[en] Hypogonadism in patients with heart problems is a frequently underestimated clinical syndrome, characterized by signs and symptoms of androgen deficiency but also by fertility disorders. The pathophysiology of hypogonadism is complex and multifactorial. Age, diabetes and obesity determine hypothalamic and gonadal dysfunction. Historically, Brown Sequard initiated in 1889 the era of androgen treatment by injecting himself testicular extract of animal . He observed positive effects in iths strength as evaluated by dynamometer (1). Since 1917, Serge Voronoff did testes graft first in animals, then in aged males claiming in some of them some positif results (2)
A bundle of new arguments raise the interest of search and to consider treatment in selected patients with hypogonadism. First of all, several epidemiological studies (3) show that testosterone deficit predicts the occurrence of a metabolic syndrome and diabetes, and that this deficit is accompanied by a higher cardiovascular mortality (4). Then, nine recent studies show that intensive weight loss achieved by diet and/or weight loss surgery normalizes levels of testosterone (3). Furthermore, a meta analysis bearing on five studies confirms that the supplementation of testosterone in diabetic hypogonadic patients induces a modest reduction in abdominal circumference, decreasing glycemia and HbA1c (5). Finally, some studies indicate that supplementation with testosterone in these patients improve their survival (6).
If all these of observation and intervention studies suggest positive effects induced by testosterone, we should regret a lack of randomized large studies, assessing the risks and benefits of testosterone long term hormonal supplementation in these patients. This presentation summarizes the current evidence linking testosterone and cardiovascular health.
