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Volume 14, Issue 3 (May 2012) 14, 428–435; 10.1038/aja.2012.21

Testosterone and cardiovascular disease in men

Paul D Morris and Kevin S Channer

Sheffield Teaching Hospital NHS Trust, Sheffield, UK.

Correspondence: Professor KS Channer, (Kevin.Channer@sth.nhs.uk)

Received 26 July 2011; Revised 7 December 2011; Accepted 2 January 2012; Advance online publication 23 April 2012


Despite regional variations in the prevalence of coronary artery disease (CAD), men are consistently more at risk of developing and dying from CAD than women, and the gender-specific effects of sex hormones are implicated in this inequality. This 'Perspectives' article reviews the current evidence regarding the cardiovascular effects of testosterone in men including an examination of the age-related decline in testosterone, the relationship between testosterone levels and coronary disease, coronary risk factors and mortality. We also review the vaso-active effects of testosterone, and discuss how these have been used in men with heart failure and angina. We discuss the 'cause' versus 'effect' controversy, regarding low testosterone levels in men with coronary heart disease, as well as concerns over the use of testosterone replacement therapy in middle aged and elderly men. The article concludes with a discussion regarding the future direction for work in this interesting area, including the relative merits of screening for, and treating hypogonadism with testosterone replacement therapy in men with heart disease.

Keywords: atherosclerosis; chronic heart failure; ischaemic heart disease; replacement therapy; testosterone

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