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Clinical focus: Mens Health - Review

Hypogonadism management and cardiovascular health

ORCID Icon & ORCID Icon
Pages 35-41 | Received 29 Jun 2020, Accepted 03 Aug 2020, Published online: 19 Oct 2020

References

  • Cunningham GR, Stephens-Shields AJ, Rosen RC, et al. Association of sex hormones with sexual function, vitality, and physical function of symptomatic older men with low testosterone levels at baseline in the testosterone trials. J Clin Endocrinol Metab. 2015. DOI:10.1210/jc.2014-3818.
  • Storer TW, Woodhouse L, Magliano L, et al. Changes in muscle mass, muscle strength, and power but not physical function are related to testosterone dose in healthy older men. J Am Geriatr Soc. 2008. DOI:10.1111/j.1532-5415.2008.01927.x.
  • Tsametis CP, Isidori AM. Testosterone replacement therapy: for whom, when and how? Metabolism. 2018. DOI:10.1016/j.metabol.2018.03.007
  • Smith JB, Rosen J, Colbert A. Low serum testosterone in outpatient psychiatry clinics: addressing challenges to the screening and treatment of hypogonadism. Sex Med Rev. 2018. DOI:10.1016/j.sxmr.2017.08.007
  • Dohle G, Arver S, Bettocchi C, et al. Guidelines on male hypogonadism. Eur Assoc Urol. 2015. DOI:10.1007/978-1-60761-193-6
  • Huggins C, Hodges CV. Studies on prostatic cancer i. the effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. Cancer Res. 1941. DOI:10.3322/canjclin.22.4.232
  • Roddam AW, Allen NE, Appleby P, et al. Endogenous sex hormones and prostate cancer: A collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008. DOI:10.1093/jnci/djm323
  • Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004. DOI:10.1056/NEJMra022251
  • Morgentaler A, Traish A. The history of testosterone and the evolution of its therapeutic potential. Sex Med Rev. 2020. DOI:10.1016/j.sxmr.2018.03.002
  • Morgentaler A, Miner MM, Caliber M, et al. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015. DOI:10.1016/j.mayocp.2014.10.011
  • Basaria S, Coviello AD, Travison TG, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010. DOI:10.1056/NEJMoa1000485.
  • US Food and Drug Administration. Citizen petition denial response from FDA CDER to public citizen. Published July 16, 2014. Cited 2020 Jun 15. Available from: http://www.citizen.org/documents/2184_FDA%20Denial%20of%20Petition_July%2016%202014.pdf
  • Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. J Am Med Assoc. 2013. DOI:10.1001/jama.2013.280386.
  • Morgentaler A, Lunenfeld B. Testosterone and cardiovascular risk: world’s experts take unprecedented action to correct misinformation. Aging Male. 2014. DOI:10.3109/13685538.2014.913413
  • Finkle WD, Greenland S, Ridgeway GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One. 2014. DOI:10.1371/journal.pone.0085805.
  • Woodcock J Letter to Sidney Wolfe, M.D. and Michael Carome, M.D., responding toFDA-2014-P-0258, Public Citizen’s petition for boxed warning for testosterone-containing drugs. Food and Drug Administration. July 16, 2014. Cited 2020 Jun 15. Available from: http://www.citizen.org/documents/2184_FDA Denial of Petition_July 16, 2014.pdf Cited 2020 Jun 15.
  • Xu L, Freeman G, Cowling BJ, et al. Testosterone therapy and cardiovascular events among men: A systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med. 2013. DOI:10.1186/1741-7015-11-108
  • FDA drug safety communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use 2015 [cited 2020 Jun 18]. Available from: http://www.fda.gov/Drugs/DrugSafety/ucm436259.htm
  • Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018. DOI:10.1016/j.juro.2018.03.115.
  • Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2018. DOI:10.1210/jc.2018-00229.
  • European Medicines agency. No consistent evidence of an increased risk of heart problems with testosterone medicines. Cited 2020 Jun 15. Available from: www.ema.europa.eu/docs/ en_GB/document_library/Press_release/2014/11/WC500177618.pdf.
  • Ohlsson C, Barrett-Connor E, Bhasin S, et al. High serum testosterone is associated with reduced risk of cardiovascular events in elderly men: the MrOS (osteoporotic fractures in men) study in Sweden. J Am Coll Cardiol. 2011. DOI:10.1016/j.jacc.2011.07.019.
