title: Hypogonadism and metabolic syndrome.
abstract: BACKGROUND
  The relationship between metabolic syndrome (MetS), male hypogonadism and their possible interaction in cardiovascular (CV) risk stratification are not completely understood.
  
  
  OBJECTIVE
  We reviewed relationships between testosterone (T) and MetS emphasizing their possible interaction in the pathogenesis of CV diseases.
  
  
  METHODS
  A systematic search of published evidence was performed using Medline (1969 to January 2011).
  
  
  RESULTS
  Cross-sectional data have shown that subjects with MetS have lower levels of total T (TT) (about 3 nmol/l), as hypogonadism is more evident in subjects with than in those without erectile dysfunction (ED) than in those without. Longitudinal evidence shows that low T is allocated with a higher risk of subsequent development of MetS, although the reverse condition is also possible. Which are the factors in MetS responsible for the low T is not completely clarified. In clinical studies, increased waist circumference is the major determinant of MetS-associated hypogonadism. Our experiments in rabbits do not support the idea that visceral fat is the main determinant of MetS-associated male hypogonadism. Only few randomized clinical trials have evaluated the impact of T replacement therapy (TRT) in patients with MetS. Available evidence suggests that TRT decreases visceral fat accumulation and ameliorates insulin sensitivity, whereas androgen deprivation increases abdominal adiposity.
  
  
  CONCLUSIONS
  The clinical significance of the MetS-associated hypogonadism needs further clarifications. In particular, it has not been completely clarified if low T might be considered a cause or a consequence of MetS. The benefit of TRT in term of the reduction of CV risk needs to be confirmed in larger and longer studies.
authors: Andrology and Sexual Medicine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
authors: G
authors: G
authors: Corona
authors: G
authors: G
authors: Rastrelli
authors: A
authors: A
authors: Morelli
authors: L
authors: L
authors: Vignozzi
authors: E
authors: E
authors: Mannucci
authors: M
authors: M
authors: Maggi
mesh_terms: D000818:Animals; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology; D002986:Clinical Trials as Topic; D007172:Erectile Dysfunction / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007006:Hypogonadism / Q000150:complications / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D016239:MEDLINE; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology*; D012307:Risk Factors; D013739:Testosterone / Q000378:metabolism
chemical_list: D013739:Testosterone