Testosterone: Bad for Men, Good for Women?

Abstract

Generally, high testosterone levels within the physiological range are associated with a more favourable cardiometabolic profile. Although the FDA has approved testosterone for use only in men with hypogonadism, whose sex glands produce extremely low amounts of testosterone, off-label use has dramatically increased in recent years. In the past two decades, there has been a huge increase in testosterone prescriptions, and many trials have shown benefit in terms of risk factor modification and symptoms. These observations fit also into the picture that reduced testosterone levels in men are associated with increased cardiovascular risk inducing elevated triglyceride levels, low high-density lipoprotein (HDL) cholesterol levels, central obesity, glucose intolerance, and diabetes. This has recently been demonstrated by Malkin et al. (October 26 issue, 2010, Heart), who showed that low testosterone levels (total testosterone <8.1 nmol/l) are associated with early death in men with heart disease. The longitudinal follow-up study involved 930 men with coronary heart disease for a period of about 7 years. During the study period, 41 of 194 (21%) men with low testosterone levels died compared with 88 of 736 (12%) men with normal levels of the hormone (p = 0.002). It was concluded that, if androgen deficiency is part of the underlying pathophysiology of atherosclerotic disease in men, the serum testosterone level could be viewed as a favourable modifiable risk factor.