Testosterone replacement, cardiovascular system and risk factors in the aging male

Investigations concerning the role of testosterone replacement on cardiovascular risk show conflicting results. Treatments with supraphysiological doses seem detrimental in animal models and men. On the other hand, cross-sectional, prospective and angiographic studies frequently find an inverse, favorable relationship between plasma testosterone and cardiovascular events. Testosterone replacement therapy in the hypogonadic elderly has a positive or at least neutral effect on several coronary disease risk factors. Testosterone appears to decrease LDL-cholesterol without adversely affecting HDL cholesterol, and improve insulin sensibility and the thrombotic/fibrinolytic balance; testosterone does not negatively influence the inflammatory response and arterial wall vasoreactivity. These findings provide a measure of reassurance concerning potential adverse heart effects of testosterone substitutional therapy in older men, even if more specific trials than reported are needed to overcome residual suspicions.