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**5** 

**Testosterone Therapy and the Heart** 

Testosterone (T) therapy has been offered to men who have low T levels, who are symptomatic with classical androgen deficiency syndromes, to induce and maintain secondary sex characteristics and to improve muscle mass and strength, bone mineral density, their sexual function, and sense of well-being. Hypogonadism is a clinical syndrome that is caused by inability of the testis to produce physiological levels of T in men. The age-related reduction in T levels is a result of defects in both hypothalamic-pituitary and testicular function. A diagnosis of androgen deficiency should be made only when low serum T and consistent symptoms and signs are encountered in men. It is not recommended to offer T therapy to all older men with low T level. A decision should be made on an individualized basis for older men with clinically significant symptoms of androgen deficiency and consistently low T level. Hyperandrogenemia in women and hypoandrogenemia in men are associated with increased risk of coronary artery disease. In addition, these states are associated with insulin resistance, visceral obesity, elevated triglycerides, low high-density lipoprotein (HDL) cholesterol, lowdensitylipoprotein (LDL) cholesterol and plasminogen activator inhibitor (PAI-1). These gender differences and confounders make the exact role of endogenous androgens in atherosclerosis unclear. In contrast, exogenous androgens exert both apparently beneficial and deleterious effects on cardiovascular risk factors by reducing serum levels of PAI-1 (apparently deleterious), HDL-C, insulin, leptin, lipoprotein(a), visceral fat mass (apparently beneficial), and fibrinogen in women as well as men. Androgen-induced reduction in circulating HDL-C levels should not reflexively be considered to be pro-atherogenic, because it may show increased reverse cholesterol transport instead. Short-term use of supraphysiological doses of exogenous T can decrease the severity and frequency of angina pectoris and reverse the electrocardiographic signs of myocardial ischaemia; yet long-term effects have not been determined. Nonetheless, the effects of pharmacological doses of androgens particularly on flow-mediated dilatation and arterial compliance must be interpreted with caution, since in addition at physiological concentrations detrimental effects, neutral, and beneficial effects on vascular reactivity can be observed. Testosterone induces an anti-atherogenic effect by facilitating efflux of cellular cholesterol to HDL and induces pro-atherogenic effects on

macrophage function by increasing the uptake of modified lipoproteins.

In half of cross-sectional studies [Wu and Eckardstein 2003; Alexandersen et al 1996], serum levels of T were lower in patients with CAD than healthy controls. The other half of the

**2. Endogenous T and CAD morbidity\mortalitiy** 

**1. Introduction** 

Güzin Fidan Yaylal and Yaln Tolga Yaylal

 *Pamukkale University Turkey* 

