Abstract
The diagnosis and treatment of androgen deficiency in boys and adult men with classical syndromes of hypogonadism are well established. Older men show a progressive decline of total and free testosterone levels, which have been related to sexual, somatic, and psychological symptoms. Some comorbid diseases, such as obesity, metabolic syndrome, diabetes, and atherosclerosis, further accentuate age-related testosterone deficiency, also named late-onset hypogonadism. Epidemiological data indicate that late-onset hypogonadism can be considered a new marker of cardiovascular health and mortality. The diagnosis of this emergent condition is challenged by the limitations of laboratory methods, the lack of standardized age-dependent thresholds of testosterone concentrations, and the uncertainties about the clinical significance of the symptoms attributable to hypogonadism. Whether low testosterone is just a consequence of metabolic imbalance and/or cardiovascular disease or a contributory factor to the progression of atherosclerosis is currently unclear, but it is likely that a bidirectional effect between decreased testosterone concentrations and disease pathology exists. Current indications for testosterone replacement therapy are limited to men with consistent symptoms and signs, and clearly low levels of testosterone. Nevertheless, testosterone treatment, beyond their known physiological actions on sexual function, bone mineralization, and body composition, has demonstrated modest positive effects on insulin resistance, glycemic control, and lipid profile in some trials performed in hypogonadal men with metabolic syndrome and/or diabetes. Furthermore, acute and chronic effects of testosterone suggest a vasodilator action on coronary vessels. Periodic monitoring of patients will be necessary to assess the treatment outcome, to decide the need for continuing treatment, and to avoid adverse effects, especially erythrocytosis and prostate cancer. While the old paradigm of testosterone being a dangerous hormone for the heart is no longer valid, the available evidence on the benefits and long-term risks of testosterone replacement therapy is still limited, especially in older men, and more basic and clinical research is needed to expand our knowledge on the role and the possibilities of testosterone.
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Abbreviations
- BMI:
-
Body mass index
- DHT:
-
Dihydrotestosterone
- FT:
-
Free testosterone
- HDL:
-
High-density lipoprotein
- HOMA:
-
Homeostatic model assessment
- IL-6:
-
Interleukin-6
- LDL:
-
Low-density lipoprotein
- LH:
-
Luteinizing hormone
- LOH:
-
Late-onset hypogonadism
- PADAM:
-
Partial androgen deficiency of the aging male
- PSA:
-
Prostate-specific antigen
- SHBG:
-
Sex hormone-binding globulin
- SOCCs:
-
Store-operated Ca2+ channels
- TDS:
-
Testosterone deficiency syndrome
- Tfm:
-
Testicular-feminized mouse
- TNF-α:
-
Tumor necrosis factor-α
- TT:
-
Total testosterone
- VOCCs:
-
Voltage-operated Ca2+ channels
References
Ajayi AA, Mathur R, Halushka PV (1995) Testosterone increases human platelet thromboxane A2 receptor density and aggregation responses. Circulation 91:2742–2747
Aksut SV, Aksut G, Karamehmetoglu A, Oram E (1986) The determination of serum estradiol, testosterone and progesterone in acute myocardial infarction. Jpn Heart J 27:825–837
Alexandersen P, Haarbo J, Byrialsen I, Lawaetz H, Christiansen C (1999) Natural androgens inhibit male atherosclerosis. A study in castrated, cholesterol fed rabbits. Circ Res 84:813–819
Anderson FH, Francis RM, Faulkner K (1996) Androgen supplementation in eugonadal men with osteoporosis-effects of 6 months of treatment on bone mineral density and cardiovascular risk factors. Bone 18:171–177
