Testosterone, atherosclerosis and cardiovascular risks

The study highlighted the most significant scientific works that examined the influence of androgen deficiency and its drug correction in coronary heart disease. The effects of androgens on metabolic parameters, development of atherosclerosis, inflammation, coagulation and thromboembolism, blood pressure, and development of cardiovascular complications were also evaluated. The importance of conducting long-term randomized international studies evaluating the effects of testosterone in men with androgen deficiency and cardiovascular diseases, a cautious approach to androgen replacement therapy, and the need for individualization of therapy were discussed. Cardiovascular diseases are the leading cause of mortality. Thus, the study of the role of sex steroids in the development of atherosclerosis and coronary heart disease is of great interest. Testosterone is the main sex hormone that determines a man’s health. With age, testosterone levels gradually decrease, and mortality from cardiovascular complications increases. Low testosterone levels are associated with erectile dysfunction, decreased libido, decreased skeletal muscle mass, metabolic disorders, osteoporosis, and depression, and the importance of androgens for the circulatory system remains insufficiently studied. Many men receive testosterone replacement therapy, which leads to the improvement of well-being, sexual function, surge of strength, and favorable metabolic changes. The scientific literature describes the possible cardioprotective effect of testosterone, and it is believed to have vasodilating properties, shorten the Q–T interval, and normalize the ratio of fat and muscle mass. However, the expediency and safety of prescribing testosterone drugs to patients with hypogonadism and high cardiovascular risk is debatable because only several studies have described an increase in the number of cardiovascular complications in the androgen therapy group relative to the placebo group. Most studies on testosterone replacement therapy did not assess cardiovascular risks and excluded people with a recent stroke, heart attack, or severe heart failure. In addition, data interpretation is complicated by the lack of generally accepted international standards of testosterone for men of different ages, and most studies do not consider the change in androgen status relative to peak values at a young age and features of the receptor apparatus.