Beneficial and adverse effects of testosterone on the cardiovascular system in men.
BACKGROUND
The widespread use of T therapy, particularly in aging males, necessitates knowledge of the relationship between T and the cardiovascular system.


METHODS
The review is based on a 1970 to 2013 PubMed search with terms related to androgens in combination with cardiovascular disease, including T, dihydrotestosterone, trial, mortality, cardiovascular disease, myocardial infarction, blood pressure, endothelial function, dyslipidemia, thrombosis, ventricular function, and arrhythmia. Original articles, systematic reviews and meta-analyses, and relevant citations were screened.


RESULTS
Low T has been linked to increased blood pressure, dyslipidemia, atherosclerosis, arrhythmia, thrombosis, endothelial dysfunction, as well as to impaired left ventricular function. On the one hand, a modest association is suggested between low endogenous T and incident cardiovascular disease or cardiovascular mortality, implying unrecognized beneficial T effects, residual confounding, or a relationship with health status. On the other hand, treatments with T to restore "normal concentrations" have so far not been proven to be beneficial with respect to cardiovascular disease; neither have they definitely shown specific adverse cardiovascular effects. The cardiovascular risk-benefit profile of T therapy remains largely evasive in view of a lack of well-designed and adequately powered randomized clinical trials.


CONCLUSIONS
The important knowledge gap as to the exact relationship between T and cardiovascular disease would support a cautious, restrained approach to T therapy in aging men, pending clarification of benefits and risks by adequately powered clinical trials of sufficient duration.
MD, PhD, Department of Endocrinology, Ghent University Hospital, De Pintelann 185, B9000 Gent, Belgium. jean.kaufman@ugent.be.
Johannes B
JB
Ruige
D Margriet
DM
Ouwens
Jean-Marc
JM
Kaufman
D000368:Aged; D000375:Aging / Q000502:physiology; D000728:Androgens / Q000008:administration & dosage / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000401:mortality / Q000517:prevention & control; D002319:Cardiovascular System / Q000187:drug effects*; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D054526:Men's Health; D008875:Middle Aged; D012307:Risk Factors; D013739:Testosterone / Q000008:administration & dosage* / Q000009:adverse effects*
D000728:Androgens; D013739:Testosterone