More testosterone a good or bad thing? Cardiovascular perspective

Summary

Some studies suggest testosterone decreases HDL cholesterol and total cholesterol levels, while others indicate it leads to inconsequential changes in cholesterol levels.

Introduction

Testosterone, a key male sex hormone, has been studied for its potential effects on cholesterol levels and cardiovascular health. Understanding these effects is crucial, especially for men undergoing testosterone replacement therapy or those with low testosterone levels.

Key Insights

• Testosterone and HDL Cholesterol:

  • Testosterone therapy generally decreases high-density lipoprotein (HDL) cholesterol (good cholesterol) levels.

• Testosterone and Total Cholesterol:

  • Some studies indicate that testosterone therapy can reduce total cholesterol levels, while others show no significant change.

• Testosterone and LDL Cholesterol:

  • Lowering testosterone levels increases low-density lipoprotein (LDL) cholesterol (bad cholesterol), indicating that testosterone helps maintain lower LDL cholesterol levels.

  • Conversely, testosterone replacement therapy in hypogonadal and elderly men has been shown to decrease LDL cholesterol levels.

• Testosterone and Triglycerides:

  • Testosterone therapy does not significantly affect triglyceride levels.

• Testosterone and Insulin Sensitivity:

  • Testosterone therapy improves insulin sensitivity and glycemic control in men with type 2 diabetes, which may indirectly influence cholesterol metabolism.

• Testosterone and Inflammatory Markers:

  • Testosterone therapy can reduce pro-inflammatory cytokines and increase anti-inflammatory cytokines, potentially impacting cholesterol metabolism and cardiovascular risk.

• Mechanisms of Action:

  • Testosterone up-regulates scavenger receptor BI (SR-BI) and stimulates cholesterol efflux from macrophages, which may enhance reverse cholesterol transport and exert anti-atherogenic effects despite lowering HDL cholesterol.

Conclusion

Testosterone generally decreases HDL cholesterol levels and may sometimes reduce total cholesterol. Its effects on LDL cholesterol and triglycerides are less consistent. Additionally, testosterone improves insulin sensitivity and reduces inflammation, which could positively influence cholesterol metabolism and cardiovascular health. However, the clinical significance of these changes requires further investigation through larger, long-term studies.

Sources:

1. C. Langer et al. "Testosterone up-regulates scavenger receptor BI and stimulates cholesterol efflux from macrophages.." Biochemical and biophysical research communications, 296 5 (2002): 1051-7 .

2. R. Goldberg et al. "Suppression of plasma testosterone leads to an increase in serum total and high density lipoprotein cholesterol and apoproteins A-I and B.." The Journal of clinical endocrinology and metabolism, 60 1 (1985): 203-7 .

3. J. Mäkinen et al. "Endogenous testosterone and serum lipids in middle-aged men.." Atherosclerosis, 197 2 (2008): 688-93 .

4. J. S. Tenover et al. "Effects of testosterone supplementation in the aging male.." The Journal of clinical endocrinology and metabolism, 75 4 (1992): 1092-8 .

5. J. Morrison et al. "Serum testosterone associates with lower high-density lipoprotein cholesterol in black and white males, 10 to 15 years of age, through lowered apolipoprotein AI and AII concentrations.." Metabolism: clinical and experimental, 51 4 (2002): 432-7 .

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