  • Soisson V, Brailly-Tabard S, Helmer C, et al. A J-shaped association between plasma testosterone and risk of ischemic arterial event in elderly men: the French 3C cohort study. Maturitas. 2013. DOI:10.1016/j.maturitas.2013.04.012.
  • Araujo AB, Dixon JM, Suarez EA, et al. Endogenous testosterone and mortality in men: A systematic review and meta-analysis. J Clin Endocrinol Metab. 2011. DOI:10.1210/jc.2011-1137
  • Hak AE, Witteman JCM, de Jong FH, et al. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam study. J Clin Endocrinol Metab. 2002. DOI:10.1210/jcem.87.8.8762
  • Rosano GMC, Sheiban I, Massaro R, et al. Low testosterone levels are associated with coronary artery disease in male patients with angina. Int J Impot Res. 2007. DOI:10.1038/sj.ijir.3901504.
  • Corona G, Rastrelli G, Di Pasquale G, et al. Endogenous testosterone levels and cardiovascular risk: meta-analysis of observational studies. J Sex Med. 2018. DOI:10.1016/j.jsxm.2018.06.012
  • Adelborg K, Rasmussen TB, Nørrelund H, et al. Cardiovascular outcomes and all-cause mortality following measurement of endogenous testosterone levels. Am J Cardiol. 2019. DOI:10.1016/j.amjcard.2019.02.042
  • Malkin CJ, Pugh PJ, Morris PD, et al. Low serum testosterone and increased mortality in men with coronary heart disease. Heart. 2010. DOI:10.1136/hrt.2010.195412
  • Zeller T, Appelbaum S, Kuulasmaa K, et al. Predictive value of low testosterone concentrations regarding coronary heart disease and mortality in men and women – evidence from the FINRISK97 study. J Intern Med. 2019. DOI:10.1111/joim.12943.
  • Karakas M, Schäfer S, Appelbaum S, et al. Testosterone levels and type 2 diabetes—No correlation with age, differential predictive value in men and women. Biomolecules. 2018. DOI:10.3390/biom8030076.
  • Zeller T, Schnabel RB, Appelbaum S, et al. Low testosterone levels are predictive for incident atrial fibrillation and ischaemic stroke in men, but protective in women – results from the FINRISK study. Eur J Prev Cardiol. 2018. DOI:10.1177/2047487318778346.
  • Yeap BB, Alfonso H, Paul Chubb SA, et al. In older men an optimal plasma testosterone is associated with reduced all-cause mortality and higher dihydrotestosterone with reduced ischemic heart disease mortality, while estradiol levels do not predict mortality. J Clin Endocrinol Metab. 2014. DOI:10.1210/jc.2013-3272.
  • Brand JS, Rovers MM, Yeap BB, et al. Testosterone, sex hormone-binding globulin and the metabolic syndrome in men: an individual participant data meta-analysis of observational studies. PLoS One. 2014. DOI:10.1371/journal.pone.0100409.
  • Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017. DOI:10.1056/NEJMoa1614362.
  • Lamm S, Chidakel A, Bansal R. Obesity and hypogonadism. Urol Clin North Am. 2016. DOI:10.1016/j.ucl.2016.01.005
  • O’Reilly MW, Glisic M, Kumarendran B, et al. Serum testosterone, sex hormone-binding globulin and sex-specific risk of incident type 2 diabetes in a retrospective primary care cohort. Clin Endocrinol (Oxf). 2019. DOI:10.1111/cen.13862.
  • Liu X, Jiang J, Liu X, et al. Association of serum testosterone with different classes of glucose metabolism and the mediation effect of obesity: the henan rural cohort study. Diabetes Metab Res Rev. 2019. DOI:10.1002/dmrr.3133.
  • Jones TH, Arver S, Behre HM, et al. Testosterone replacement in hypogonadal men with Type 2 diabetes and/or metabolic syndrome (the TIMES2 study). Diabetes Care. 2011. DOI:10.2337/dc10-1233.
  • Malkin CJ, Pugh PJ, Jones RD, et al. The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. J Clin Endocrinol Metab. 2004. DOI:10.1210/jc.2003-031069
  • Kelly DM, Jones TH. Testosterone and obesity. Obes Rev. 2015. DOI:10.1111/obr.12282
  • Haddad RM, Kennedy CC, Caples SM, et al. Testosterone and cardiovascular risk in men: A systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007. DOI:10.4065/82.1.29.
