FOIU 2018: Testosterone and Cardiovascular Mortality

Tel-Aviv, Israel ( Claude Schulman, MD discussed the topic of testosterone and its effect on cardiovascular mortality. Testosterone has significant roles in several organs, including skin, liver, bone, male sexual organs, brain, muscle, kidney, and bone marrow (Figure 1). In the “HIM” study low testosterone levels were associated with a myriad of chronic diseases (Table 1). 1 Lower volumes of testosterone are risk factors for hypertension, diabetes, cardiovascular disease (CVD), and metabolic syndrome.

Figure 1: Testosterone roles
UroToday FOIU2018 Testosterone roles

Table 1 – The association between low testosterone and other medical conditions:
UroToday FOIU2018 The association between low testosterone and other medical conditions

In the Massachusetts male aging study 3518 men were followed for 17 years. Men with lower testosterone levels (<200 ng/dl) had a 1.93 fold risk for all mortalities (p=0.03), 3.3 fold risk for cancer death (p=0.03), and 1.93 fold risk for CVD death.2 In fact, low testosterone levels are associated with decreased general life expectancy (Figure 2).  Low testosterone levels are associated with increased waist circumference, and excess leptin, secreted from fat tissue, causes less testosterone to be secreted.

Figure 2 – Low testosterone and life expectancy:
UroToday FOIU2018 Low testosterone and life expectancys

Metabolic syndrome, composed of the “deadly 4”: diabetes, obesity, hypertension, and dyslipidemia, are associated with low levels of testosterone (TDS). The association between metabolic syndrome and TDS leads to endothelial dysfunction and vascular morbidity (Figure 3). Normalization of testosterone levels is associated with reduced incidence of myocardial infarction, and mortality in men. The European medicines society has demonstrated no consistent evidence of an increased risk of heart problems with testosterone medicines.

Figure 3  - Low testosterone, endothelial dysfunction, and vascular morbidity:
UroToday FOIU2018 Low testosterone endothelial dysfunction and vascular morbidity

1. Mulligan et al. Int J. Clin Pract 2006
2. Araujo AB et al. Total testosterone as a predictor of mortality in men. The endocrine society 2005 annual meeting, San-Diego, CA, June 4-7.

Presented by: Claude Schulman, MD, Brussels, Belgium

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan  at the 2018 FOIU 4th Friends of Israel Urological Symposium, July 3-5. 2018, Tel-Aviv, Israel