Further research is required to determine the relationship between testosterone levels and cardiovascular disease in men and to explore the risk-benefit of testosterone therapy, according to a review published online Sept. 24 in the Journal of Clinical Endocrinology & Metabolism.

Johannes B. Ruige, M.D., of the Ghent University Hospital in Belgium, and colleagues reviewed literature published between 1970 and 2013 to assess the beneficial and adverse effects of testosterone on the cardiovascular system in men.

The researchers found that low testosterone levels in men are associated with increased blood pressure, dyslipidemia, atherosclerosis, thrombosis, endothelial dysfunction, arrhythmia, and impaired left ventricular function. Although evidence suggests a modest association between low levels of testosterone and cardiovascular disease and mortality in men, the benefit of testosterone therapy has not been established. Little evidence was found for a connection between low testosterone and artherosclerosis and no relationship was seen between testosterone levels and heart attacks.

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“The important knowledge gap as to the exact relationship between testosterone and cardiovascular disease would support a cautious, restrained approach to testosterone therapy in aging men, pending clarification of benefits and risks by adequately powered clinical trials of sufficient duration,” the authors write.