  • Etminan M, Skeldon SC, Goldenberg SL, et al. Testosterone therapy and risk of myocardial infarction: A pharmacoepidemiologic study. Pharmacotherapy. 2015. DOI:10.1002/phar.1534
  • Wallis CJD, Lo K, Lee Y, et al. Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study. Lancet Diabetes Endocrinol. 2016. DOI:10.1016/S2213-8587(16)00112-1.
  • Sharma R, Oni OA, Gupta K, et al. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J. 2015. DOI:10.1093/eurheartj/ehv346.
  • Sharma R, Oni OA, Gupta K, et al. Normalization of testosterone levels after testosterone replacement therapy is associated with decreased incidence of atrial fibrillation. J Am Heart Assoc. 2017. DOI:10.1161/JAHA.116.004880.
  • Traish AM, Haider A, Haider KS, et al. Long-term testosterone therapy improves cardiometabolic function and reduces risk of cardiovascular disease in men with hypogonadism. J Cardiovasc Pharmacol Ther. 2017. DOI:10.1177/1074248417691136
  • Cheetham TC, An JJ, Jacobsen SJ, et al. Association of testosterone replacement with cardiovascular outcomes among men with androgen deficiency. JAMA Intern Med. 2017. DOI:10.1001/jamainternmed.2016.9546.
  • Oni OA, Sharma R, Chen G, et al. Normalization of TESTOSTERONE LEVELS AFTER TESTOSTERONE REPLACEMENT THERAPY IS NOT ASSOCIATED WITH REDUCED MYOCARDIAL INFARCTION IN SMOkers. Mayo Clin Proc Innov Qual Outcomes. 2017. DOI:10.1016/j.mayocpiqo.2017.05.003.
  • Pantalone KM, George J, Ji X, et al. Testosterone replacement therapy and the risk of adverse cardiovascular outcomes and mortality. Basic Clin Androl. 2019. DOI:10.1186/s12610-019-0085-7.
  • Saad F, Caliber M, Doros G, et al. Long-term treatment with testosterone undecanoate injections in men with hypogonadism alleviates erectile dysfunction and reduces risk of major adverse cardiovascular events, prostate cancer, and mortality. Aging Male. 2020. DOI:10.1080/13685538.2019.1575354
  • Jaffe MD. Effect of testosterone cypionate on postexercise ST segment depression. Heart. 1977. DOI:10.1136/hrt.39.11.1217
  • Rosano GMC, Leonardo F, Pagnotta P, et al. Acute anti-ischemic effect of testosterone in men with coronary artery disease. Circulation. 1999. DOI:10.1161/01.CIR.99.13.1666.
  • Webb CM, Adamson DL, De Zeigler D, et al. Effect of acute testosterone on myocardial ischemia in men with coronary artery disease. Am J Cardiol. 1999. DOI:10.1016/S0002-9149(98)00880-7
  • Malkin CJ, Pugh PJ, Morris PD, et al. Testosterone replacement in hypogonadal men with angina improves ischaemic threshold and quality of life. Heart. 2004. DOI:10.1136/hrt.2003.021121.
  • Mathur A, Malkin C, Saeed B, et al. Long-term benefits of testosterone replacement therapy on angina threshold and atheroma in men. Eur J Endocrinol. 2009. DOI:10.1530/EJE-09-0092
  • English KM, Steeds RP, Jones TH, et al. Low-dose transdermal testosterone therapy improves angina threshold in men with chromic stable angina: A randomized, double-blind, placebo-controlled study. Circulation. 2000. DOI:10.1161/01.CIR.102.16.1906
  • Pugh PJ, Jones RD, West JN, et al. Testosterone treatment for men with chronic heart failure. Heart. 2004. DOI:10.1136/hrt.2003.014639
  • Malkin CJ, Pugh PJ, West JN, et al. Testosterone therapy in men with moderate severity heart failure: A double-blind randomized placebo controlled trial. Eur Heart J. 2006. DOI:10.1093/eurheartj/ehi443
  • Caminiti G, Volterrani M, Iellamo F, et al. Effect of long-acting testosterone treatment on functional exercise capacity, skeletal muscle performance, insulin resistance, and baroreflex sensitivity in elderly patients with chronic heart failure. a double-blind, placebo-controlled, randomized study. J Am Coll Cardiol. 2009. DOI:10.1016/j.jacc.2009.04.078.