Araujo AB, Dixon JM, Suarez EA, Murad MH, Guey LT, Wittert GA (2011) Clinical review: endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol Metab 96:3007–3019
Aversa A, Isidori AM, De Martino MU, Caprio M, Fabbrini E, Rocchietti-March M, Frajese G, Fabbri A (2000) Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction. Clin Endocrinol (Oxf) 53:517–522
Bagatell CJ, Bremner WJ (1996) Androgens in men – uses and abuses. N Engl J Med 334:707–714
Baldo-Enzi G, Giada F, Zuliani G, Baroni L, Vitale E, Enzi G, Magnanini P, Fellin R (1990) Lipid and apoprotein modifications in body builders during and after self-administration of anabolic steroids. Metabolism 39:203–208
Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, Jette AM, Eder R, Tennstedt S, Ulloor J, Zhang A, Choong K, Lakshman KM, Mazer NA, Miciek R, Krasnoff J, Elmi A, Knapp PE, Brooks B, Appleman E, Aggarwal S, Bhasin G, Hede-Brierley L, Bhatia A, Collins L, LeBrasseur N, Fiore LD, Bhasin S (2010) Adverse events associated with testosterone administration. N Engl J Med 363:109–122
Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM, Task Force, Endocrine Society (2010) Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 95:2536–2559
Bhasin S, Pencina M, Jasuja GK, Travison TG, Coviello A, Orwoll E, Wang PY, Nielson C, Wu F, Tajar A, Labrie F, Vesper H, Zhang A, Ulloor J, Singh R, D’Agostino R, Vasan RS (2011) Reference ranges for testosterone in men generated using liquid chromatography tandem mass spectrometry in a community-based sample of healthy nonobese young men in the Framingham Heart Study and applied to three geographically distinct cohorts. J Clin Endocrinol Metab 96:2430–2439
Brand JS, van der Tweel I, Grobbee DE, Emmelot-Vonk MH, van der Schouw YT (2011) Testosterone, sex hormone-binding globulin and the metabolic syndrome: a systematic review and meta-analysis of observational studies. Int J Epidemiol 40:189–207
Calof OM, Singh AB, Lee ML, Kenny AM, Urban RJ, Tenover JL, Bhasin S (2005) Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci 60:1451–1457
Caminiti G, Volterrani M, Iellamo F, Marazzi G, Massaro R, Miceli M, Mammi C, Piepoli M, Fini M, Rosano GM (2009) 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 54:919–927
Cohen PG (1999) The hypogonadal-obesity cycle: role of aromatase in modulating the testosterone–estradiol shunt – a major factor in the genesis of morbid obesity. Med Hypotheses 52:49–51
Corona G, Mannucci E, Schulman C, Petrone L, Mansani R, Cilotti A, Balercia G, Chiarini V, Forti G, Maggi M (2006) Psychobiologic correlates of the metabolic syndrome and associated sexual dysfunction. Eur Urol 50:595–604
Corona G, Monami M, Rastrelli G, Aversa A, Tishova Y, Saad F, Lenzi A, Forti G, Mannucci E, Maggi M (2011a) Testosterone and metabolic syndrome: a meta-analysis study. J Sex Med 8:272–283
Corona G, Monami M, Rastrelli G, Aversa A, Sforza A, Lenzi A, Forti G, Mannucci E, Maggi M (2011b) Type 2 diabetes mellitus and testosterone: a meta-analysis study. Int J Androl 34:528–540
Corona G, Rastrelli G, Monami M, Guay A, Buvat J, Sforza A, Forti G, Mannucci E, Maggi M (2011c) Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. Eur J Endocrinol 165:687–701
Corrales JJ, Almeida M, Burgo R, Mories MT, Miralles JM, Orfao A (2006) Androgen-replacement therapy depresses the ex vivo production of inflammatory cytokines by circulating antigen-presenting cells in aging type-2 diabetic men with partial androgen deficiency. J Endocrinol 189:595–604
Cunningham GR, Toma SM (2011) Clinical review: why is androgen replacement in males controversial? J Clin Endocrinol Metab 96:38–52
