Testosterone addition to estrogen therapy – Effects on inflammatory markers for cardiovascular disease

Abstract

Data suggest that testosterone addition to estrogen treatment in postmenopausal women has a modest influence on inflammatory markers and there were no apparent adverse effects. On the contrary, the estrogen-induced increase in hsCRP was suppressed.

The Impact of Testosterone Therapy on Cardiovascular Risk Among Postmenopausal Women

“…Four studies were double-blind randomized controlled trials, 2 were randomized controlled trials, and 1 was observational. Of the 7 studies included in the data extraction, 4 reported improvements in cardiovascular risk markers, which included improvements in functional capacity [ 12 ], ventilatory efficiency [ 12 ], muscle strength [ 12-14 ], cholesterol [ 13 , 15 , 16 ], inflammatory markers [ 16 , 17 ], and lean body mass [ 13 , 14 , 16 , 18 ]. Conversely, 4 of the 7 studies reported negative effects on high-density lipoprotein (HDL) cholesterol [ 14 , 15 , 17 ], visceral adipose tissue (VAT) [ 15 ], increased insulin resistance, and increased risk of cardiovascular disease (CVD) [ 12 , 14 ].…”

“…However, both estrogen + testosterone and estrogen + placebo groups showed a significant decline in plasma fibrinogen levels, indicating an estrogenic effect on the latter parameter, which was preserved in those treated with testosterone [ 16 ]. In addition, Kocoska-Maras et al [ 17 ] conducted a 48-week study using a combination of oral testosterone undecanoate (40 mg/day) and oral estradiol valerate (2 mg/day). Their findings suggest a modest influence on inflammatory markers with no apparent adverse effects.…”

“…Notably, increased fibrinogen and CRP has been identified as an independent CVD risk factor and is associated with traditional cardiovascular risk factors [ 31 , 32 ]. Therefore, based on the Leao et al [ 16 ] and Kocoska-Maras et al [ 17 ] studies, testosterone + estrogen treatment may provide potential improvements in cardiovascular risk through declines in CRP and plasma fibrinogen levels.…”

“…Minor increases in hsCRP have been linked to an increased risk of CVD [ 33 , 34 ]. Kocoska-Maras et al [ 17 ] identified a suppressive effect of testosterone on estrogen-induced hsCRP increase. Therefore, as indicated by Kocoska-Maras et al [ 17 ], the use of exogenous testosterone in combination with estrogen therapy could be beneficial in reversing the estrogenic increases in hsCRP back to baseline.…”

“…Kocoska-Maras et al [ 17 ] identified a suppressive effect of testosterone on estrogen-induced hsCRP increase. Therefore, as indicated by Kocoska-Maras et al [ 17 ], the use of exogenous testosterone in combination with estrogen therapy could be beneficial in reversing the estrogenic increases in hsCRP back to baseline. Overall, further studies are required to explore testosterone's effect on cardiovascular risk through influencing CRP levels, plasma fibrinogen levels, and its ability to reverse estrogenic increases in hsCRP.…”