title: Testosterone and cardiovascular disease risk.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia and Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Perth, Western Australia, Australia.
authors.forename: Bu B
authors.initials: BB
authors.lastname: Yeap
mesh_terms: D000375:Aging / Q000187:drug effects / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000378:metabolism*; D006801:Humans; D008297:Male; D013739:Testosterone / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism*
chemical_list: D013739:Testosterone