Conclusions about testosterone therapy and cardiovascular risk

Abstract

In this issue of Asian Journal of Andrology (AJA), several experts have reviewed the latest data on the potential and known effects of endogenous and exogenous testosterone (T) on cardiovascular risk. In the review by Meyer and Wittert, low endogenous serum T appears to be associated with higher risk of cardiovascular disease and overall mortality in certain populations such as Klinefelter syndrome and older men, but not in men with congenital hypogonadotropic hypogonadism.1 Whether this association is causal or whether low serum testosterone is a marker of other risk factors for cardiovascular disease such as obesity, diabetes mellitus, or other systemic disease is unknown. In Yeap's review of the relationship between circulating endogenous testosterone and its major metabolites, dihydrotestosterone, and estradiol, he raises the provocative hypotheses that there might be differential effects on cardiovascular and cerebrovascular risk related to endogenous testosterone and dihydrotestosterone concentrations.2 Based on the same epidemiological studies, Yeap postulates that there might be a U-shaped curve for circulating endogenous androgen concentrations such that lower and higher concentrations might confer greater risk of cardiovascular events and all-cause mortality than midrange concentrations. Shores demonstrates in a carefully done review of studies of large prescription databases (including >200 000 men) that testosterone therapy is not associated with overall mortality, myocardial infarction, stroke, or deep venous thrombosis events.3

Testosterone deficiency in non-cancer opioid-treated patients

“…A possible relationship between low testosterone and increased cardiovascular risk has also been suggested [ 119 – 121 ]. However, it is not clear whether low testosterone in aging men plays a direct pathogenic role in cardiovascular disease, is a marker of poor health, or even a protective mechanism, turning off testosterone-dependent functions (such as reproduction and/or physical and sexual activity) when cardiovascular function is impaired [ 122 , 123 ].…”

The Interplay Between Pituitary Health and Diabetes Mellitus – The Need for ‘Hypophyseo-vigilance’

“…93 Testosterone replacement is recommended in symptomatic males with HH, but there is controversy regarding the CV risk associated with testosterone therapy. 94,95 An interesting observation is that the hypogonadism in these conditions responds well to clomiphene. 96 The prevalence of HH in males with T1DM does not appear to be increased, and risk factors in T1DM for low testosterone levels are similar to that of the general population.…”

Naturopathic Primary Care Cardiovascular Disease Risk Reduction Model

“…For example, observational studies have shown that both low levels of serum testosterone and high levels of serum testosterone have been associated with increased CVD risk. 7 Taking this biomarker into the normal range through lifestyle improvements, dietary recommendations and herbal prescribing could provide a beneficial vasodilatory effect, positive cardiac and skeletal muscle strength and improved insulin sensitivity. 7 This is the kind of detail personalized risk management we can facilitate.…”

“…7 Taking this biomarker into the normal range through lifestyle improvements, dietary recommendations and herbal prescribing could provide a beneficial vasodilatory effect, positive cardiac and skeletal muscle strength and improved insulin sensitivity. 7 This is the kind of detail personalized risk management we can facilitate. If our therapeutic approach provides the time and resources for such detailed analysis we have a duty to provide it.…”