Deenadayalu VP, White RE, Stallone JN, Gao X, Garcia AJ (2001) Testosterone relaxes coronary arteries by opening the large-conductance, calcium-activated potassium channel. Am J Physiol 281:H1720–H1727
Ding EL, Song Y, Malik VS, Liu S (2006) Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 295:1288–1299
English KM, Steeds RP, Jones TH, Diver MJ, Channer KS (2000) Low-dose transdermal testosterone therapy improves angina threshold in men with chronic stable angina: a randomized, double-blind, placebo-controlled study. Circulation 102:1906–1911
English KM, Jones RD, Jones TH, Morice AH, Channer KS (2002) Testosterone acts as a coronary vasodilator by a calcium channel antagonist action. J Endocrinol Invest 25:455–458
Fernández-Balsells MM, Murad MH, Lane M, Lampropulos JF, Albuquerque F, Mullan RJ, Agrwal N, Elamin MB, Gallegos-Orozco JF, Wang AT, Erwin PJ, Bhasin S, Montori VM (2010) Clinical review 1: adverse effects of testosterone therapy in adult men: a systematic review and meta-analysis. J Clin Endocrinol Metab 95:2560–2575
Fowler JE Jr, Whitmore WF Jr (1981) The response of metastatic adenocarcinoma of the prostate to exogenous testosterone. J Urol 126:372–375
Friedrich N, Völzke H, Rosskopf D, Steveling A, Krebs A, Nauck M, Wallaschofski H (2008) Reference ranges for serum dehydroepiandrosterone sulfate and testosterone in adult men. J Androl 29:610–617
Giannoulis MG, Martin FC, Nair KS, Umpleby AM, Sonksen P (2012) Hormone replacement therapy and physical function in healthy older men. Time to talk hormones? Endocr Rev 33:314–377
Giton F, Fiet J, Guéchot J, Ibrahim F, Bronsard F, Chopin D, Raynaud JP (2006) Serum bioavailable testosterone: assayed or calculated? Clin Chem 52:474–481
Gray A, Feldman HA, McKinlay JB, Longcope C (1991) Age, disease, and changing sex hormone levels in middle-aged men: results of the Massachusetts Male Aging Study. J Clin Endocrinol Metab 73:1016–1025
Haffner SM, Ksuhwaha RS, Foster DM, Applebaum-Bowden D, Hazzard WR (1983) Studies on the metabolic mechanism of reduced high density lipoprotein during anabolic steroid therapy. Metabolism 32:413–417
Hall J, Jones RD, Jones TH, Channer KS, Peers C (2006) Selective inhibition of L-type Ca2+ channels in A7r5 cells by physiological levels of testosterone. Endocrinology 147:2675–2680
Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR, Baltimore Longitudinal Study of Aging (2001) Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 86:724–731
Isidori AM, Caprio M, Stroll F, Moretti C, Frajese G, Isidori A, Fabbri A (1999) Leptin and androgens in male obesity: evidence for leptin contribution to reduced androgen levels. J Clin Endocrinol Metab 84:3673–3680
Jeppesen LL, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS, Winther K (1996) Decreased serum testosterone in men with acute ischemic stroke. Arterioscler Thromb Vasc Biol 16:749–754
Johannsson G, Gibney J, Wolthers T, Leung KC, Ho KK (2005) Independent and combined effects of testosterone and growth hormone on extracellular water in hypopituitary men. J Clin Endocrinol Metab 90:3989–3994
Jones TH (2007) Testosterone associations with erectile dysfunction, diabetes and the metabolic syndrome. Eur Urol Suppl 6:847–857
Jones TH, Arver S, Behre HM, Buvat J, Meuleman E, Moncada I, Morales AM, Volterrani M, Yellowlees A, Howell JD, Channer KS, TIMES2 Investigators (2011) Testosterone replacement in hypogonadal men with type 2 diabetes and/or metabolic syndrome (the TIMES2 study). Diabetes Care 34:828–837
Kalinchenko SY, Tishova YA, Mskhalaya GJ, Gooren LJ, Giltay EJ, Saad F (2010) Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol 73:602–612
Kaufman JM, Vermeulen A (2005) The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev 26:833–876
