Testosterone and Cardiovascular Risk in Men: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials

Haddad, Rudy M.; Kennedy, Cassie C.; Caples, Sean M.; Tracz, Michał; Boloña, Enrique R.; Sideras, Kostandinos; Uraga, Maria V.; Erwin, Patricia J.; Montori, Víctor M.

doi:10.4065/82.1.29

Cited by 308 publications

(207 citation statements)

References 44 publications

(53 reference statements)

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“…102 It has been also reported that testosterone accelerates vascular remodeling 119 and stimulates renal prohypertensive processes, including the renin-angiotensin-aldosterone system. 120 Recent metaanalyses have revealed that CVD events were not different between testosterone and placebo groups, 86,121 indicating the complexity of testosterone therapy, as was shown for estrogen therapy in women.…”

Section: Possible Harmful Effects Of Testosterone On Blood Vesselsmentioning

confidence: 97%

“…85 Taken together, testosterone administration, at least in hypogonadal men, may have a favorable vascular effect, including endotheliumdependent or -independent vasodilation and reduction of arterial stiffness and inflammatory markers. In contrast, the effects of testosterone replacement on the progression of carotid intima-media thickness or other atherosclerotic lesions, as well as on CVD risk, 86 are unknown.…”

Section: Clinical Effects Of Androgen Replacement Therapymentioning

confidence: 99%

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Hormonal effects on blood vessels

Akishita

2012

Hypertens Res

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The incidence of cardiovascular disease (CVD) is lower in younger women than in men of the same age, but it increases after menopause, implicating the atheroprotective action of endogenous estrogen. Although observational studies have suggested the efficacy of estrogen therapy in postmenopausal women, placebo-controlled, randomized trials, such as the Women's Health Initiative, have not confirmed effects of estrogen therapy on CVD. Conversely, basic, experimental research has progressed and provided mechanistic insight into estrogen's action on blood vessels. By contrast, the vascular effects of androgens remain poorly understood and have been controversial for a long time. In recent years, an increasing body of evidence has suggested that androgens may exert protective effects against the development of atherosclerosis, at least in elderly men. Epidemiological studies have shown that the incidence of and mortality due to CVD were increased in elderly men with low testosterone levels, although the efficacy of androgen therapy remains unknown. Furthermore, recent experimental studies have demonstrated the direct action of androgens on the vasculature. In this review, we illustrate the effects of sex steroids on the cardiovascular system, focusing on the action of testosterone on the blood vessels.

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Section: Possible Harmful Effects Of Testosterone On Blood Vesselsmentioning

confidence: 97%

Section: Clinical Effects Of Androgen Replacement Therapymentioning

confidence: 99%

Hormonal effects on blood vessels

Akishita

2012

Hypertens Res

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“…Physiologic testosterone replacement in men with modestly reduced testosterone slightly decreases HDL and has little effect on other lipid fractions (33,34). There is no effect on systolic or diastolic blood pressure (34).…”

Section: Testosterone Replacement and Cardiovascular Eventsmentioning

confidence: 99%

Testosterone therapy and cardiovascular risk

Walsh

Kitchens

2015

Trends in Cardiovascular Medicine

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Endogenous testosterone levels are inversely associated with cardiovascular risk in older men and men with cardiovascular disease. Current data on cardiovascular outcomes of testosterone therapy include only observational studies and adverse event monitoring in short term trials that were not designed to measure cardiovascular outcomes. These studies have yielded conflicting results, and some have raised concerns that testosterone therapy may increase cardiovascular risk. A well designed, adequately powered, prospective trial will ultimately be required to clarify whether testosterone therapy impacts cardiovascular outcomes. This review describes the findings and limitations of recent studies of cardiovascular risk in older men on testosterone therapy and discusses some of the mechanisms through which testosterone may modify cardiovascular risk

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“…A meta-analysis [51] in 2007 concluded that the current npg available evidence shows no association between testosterone replacement therapy and cardiac events. However, trials of testosterone therapy generally have not been designed or adequately powered to detect effects on clinically significant cardiovascular events [52].…”

Section: Improving Metabolic Syndrome and Diabetes Type 2 Cardiovascmentioning

confidence: 99%

Androgens and male aging: current evidence of safety and efficacy

Gooren¹

2010

Asian J Androl

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Many signs of aging, such as sexual dysfunction, visceral obesity, impaired bone and muscle strength, bear a close resemblance to features of hypogonadism in younger men. The statistical decline of serum testosterone in aging men is solidly documented. It has been presumed that the above features of aging are related to the concurrent decline of androgens, and that correction of the lower-than-normal circulating levels of testosterone will lead to improvement of symptoms of aging. But in essence, the pivotal question whether the age-related decline of testosterone must be viewed as hypogonadism, in the best case reversed by testosterone treatment, has not been definitively resolved. Studies in elderly men with lower-than-normal testosterone report improvement of features of the metabolic syndrome, bone mineral density, of mood and of sexual functioning. But as yet there is no definitive proof of the beneficial effects of restoring testosterone levels to normal in elderly men on clinical parameters. Few of these studies meet as yet rigorous standards of scientific enquiry: double-blind, placebo-controlled design of the study. The above applies also to the assessment of safety of testosterone administration to elderly men. There is so far no convincing evidence that testosterone is a main factor in the development of prostate cancer in elderly men and guidelines for monitoring the development of prostate disease have been developed. It is of note that there are presently no long-term safety data with regard to the prostate. Polycythemia is another potential complication of testosterone treatment. It is dose dependent and can be managed with dose adjustment.

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Testosterone and Cardiovascular Risk in Men: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials

Cited by 308 publications

References 44 publications

Hormonal effects on blood vessels

Hormonal effects on blood vessels

Testosterone therapy and cardiovascular risk

Androgens and male aging: current evidence of safety and efficacy

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