Testosterone Deficiency and Cardiovascular Diseases

A study published in July 2019 demonstrates the benefits of adjusting testosterone in patients with deficiency.

The development of subnormal testosterone (T) levels is not universal in aging men, with 75% of men maintaining normal levels. However, a substantial number of men develop T deficiency (TD), with many of them presenting a portfolio of cardiovascular (CV) risk factors, including type 2 diabetes (T2D) and metabolic syndrome. TD increases the risk of cardiovascular disease (CVD) and the risk of developing T2D and metabolic syndrome. The main symptoms suggesting low T are sexual in nature, including erectile dysfunction (ED), loss of nocturnal erections, and reduced libido. Many men with heart disease, if asked, admit to the presence of ED; a problem that is often exacerbated by medications used to treat CVD. A large number of studies and meta-analyses have provided evidence of the link between TD and an increase in CVD and all-cause mortality.(chart beside)

Patients with chronic heart failure (CHF) with TD have a poor prognosis, and this is associated with more frequent hospitalizations and increased mortality compared to those without TD. Conversely, in men with symptoms and documented TD, T therapy has been shown to have beneficial effects, such as improved exercise capacity in CHF patients, improved myocardial ischemia, and coronary artery disease. Reductions in BMI and waist circumference, and improvements in glycemic control and lipid profile, are observed in men with T deficiency who receive T therapy. These effects can be expected to translate into benefits, and there are over 100 studies showing CV benefit or improved CV risk factors with T therapy. There are flawed retrospective and prescription data studies that have suggested increased mortality in treated men, leading to regulatory warnings, and a placebo-controlled study demonstrating an increase in total non-calcified and total coronary artery plaque volume in men treated with T, which is open to debate. Men with ED and TD who do not respond to phosphodiesterase type 5 (PDE5) inhibitors may recover by treating TD. There is data suggesting that T and PDE5 inhibitors may act synergistically to reduce CV risk.

Eur Cardiol. 2019 Jul 11;14(2):103-110. doi: 10.15420/ecr.2019.13.1. eCollection 2019 Jul.

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