Keating NL, O’Malley AJ, Smith MR (2006) Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol 24:4448–4456
Kelly DM, Jones TH (2013a) Testosterone: a metabolic hormone in health and disease. J Endocrinol 217:R25–R45
Kelly DM, Jones TH (2013b) Testosterone: a vascular hormone in health and disease. J Endocrinol 217:R47–R71
Khaw KT, Dowsett M, Folkerd E, Bingham S, Wareham N, Luben R, Welch A, Day N (2007) Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation 116:2694–2701
Kupelian V, Page ST, Araujo AB, Travison TG, Bremner WJ, McKinlay JB (2006) Low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men. J Clin Endocrinol Metab 91:843–850
Laughlin GA, Barrett-Connor E, Bergstrom J (2008) Low serum testosterone and mortality in older men. J Clin Endocrinol Metab 93:68–75
Lesser MA (1942) The treatment of angina pectoris with testosterone propionate; preliminary report. N Engl J Med 226:51–54
Maggio M, Lauretani F, Ceda GP, Bandinelli S, Ling SM, Metter EJ, Artoni A, Carassale L, Cazzato A, Ceresini G, Guralnik JM, Basaria S, Valenti G, Ferrucci L (2007) Relationship between low levels of anabolic hormones and 6-year mortality in older men: the aging in the Chianti Area (InCHIANTI) study. Arch Intern Med 167:2249–2254
Malkin CJ, Pugh PJ, Morris PD, Kerry KE, Jones RD, Jones TH, Channer KS (2004) Testosterone replacement in hypogonadal men with angina improves ischaemic threshold and quality of life. Heart 90:871–876
Malkin CJ, Pugh PJ, West JN, van Beek EJ, Jones TH, Channer KS (2006) Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial. Eur Heart J 27:57–64
Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, Channer KS (2010) Low serum testosterone and increased mortality in men with coronary heart disease. Heart 96:1821–1825
Mårin P, Holmäng S, Gustafsson C, Jönsson L, Kvist H, Elander A, Eldh J, Sjöström L, Holm G, Björntorp P (1993) Androgen treatment of abdominally obese men. Obes Res 1:245–251
Mathur A, Malkin C, Saeed B, Muthusamy R, Jones TH, Channer K (2009) Long-term benefits of testosterone replacement therapy on angina threshold and atheroma in men. Eur J Endocrinol 161:443–449
Mohr BA, Guay AT, O’Donnell AB, McKinlay JB (2005) Normal, bound and non-bound testosterone levels in normally ageing men: results from the Massachusetts Male Ageing study. Clin Endocrinol 62:64–73
Morgentaler A, Schulman C (2009) Testosterone and prostate safety. Front Horm Res 37:197–203
Morris PD, Channer KS (2012) Testosterone and cardiovascular disease in men. Asian J Androl 14:428–435
Musabak U, Bolu E, Ozata M, Oktenli C, Sengul A, Inal A, Yesilova Z, Kilciler G, Ozdemir IC, Kocar IH (2003) Gonadotropin treatment restores in vitro interleukin-1beta and tumour necrosis factor-alpha production by stimulated peripheral blood mononuclear cells from patients with idiopathic hypogonadotropic hypogonadism. Clin Exp Immunol 132:265–270
Nettleship JE, Jones TH, Channer KS, Jones RD (2007) 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 116:2427–2434
Nguyen PL, Je Y, Schutz FA, Hoffman KE, Hu JC, Parekh A, Beckman JA, Choueiri TK (2011) Association of androgen deprivation therapy with cardiovascular death in patients with prostate cancer: a meta-analysis of randomized trials. JAMA 306:2359–2366
Nieminen MS, Rämö MP, Viitasalo M, Heikkilä P, Karjalainen J, Mäntysaari M, Heikkilä J (1996) Serious cardiovascular side effects of large doses of anabolic steroids in weight lifters. Eur Heart J 17:1576–1583
Phillips GB, Pinkernell BH, Jing TY (1994) The association of hypotestosteronemia with coronary artery disease in men. Arterioscler Thromb 14:701–706
