Total testosterone and SHBG levels are reduced in men who are obese and hyperin-sulinemic, and men with type 2 diabetes. Men with lower levels of testosterone have lower levels of HDL-C and triglycerides and higher levels of the thrombotic factors, tissue PAI, fibrinogen, and factor VII. Low testosterone increases the risk for developing type 2 diabetes and, perhaps, hypertension. Each of these factors predisposes to atherosclerosis and coronary vascular disease, whereas the contribution of low testosterone to the metabolic-cardiovascular syndrome is less certain. More studies are needed to examine the contribution of low SHBG levels when total testosterone or analog methods for free testosterone were used to assess androgenicity in men who are at risk for cardiovascular disease. Furthermore, prospective trials to determine whether testosterone replacement protects against the development of coronary vascular disease are justified.

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