  • Stout M, Tew GA, Doll H, et al. Testosterone therapy during exercise rehabilitation in male patients with chronic heart failure who have low testosterone status: A double-blind randomized controlled feasibility study. Am Heart J. 2012. DOI:10.1016/j.ahj.2012.09.016.
  • Dhindsa S, Ghanim H, Batra M, et al. Insulin resistance and inflammation in hypogonadotropic hypogonadism and their reduction after testosterone replacement in men with type 2 diabetes. Diabetes Care. 2016. DOI:10.2337/dc15-1518.
  • Konaka H, Sugimoto K, Orikasa H, et al. Effects of long-term androgen replacement therapy on the physical and mental statuses of aging males with late-onset hypogonadism: A multicenter randomized controlled trial in Japan (EARTH Study). Asian J Androl. 2016. DOI:10.4103/1008-682X.148720.
  • Paduch DA, Polzer PK, Ni X, et al. Testosterone replacement in androgen-deficient men with ejaculatory dysfunction: A randomized controlled trial. J Clin Endocrinol Metab. 2015. DOI:10.1210/jc.2014-4434
  • Basaria S, Travison TG, Alford D, et al. Effects of testosterone replacement in men with opioid-induced androgen deficiency: A randomized controlled trial. Pain. 2015. DOI:10.1097/01.j.pain.0000460308.86819.aa.
  • Budoff MJ, Ellenberg SS, Lewis CE, et al. Testosterone treatment and coronary artery plaque volume in older men with low testosterone. J Am Med Assoc. 2017. DOI:10.1001/jama.2016.21043.
  • Park HB, Heo R, Ó Hartaigh B, et al. Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: A direct comparison to fractional flow reserve. JACC Cardiovasc Imaging. 2015. DOI:10.1016/j.jcmg.2014.11.002.
  • Criqui MH, Denenberg JO, Ix JH, et al. Calcium density of coronary artery plaque and risk of incident cardiovascular events. J Am Med Assoc. 2014. DOI:10.1001/jama.2013.282535.
  • Basaria S, Harman SM, Travison TG, et al. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with lowor low-normal testosterone levels: A randomized clinical trial. J Am Med Assoc. 2015. DOI:10.1001/jama.2015.8881.
  • Rastrelli G, Dicuio M, Reismann Y, et al. Cardiovascular impact of testosterone therapy for hypogonadism. Expert Rev Cardiovasc Ther. 2018. DOI:10.1080/14779072.2018.1510314
  • Corona G, Maseroli E, Rastrelli G, et al. Cardiovascular risk associated with testosterone-boosting medications: A systematic review and meta-Analysis. Expert Opin Drug Saf. 2014. DOI:10.1517/14740338.2014.950653.
  • Alexander GC, Iyer G, Lucas E, et al. Cardiovascular risks of exogenous testosterone use among men: a systematic review and meta-analysis. Am J Med. 2017. DOI:10.1016/j.amjmed.2016.09.017
  • Kloner RA, Carson C, Dobs A, et al. Testosterone and Cardiovascular Disease. J Am Coll Cardiol. 2016. DOI:10.1016/j.jacc.2015.12.005
  • Layton JB, Meier CR, Sharpless JL, et al. Comparative safety of testosterone dosage forms. JAMA Intern Med. 2015. DOI:10.1001/jamainternmed.2015.1573
  • US National Library of Medicine. 2019 [cited 2020 Jun 18]. ClinicalTrials.gov. Available from:http://www.clinicaltrials.gov/ct2/show/NCT03518034
  • Kappert K, Böhm M, Schmieder R, et al. Impact of sex on cardiovascular outcome in patients at high cardiovascular risk: analysis of the telmisartan randomized assessment study in ACE-intolerant subjects with cardiovascular disease (TRANSCEND) and the ongoing telmisartan alone and in combination with ramipril global end point trial (ONTARGET). Circulation. 2012. DOI:10.1161/CIRCULATIONAHA.111.086660.
  • Kalin MF, Zumoff B. Sex hormones and coronary disease: a review of the clinical studies. Steroids. 1990. DOI:10.1016/0039-128X(90)90058-J
  • Tenover JS. Effects of testosterone supplementation in the aging male. J Clin Endocrinol Metab. 1992. DOI:10.1210/jcem.75.4.1400877
  • Ohlander SJ, Varghese B, Pastuszak AW. Erythrocytosis following testosterone therapy. Sex Med Rev. 2018. DOI:10.1016/j.sxmr.2017.04.001
  • Ajayi AAL, Mathur R, Halushka PV. Testosterone increases human platelet thromboxane A2 receptor density and aggregation responses. Circulation. 1995. DOI:10.1161/01.CIR.91.11.2742
  • Bachman E, Feng R, Travison T, et al. Testosterone suppresses hepcidin in men: A potential mechanism for testosterone-induced erythrocytosis. J Clin Endocrinol Metab. 2010. DOI:10.1210/jc.2010-0864.
