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1 May 2015

Testosterone, Mortality and Longevity

Testosterone, Mortality and Longevity

Testosterone and mortality. Muraleedharan V, Jones TH. Clin. Endocrinol. (Oxf). 2014;81(4):477-487.

Observational studies demonstrate that men with low or low-normal endogenous testosterone are at an increased risk of mortality compared to those with higher levels, and that cardiovascular disease accounts for the greater proportion of deaths in those with low testosterone.

This editorial summarises a review paper which addressed the following two questions:

  1. Is testosterone deficiency directly involved in the pathogenesis of these conditions or is it merely a biomarker of ill health and the severity of underlying disease processes?
  2. Does testosterone replacement therapy retard disease progression and ultimately enhance the clinical prognosis and survival?

Key Points

  • Testosterone deficiency is an independent risk factor for future development of obesity, the metabolic syndrome and type 2 diabetes, which are major risk factors for cardiovascular disease, which is the leading cause of death worldwide.
  • Testosterone deficiency is an indicator of general poor health and the severity of underlying disease processes.
  • Experimental data suggest that testosterone deficiency may be directly involved in the pathogenesis of atherogenesis and development of cardiovascular disease.
  • Men with testosterone deficiency have an up to 2-fold increased mortality risk primarily from cardiovascular disease.
  • Survival and longevity are the ultimate goals of interventions in medicine. Two notable studies show that testosterone therapy increases longevity in hypogonadal men 2-fold.

1 May 2015

Testosterone, Cardiovascular Risk, Mortality and Longevity

Testosterone, Cardiovascular Risk, Mortality and Longevity

Testosterone Therapy and Cardiovascular Risk: Advances and Controversies. Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Mayo Clin. Proc. 2015;90(2):224-251.

Testosterone and mortality. Muraleedharan V, Jones TH. Clin. Endocrinol. (Oxf). 2014;81(4):477-487.

One of the most debated issues related to testosterone replacement therapy is its effects on cardiovascular risk and clinical events, like for example heart attack. A few flawed studies over the past years made it appear that testosterone replacement therapy increases cardiovascular risk and incidence of heart attacks. However, less known is the vast and rapidly accumulating body of evidence showing the contrary; that higher testosterone levels and testosterone replacement therapy actually may reduce mortality and increase longevity.

This editorial summarises key conclusions from a special medical review article on testosterone and cardiovascular risk, written by the Androgen Study Group, as provides answers to the following two questions:

  1. Is testosterone deficiency directly involved in the pathogenesis of these conditions or is it merely a biomarker of ill health and the severity of underlying disease processes?
  2. Does testosterone replacement therapy retard disease progression and ultimately enhance the clinical prognosis and survival?

15 April 2015

Health Consequences of Subclinical Hypogonadism

Health Consequences of Subclinical Hypogonadism

Characteristics of compensated hypogonadism in patients with sexual dysfunction. Corona G, Maseroli E, Rastrelli G, et al. The journal of sexual medicine. 2014;11(7):1823-1834.

In discussions about diagnosis and health consequences of hypogonadism, the prime focus is given to testosterone levels and signs/symptoms. However, emerging research has identified a less clinically evident gonadal dysfunction called “subclinical” hypogonadism (or “compensated” hypogonadism).

Subclinical hypogonadism is characterized by normal testosterone levels in the presence of elevated LH level. As testosterone levels are not markedly reduced in subclinical hypogonadism, intuitively one may think it does not confer negative health consequences. However, a recent study by Corona et al., which specifically was conducted to investigate the potential health ramifications of subclinical hypogonadism, shows that it should not be neglected.

