Male gender, diabetes mellitus, and obesity, are known risk factors for the development of cardiovascular disease. Increasing attention has been given in recent years to the link between testosterone deficiency and increased risk of cardiometabolic disease. Recent meta-analyses have demonstrated a correlation between metabolic syndrome (e.g., commonly defined as obesity, diabetes/insulin resistance, hypertension, dyslipoproteinemia and gout) and lower serum testosterone levels.
Hypogonadotropic hypogonadism occurs in up to 33% of men with type 2 diabetes. The Massachusetts Male Aging Study found that low levels of testosterone and sex hormone binding globulin (SHBG) are independent risk factors for the development of type 2 diabetes. In addition, this study demonstrated that low serum testosterone predicts the development of metabolic syndrome.
Declining serum testosterone levels throughout a man’s life are associated with an increase in all-cause mortality and an increase in atherosclerosis, visceral obesity, insulin resistance, dyslipidemia, and hypertension, the key components of the metabolic syndrome. Prospective clinical trials in men with prostate cancer who have undergone androgen deprivation therapy have found increased cardiovascular risk by increasing body weight, reducing insulin sensitivity, and/or resulting in dyslipidemia.
Reference: Ullah MI, Washington T, Kazi M, et al. Testosterone deficiency as a risk factor for cardiovascular disease. Horm Met Res 2001;43:153-164.