To summarize the relationships between testosterone and cardiovascular health outcomes based on both observational and interventional studies.
Key Findings:
Lower endogenous testosterone concentrations are associated with higher all-cause mortality but not with incident cardiovascular events or CVD deaths.
Testosterone treatment did not increase the risk of major adverse cardiovascular events in men with CVD or multiple risk factors.
Nonlinear associations exist between baseline testosterone concentrations and mortality, with increased risks below certain thresholds, specifically < 7.4 nmol/L (213 ng/dL) for all-cause mortality and < 5.3 nmol/L (153 ng/dL) for cardiovascular mortality.
Interpretation:
While lower testosterone levels correlate with poorer health outcomes, the debate continues regarding whether they are a cause or merely a marker of health decline in aging men.
Limitations:
The studies reviewed primarily involve men aged 40 to 69, potentially limiting generalizability to older populations.
The reliance on specific immunoassays for testosterone measurement may affect accuracy compared to mass spectrometry, which could influence study outcomes.
Conclusion:
Further studies are needed to confirm the long-term cardiovascular safety of testosterone treatment and explore its potential benefits on body composition and cardiometabolic risk, particularly focusing on randomized controlled trials.
