Normal Sex Steps Amages

Cardiovascular disease is more common in men than in menstruating women, and more common in women with elevated serum androgen levels, as in polycystic ovary syndrome (PCOS) (1) or type 2 diabetes (2) than in normal women. Interest in the relationship between androgens and cardiovascular disease has been stimulated further by the emerging use of testosterone replacement for older men because of concern that cardiovascular risk might increase as a side effect of therapy. The relationship between circulating androgens and the cardiovascular syndrome is intimately related to sex hormone-binding globulin (SHBG) and its downregulation in obesity and by insulin. In fact, SHBG is an indicator of the association between sex hormones and plasma lipids, and low levels of SHBG predict the development of type 2 diabetes. Thus, low testosterone and low SHBG are a part of the metabolic cardiovascular syndrome, and, therefore, testosterone replacement has been advocated in these men to reduce their risk for developing coronary vascular disease. In this chapter, the endocrine regulatory mechanisms that provide insight into this controversy, the epidemiological studies that evaluated the relationship between circulating testosterone levels and risk factors for

From: Male Hypogonadism: Basic, Clinical, and Therapeutic Principles Edited by: S. J. Winters © Humana Press Inc., Totowa, NJ

Hypogonadism Klinefelter Syndrome
Fig. 1. Relationship between sex hormone-binding globulin and total testosterone levels in normal men.

atherosclerotic cardiovascular disease, measures of subclinical atherosclerosis, and cardiovascular disease end-points are reviewed. Also reviewed are recent animal and laboratory experiments that provide insight into how testosterone may influence the atherosclerotic disease process.

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