Low testosterone is common in men with cardiovascular disease and decreases

March 2011

A study in the United Kingdom observed 930 men with confirmed coronary artery disease over an average of nearly 7 years to find out how many had testosterone deficiency and to examine whether low testosterone affected survival.

Key findings

  • At the start of the study, over 20% of men with coronary heart disease had low testosterone levels (the medical term is hypogonadism), shown by blood test results for bioavailable testosterone
  • Over the time of the study, the death rate in men with low testosterone was higher than in men with normal levels of testosterone
  • 21% of men with low testosterone died of any cause, while only 12% of men with normal levels died
  • As well as increasing mortality overall, low testosterone more than doubled the rate of cardiovascular deaths
  • Only impairment of the function of the left ventricle in the heart, a condition that often leads to heart failure, had a larger negative effect on survival.

Source: Low serum testosterone and increased mortality in men with coronary heart disease. Malkin CJ, Pugh PJ, Morris PD, et al. Heart 2010;96(22):1821-1825.

Background information

Men are at least two- or three-times more likely to die from coronary heart disease than women, even when cardiovascular risk factors such as high total cholesterol levels, smoking, and high blood pressure are taken into consideration. Because of this, it has been assumed that testosterone, the male sex hormone secreted by the testes, is harmful and contributes to the increased cardiovascular risk for men.

However, there is little evidence that testosterone produced by the body is a risk factor, and testosterone plays an essential part in maintaining muscle, bone mass, sex drive and energy levels in men, together with playing a key role in male health and well-being.

Although the benefits of testosterone replacement on physical and sexual function, energy levels, fat and muscle mass, blood lipids and bone density in men with low testosterone have been known for some time, there is increasing evidence that mortality increases as testosterone levels decrease. Several large studies have shown that low testosterone levels increase the risk of all-cause and cardiovascular mortality. Until now, such studies have not generally included men with pre-existing, or at high risk of developing, cardiovascular disease.

This study is important, as it is the first to examine the effects of low testosterone in men with established coronary disease. The study shows that testosterone deficiency is common in patients with coronary disease and has a considerable negative impact on their survival. Investigating whether testosterone replacement can reduce the risk of death in men with lower than normal testosterone levels is a logical next step.

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