The role of testosterone in cardiovascular health: benefits and risks of replacement therapy

Testosterone, the primary male sex hormone, significantly impacts cardiovascular health. Produced mainly in the testes, its levels decline with age, leading to increased risks of cardiovascular diseases, sexual dysfunction, and metabolic disorders. This paper examines testosterone’s dual role in the cardiovascular system. Low levels are linked to increased risks of heart failure (HF) and coronary artery disease (CAD), while testosterone replacement therapy (TRT) can improve heart function, exercise tolerance, and metabolic health. However, supraphysiological doses or long-term therapy may cause pathological heart hypertrophy and vascular complications. Testosterone influences cardiomyocyte apoptosis, calcium regulation, and oxidative stress reduction, with anti-inflammatory effects shown to lower pro-inflammatory cytokine levels. Studies demonstrate TRT’s benefits in reducing cholesterol, blood pressure, and ischemic episodes in CAD patients, but conflicting data exist regarding its association with myocardial infarction risk. Additionally, testosterone’s effects vary in different cardiomyopathies, showing both protective and harmful outcomes. This review underscores the need for carefully tailored TRT to balance the benefits of maintaining optimal testosterone levels while minimizing cardiovascular risks.