American Journal of Cardiovascular Drugs

, Volume 5, Issue 3, pp 141–154 | Cite as

Testosterone and Atherosclerosis in Aging Men

Purported Association and Clinical Implications
  • Richard D. Jones
  • Joanne E. Nettleship
  • Dheeraj Kapoor
  • Hugh T. Jones
  • Kevin S. Channer
Current Opinion


Two of the strongest independent risk factors for coronary heart disease (CHD) are increasing age and male sex. Despite a wide variance in CHD mortality between countries, men are consistently twice as likely to die from CHD than their female counterparts. This sex difference has been attributed to a protective effect of female sex hormones, and a deleterious effect of male sex hormones, upon the cardiovascular system. However, little evidence suggests that testosterone exerts cardiovascular harm. In fact, serum levels of testosterone decline with age, and low testosterone is positively associated with other cardiovascular risk factors. Furthermore, testosterone exhibits a number of potential cardioprotective actions. For example, testosterone treatment is reported to reduce serum levels of the pro-inflammatory cytokines interleukin (IL)-1β and tumor necrosis factor (TNF)-α, and to increase levels of the anti-inflammatory cytokine IL-10; to reduce vascular cell adhesion molecule (VCAM)-1 expression in aortic endothelial cells; to promote vascular smooth muscle and endothelial cell proliferation; to induce vasodilatation and to improve vascular reactivity, to reduce serum levels of the pro-thrombotic factors plasminogen activator inhibitor (PAI)-1 and fibrinogen; to reduce low-density lipoprotein-cholesterol (LDL-C); to improve insulin sensitivity; and to reduce body mass index and visceral fat mass. These actions of testosterone may confer cardiovascular benefit since testosterone therapy reduces atheroma formation in cholesterol-fed animal models, and reduces myocardial ischemia in men with CHD. Consequently, an alternative hypothesis is that an age-related decline in testosterone contributes to the atherosclerotic process. This is supported by recent findings, which suggest that as many as one in four men with CHD have serum levels of testosterone within the clinically hypogonadal range. Consequently, restoration of serum levels of testosterone via testosterone replacement therapy could offer cardiovascular, as well as other, clinical advantages to these individuals.


Testosterone Coronary Heart Disease Androgen Receptor DHEA Total Testosterone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr R.D. Jones is supported by the British Heart Foundation.

The author has no conflicts of interest that are directly relevant to the content of this article.


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Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Richard D. Jones
    • 1
  • Joanne E. Nettleship
    • 1
  • Dheeraj Kapoor
    • 1
    • 2
  • Hugh T. Jones
    • 1
    • 2
  • Kevin S. Channer
    • 3
    • 4
  1. 1.Academic Unit of Endocrinology, Division of Genomic Medicine, Hormone & Vascular Biology GroupThe University of Sheffield, The Medical SchoolSheffieldUK
  2. 2.Center for Diabetes and EndocrinologyBarnsley District General HospitalBarnsleyUK
  3. 3.Department of CardiologyRoyal Hallamshire HospitalSheffieldUK
  4. 4.Faculty of Health and WellbeingSheffield Hallam UniversitySheffieldUK

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