Endocrine Abstracts

Introduction: The role of testosterone in cardiovascular (CV) health of men is controversial. Several data suggest that hypogonadism is associated with CV mortality but not morbidity. However, recent evidence shows that hypogonadal subjects treated with testosterone replacement therapy have a higher incidence of major adverse CV events (MACE). The aim of this study is to analyse whether the gonadal status might predict MACE incidence according to the previous history of MACE, in a cohort of subjects complaining for sexual dysfunction.

Methods: A consecutive series of 1687 patients was followed-up for a mean time of 4.3±2.6 years for new occurrence of MACE, detecting 139 events.

Results: Hypogonadism (total testosterone <12 nmol/l) was not associated with an increased incidence of MACE in the entire cohort. However, when considering patients with a previous history of MACE, hypogonadism was associated with a reduced risk of MACE, even after adjusting for confounders (HR=0.498 (0.240; 0.996); P=0.049), whereas no relationship was observed in subjects free of previous MACE. Similar results were observed when reduced testis volume (TV) was considered as a predictor of MACE in subjects with previous MACE (HR=0.486 (0.257; 0.920); P=0.027). In patients with a history of MACE, but not in those free of MACE, having both low testosterone and low TV was associated with a higher incidence of MACE as compared with subjects with only one or none of these conditions, even after adjusting for confounders (HR=0.514 (0.306; 0.864); P for trend <0.02). Notably, CV risk estimated with risk engines based on traditional risk factors was not different between hypogonadal and eugonadal subjects.

Conclusions: Present data show that hypogonadism could be interpreted as a protective mechanism in unhealthy conditions, such as a previous MACE, to avoid fatherhood and spare energy.