The Present and Future
State-of-the-Art Review
Testosterone and Cardiovascular Disease

https://doi.org/10.1016/j.jacc.2015.12.005Get rights and content
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Abstract

Testosterone (T) is the principal male sex hormone. As men age, T levels typically fall. Symptoms of low T include decreased libido, vasomotor instability, and decreased bone mineral density. Other symptoms may include depression, fatigue, erectile dysfunction, and reduced muscle strength/mass. Epidemiology studies show that low levels of T are associated with more atherosclerosis, coronary artery disease, and cardiovascular events. However, treating hypogonadism in the aging male has resulted in discrepant results in regard to its effect on cardiovascular events. Emerging studies suggest that T may have a future role in treating heart failure, angina, and myocardial ischemia. A large, prospective, long-term study of T replacement, with a primary endpoint of a composite of adverse cardiovascular events including myocardial infarction, stroke, and/or cardiovascular death, is needed. The Food and Drug Administration recently put additional restrictions on T replacement therapy labeling and called for additional studies to determine its cardiac safety.

Key Words

angina
heart failure
hormone replacement therapy
major adverse cardiovascular events
male health
myocardial infarction

Abbreviations and Acronyms

6MWT
6-min walk test
ADT
androgen deprivation therapy
CI
confidence interval
CV
cardiovascular
DHT
dihydrotestosterone
ECG
electrocardiogram
ED
erectile dysfunction
FDA
Food and Drug Administration
FSH
follicle-stimulating hormone
GnRH
gonadotropin-releasing hormone
HF
heart failure
LH
luteinizing hormone
MI
myocardial infarction
SHBG
sex hormone-binding globulin
T
testosterone
TRT
testosterone replacement therapy
Vo2
peak oxygen consumption

Cited by (0)

Dr. Kloner is a consultant to Abbvie and Teso-Rx. Dr. Carson is a consultant for Abbvie, Boston Scientific, and ENDO. Dr. Dobs serves on the advisory board for Abbvie. Dr. Kopecky is a consultant for Prime Therapeutics. Dr. Mohler is a consultant for Clarus and Abbvie.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.