  • Bachman E, Travison TG, Basaria S, et al. Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point. J Gerontol - Ser A Biol Sci Med Sci. 2014. DOI:10.1093/gerona/glt154.
  • Angelova P, Momchilova A, Petkova D, et al. Testosterone replacement therapy improves erythrocyte membrane lipid composition in hypogonadal men. Aging Male. 2012. DOI:10.3109/13685538.2012.693550
  • Alexandersen P, Haarbo J, Byrjalsen I, et al. Natural androgens inhibit male atherosclerosis: A study in castrated, cholesterol-fed rabbits. Circ Res. 1999. DOI:10.1161/01.RES.84.7.813
  • Larsen BA, Nordestgaard BG, Stender S, et al. Effect of testosterone on atherogenesis in cholesterol-fed rabbits with similar plasma cholesterol levels. Atherosclerosis. 1993. DOI:10.1016/0021-9150(93)90053-W
  • Nettleship JE, Jones TH, Channer KS, et al. Physiological testosterone replacement therapy attenuates fatty streak formation and improves high-density lipoprotein cholesterol in the Tfm mouse: an effect that is independent of the classic androgen receptor. Circulation. 2007. DOI:10.1161/CIRCULATIONAHA.107.708768
  • Bourghardt J, Wilhelmson ASK, Alexanderson C, et al. Androgen receptor-dependent and independent atheroprotection by testosterone in male mice. Endocrinology. 2010. DOI:10.1210/en.2010-0663.
  • Bai CX, Kurokawa J, Tamagawa M, et al. Nontranscriptional regulation of cardiac repolarization currents by testosterone. Circulation. 2005. DOI:10.1161/CIRCULATIONAHA.104.523217
  • Zhang Y, Ouyang P, Post WS, et al. Sex-steroid hormones and electrocardiographic qt-interval duration: findings from the third national health and nutrition examination survey and the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2011. DOI:10.1093/aje/kwr172.
  • Vicente J, Johannesen L, Galeotti L, et al. Mechanisms of sex and age differences in ventricular repolarization in humans. Am Heart J. 2014. DOI:10.1016/j.ahj.2014.07.010
  • Salem JE, Waintraub X, Courtillot C, et al. Hypogonadism as a reversible cause of torsades de pointes in men. Circulation. 2018. DOI:10.1161/CIRCULATIONAHA.118.034282.
  • Eleawa SM, Sakr HF, Hussein AM, et al. Effect of testosterone replacement therapy on cardiac performance and oxidative stress in orchidectomized rats. Acta Physiol. 2013. DOI:10.1111/apha.12158
  • Golden KL, Marsh JD, Jiang Y, et al. Acute actions of testosterone on contractile function of isolated rat ventricular myocytes. Eur J Endocrinol. 2005. DOI:10.1530/eje.1.01845
  • Witayavanitkul N, Woranush W, Bupha-Intr T, et al. Testosterone regulates cardiac contractile activation by modulating SERCA but not NCX activity. Am J Physiol - Hear Circ Physiol. 2013. DOI:10.1152/ajpheart.00555.2012
  • Pugh PJ, Jones TH, Channer KS. Acute haemodynamic effects of testosterone in men with chronic heart failure. Eur Heart J. 2003. DOI:10.1016/S0195-668X(03)00083-6
  • Langer C, Gansz B, Goepfert C, et al. Testosterone up-regulates scavenger receptor bi and stimulates cholesterol efflux from macrophages. Biochem Biophys Res Commun. 2002. DOI:10.1016/S0006-291X(02)02038-7.
  • Movérare-Skrtic S, Venken K, Andersson N, et al. Dihydrotestosterone treatment results in obesity and altered lipid metabolism in orchidectomized mice. Obesity. 2006. DOI:10.1038/oby.2006.75.
  • Rubinow KB, Vaisar T, Tang C, et al. Testosterone replacement in hypogonadal men alters the HDL proteome but not HDL cholesterol efflux capacity. J Lipid Res. 2012. DOI:10.1194/jlr.P026005

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