardiovascular health and to evaluate androgen receptor polymorphisms and their physiological responses to testosterone.