Key Points

  • There are three types of hypogonadism:

    • Primary:
      • low testosterone with elevated LH (due primarily to insufficient testicular function);
    • Secondary:
      • low testosterone with low-normal LH (due primarily to insufficient hypothalamic-pituitary function);
    • Subclinical (also called compensated hypogonadism):
      • normal testosterone levels with elevated LH levels.
  • Men with subclinical hypogonadism have more hypogonadal symptoms (primarily psychological) than eugonadal men, and have an equally elevated cardiovascular risk as do men with overt hypogonadism.
  • Subclinical hypogonadism is associated with an almost 10-fold increased risk of cardiovascular mortality, comparable to that for overt hypogonadism.
  • Elevated LH in the context of apparently eugonadal total testosterone levels may be an indicator of a general poor health status, and should be followed up with a more comprehensive medical examination.

15 April 2015

Health Consequences of Subclinical Hypogonadism

Health Consequences of Subclinical Hypogonadism

Characteristics of compensated hypogonadism in patients with sexual dysfunction. Corona G, Maseroli E, Rastrelli G, et al. The journal of sexual medicine. 2014;11(7):1823-1834.

In discussions about diagnosis and health consequences of hypogonadism, the prime focus is given to testosterone levels and signs/symptoms. However, emerging research has identified a less clinically evident gonadal dysfunction called “subclinical” hypogonadism (or “compensated” hypogonadism).

Subclinical hypogonadism is characterized by normal testosterone levels in the presence of elevated LH level. As testosterone levels are not markedly reduced in subclinical hypogonadism, intuitively one may think it does not confer negative health consequences. However, a recent study which specifically was conducted to investigate the potential health ramifications of subclinical hypogonadism, shows that it should not be neglected.

1 April 2011

Men with erectile dysfunction and low testosterone levels have an increased risk of dying from cardiovascular disease

Image: Human heart

Citation: Low testosterone is associated with an increased risk of MACE lethality in subjects with erectile dysfunction. Corona G, Monami M, Boddi V, et al. J Sex Med 2010;7(4 Pt 1):1557-1564.

A consecutive series of 1687 patients attending an andrology clinic for erectile dysfunction (ED) was followed for a mean of 4.3 ± 2.6 years to investigate whether low testosterone levels predict incident fatal or nonfatal major adverse cardiovascular events (MACE) in men with ED. Patients in this prospective cohort study were interviewed using the structured interview on erectile dysfunction (SIEDY) and the ANDROTEST structured interview to measure aspects of ED and hypogonadal-related symptoms. Total testosterone was evaluated at baseline and information on MACE was obtained from registry database records.

Key Points

The nested case-control study showed:

  • At baseline, over 20% of men were hypogonadal, according to a widely accepted lower limit for normal total testosterone levels
  • Hypogonadism ranged from 5.2% to 13.8% and 22.4% depending on the threshold used (total testosterone less than 8, 10.4 and 12 nmol/L, respectively
  • During follow-up, 139 of the patients had a major cardiac event, such as ischaemic heart disease, cerebrovascular events (stroke or transient ischaemic attack) or peripheral artery disease
  • MACE were fatal in 15 men
  • Although low testosterone in itself was not associated with MACE, those patients with total testosterone levels below 10.4 nmol/L who had a major cardiac event were significantly more likely to die than those with higher testosterone levels
  • When adjusted for Chronic Diseases Score (an index of comorbidities) the risk of death was increased by a factor of seven (hazard ratio [HR] 7.1) in men with testosterone below 8 nmol/L
  • Of interest, fatal MACE were associated with a higher ANDROTEST score measuring hypogonadal-related symptoms and signs (HR = 1.2 for each ANDROTEST score increment; P = 0.05).

1 April 2011

Increased risk of dying from cardiovascular disease for men with erectile dysfunction and low testosterone

Image: Human heart

There is increasing evidence that erectile dysfunction may be a warning sign of a number of disease conditions, such as high blood pressure, metabolic syndrome, diabetes mellitus, depression and coronary heart disease.

Nearly 1700 men attending an andrology clinic for erectile dysfunction were monitored for an average of 4.3 years to find out whether those with low testosterone levels were more likely to suffer a major cardiovascular disease event, such as a heart attack or stroke.

Last updated: 2018
L.ZA.MKT.GM.10.2016.1381