Male Sexual Health and Cardiovascular Disease

Abstract

To provide an updated review on the association of erectile dysfunction (ED), male hypogonadism, and testosterone therapy with cardiovascular disease (CVD). Direct evidence links male sexual dysfunction to CVD, including higher coronary artery calcium scores, carotid narrowing, and more severe coronary artery disease. While questions about the role of ED in predicting cardiovascular risk independent of shared comorbidities have lingered, the most recent analyses favor a diagnosis of ED as a strong independent predictor of adverse cardiac events. ED has now been incorporated into the widely used QRISK3 calculator for cardiovascular risk assessment and may influence clinical decision-making about primary prevention interventions. Controversy also surrounds changes in testosterone labeling that highlight potential cardiovascular risks. While continuing to remain contentious, the most extensive meta-analyses conclude that low endogenous testosterone is independently associated with increased cardiovascular risk and that testosterone therapy does not appear to carry increased risk in most populations. The assessment of ED is an effective tool in predicting cardiovascular risk and may influence clinical decision-making with regard to primary prevention interventions. The associations between endogenous testosterone levels, testosterone therapy, and cardiovascular risk remain controversial.