Pitteloud N, Hardin M, Dwyer AA, Valassi E, Yialamas M, Elahi D, Hayes FJ (2005) Increasing insulin resistance is associated with a decrease in Leydig cell testosterone secretion in men. J Clin Endocrinol Metab 90:2636–2641
Pugh PJ, Jones TH, Channer KS (2003) Acute haemodynamic effects of testosterone in men with chronic heart failure. Eur Heart J 24:909–915
Pugh PJ, Jones RD, West JN, Jones TH, Channer KS (2004) Testosterone treatment for men with chronic heart failure. Heart 90:446–447
Raynaud JP, Gardette J, Rollet J, Legros JJ (2013) Prostate-specific antigen (PSA) concentrations in hypogonadal men during 6 years of transdermal testosterone treatment. BJU Int 111:880–890
Rey RA, Grinspon RP, Gottlieb S, Pasqualini T, Knoblovits P, Aszpis S, Pacenza N, Stewart Usher J, Bergadá I, Campo SM (2013) Male hypogonadism: an extended classification based on a developmental, endocrine physiology-based approach. Andrology 1:3–16
Roddam AW, Allen NE, Appleby P, Key TJ (2008) Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst 100:170–183
Rosano GM, Leonardo F, Pagnotta P, Pelliccia F, Panina G, Cerquetani E, Monica PL, Bonfigli B, Volpe M, Chierchia SL (1999) Acute anti-ischemic effect of testosterone in men with coronary artery disease. Circulation 99:1666–1670
Rosano GM, Sheiban I, Massaro R, Pagnotta P, Marazzi G, Vitale C, Mercuro G, Volterrani M, Aversa A, Fini M (2007) Low testosterone levels are associated with coronary artery disease in male patients with angina. Int J Impot Res 19:176–182
Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H (2007) Position statement: utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society Position Statement. J Clin Endocrinol Metab 92:405–413
Ruige JB, Mahmoud AM, De Bacquer D, Kaufman JM (2011) Endogenous testosterone and cardiovascular disease in healthy men: a meta-analysis. Heart 97:870–875
Saad F, Aversa A, Isidori AM, Zafalon L, Zitzmann M, Gooren L (2011) Onset of effects of testosterone treatment and time span until maximum effects are achieved. Eur J Endocrinol 165:675–685
Scragg JL, Jones RD, Channer KS, Jones TH, Peers C (2004) Testosterone is a potent inhibitor of L-type Ca21 channels. Biochem Biophys Res Commun 318:503–506
Sewdarsen M, Vythilingum S, Jialal I, Desai RK (1990) Abnormalities in sex hormones are a risk factor for premature manifestation of coronary artery disease in South African Indian men. Atherosclerosis 83:111–117
Shahani S, Braga-Basaria M, Basaria S (2008) Androgen deprivation therapy in prostate cancer and metabolic risk for atherosclerosis. J Clin Endocrinol Metab 93:2042–2049
Shigehara K, Sugimoto K, Konaka H, Iijima M, Fukushima M, Maeda Y, Mizokami A, Koh E, Origasa H, Iwamoto T, Namiki M (2011) Androgen replacement therapy contributes to improving lower urinary tract symptoms in patients with hypogonadism and benign prostate hypertrophy: a randomised controlled study. Aging Male 14:53–58
Shores MM, Moceri VM, Gruenewald DA, Brodkin KI, Matsumoto AM, Kivlahan DR (2004) Low testosterone is associated with decreased function and increased mortality risk: a preliminary study of men in a geriatric rehabilitation unit. J Am Geriatr Soc 52:2077–2081
Shores MM, Matsumoto AM, Sloan KL, Kivlahan DR (2006) Low serum testosterone and mortality in male veterans. Arch Intern Med 166:1660–1665
Shores MM, Smith NL, Forsberg CW, Anawalt BD, Matsumoto AM (2012) Testosterone treatment and mortality in men with low testosterone levels. J Clin Endocrinol Metab 97:2050–2058
Spratt DI, Bigos ST, Beitins I, Cox P, Longcope C, Orav J (1992) Both hyper- and hypogonadotropic hypogonadism occur transiently in acute illness: bio- and immunoactive gonadotropins. J Clin Endocrinol Metab 75:1562–1570
