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Testosterone and cardiovascular disease risk

Yeap, Bu B.

Current Opinion in Endocrinology & Diabetes and Obesity: June 2015 - Volume 22 - Issue 3 - p 193–202
doi: 10.1097/MED.0000000000000161
ANDROGENS: Edited by David Handelsman
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Purpose of review Ageing is accompanied by a reduction in circulating testosterone and progressive accumulation of medical morbidities. There is an intense debate whether low testosterone contributes to ill-health as opposed to being a biomarker for its presence. Prescriptions for testosterone are rising on a background of concern over potential adverse effects. This review examines evidence relating androgens to cardiovascular risk in older men.

Recent findings Observational studies show lower risk of cardiovascular events in older men with higher testosterone, and lower mortality from ischaemic heart disease in men with higher concentrations of its more potent androgenic metabolite dihydrotestosterone. However, randomized controlled trials of testosterone supplementation have been underpowered for the outcome of cardiovascular events. Recent meta-analyses have reached contrasting conclusions regarding cardiovascular adverse events associated with testosterone therapy. Retrospective studies of prescription databases have produced controversial and conflicting results.

Summary Additional randomized controlled trials are required to clarify the role of testosterone supplementation in older men in the absence of pituitary or gonadal disease. Pending such studies, testosterone therapy should be considered in androgen-deficient men, with evaluation of potential benefits and risks.

School of Medicine and Pharmacology, University of Western Australia and Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Perth, Western Australia, Australia

Correspondence to Bu B. Yeap, MBBS, PhD, Harry Perkins Research Institute, Fiona Stanley Hospital, Robin Warren Drive, 102-118 Murdoch Drive, Murdoch 6150, Western Australia, Australia. Tel: +61 8 6151 1149; fax: +61 8 6151 1199; e-mail: bu.yeap@uwa.edu.au

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