Strain GW, Zumoff B, Miller LK, Rosner W, Levit C, Kalin M, Hershcopf RJ, Rosenfeld RS (1988) Effect of massive weight loss on hypothalamic-pituitary-gonadal function in obese men. J Clin Endocrinol Metab 66:1019–1023
Tajar A, Forti G, O’Neill TW, Lee DM, Silman AJ, Finn JD, Bartfai G, Boonen S, Casanueva FF, Giwercman A, Han TS, Kula K, Labrie F, Lean ME, Pendleton N, Punab M, Vanderschueren D, Huhtaniemi IT, Wu FC, EMAS Group (2010) Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study. J Clin Endocrinol Metab 95:1810–1818
Taskinen MR (2007) Is the metabolic syndrome the main threat to human health in the twenty-first century? Arterioscler Throm Vasc Biol 27:2275
Tenover JL (1992) Effects of testosterone supplementation in the ageing male. J Clin Endocrinol Metab 75:1092–1098
Traish AM, Guay A, Feeley R, Saad F (2009a) The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. J Androl 30:10–22
Traish AM, Saad F, Guay A (2009b) The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J Androl 30:23–32
Tsai HK, D’Amico AV, Sadetsky N, Chen MH, Carroll PR (2007) Androgen deprivation therapy for localized prostate cancer and the risk of cardiovascular mortality. J Natl Cancer Inst 99:1516–1524
Vermeulen A, Verdonck L, Kaufman JM (1999) A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 84:3666–3672
Vesper HW, Bhasin S, Wang C, Tai SS, Dodge LA, Singh RJ, Nelson J, Ohorodnik S, Clarke NJ, Salameh WA, Parker CR Jr, Razdan R, Monsell EA, Myers GL (2009) Interlaboratory comparison study of serum total testosterone [corrected] measurements performed by mass spectrometry methods. Steroids 74:498–503
Wang C, Catlin DH, Demers LM, Starcevic B, Swerdloff RS (2004) Measurement of total serum testosterone in adult men: comparison of current laboratory methods versus liquid chromatography–tandem mass spectrometry. J Clin Endocrinol Metab 89:534–543
Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, Kaufman JM, Legros JJ, Lunenfeld B, Morales A, Morley JE, Schulman C, Thompson IM, Weidner W, Wu FC (2008) Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol 159:507–514
Webb CM, McNeill JG, Hayward CS, de Zeigler D, Collins P (1999a) Effects of testosterone on coronary vasomotor regulation in men with coronary heart disease. Circulation 100:1690–1696
Webb CM, Adamson DL, de Zeigler D, Collins P (1999b) Effect of acute testosterone on myocardial ischaemia in men with coronary artery disease. Am J Cardiol 83:437–439
Wu FC, Tajar A, Pye SR, Silman AJ, Finn JD, O’Neill TW, Bartfai G, Casanueva F, Forti G, Giwercman A, Huhtaniemi IT, Kula K, Punab M, Boonen S, Vanderschueren D, European Male Aging Study Group (2008) Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab 93:2737–2745
Wu FC, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, O’Neill TW, Bartfai G, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Lean ME, Pendleton N, Punab M, Boonen S, Vanderschueren D, Labrie F, Huhtaniemi IT, EMAS Group (2010) Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 363:123–135
Zirkin BR, Tenover JL (2012) Aging and declining testosterone: past, present, and hopes for the future. J Androl 33:1111–1118
Further Reading
Kang HY (2013) Beyond the male sex hormone: deciphering the metabolic and vascular actions of testosterone. J Endocrinol 217:C1–C3. doi:10.1530/JOE-13-0052
Surampudi PN, Wang C, Swerdloff R (2012) Hypogonadism in the aging male diagnosis, potential benefits, and risks of testosterone replacement therapy. Int J Endocrinol 2012:625434. doi:10.1155/2012/625434
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Bassas, L., Resmini, E. (2015). Hormone Replacement Therapy with Testosterone and the Vascular System. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37078-6_173
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