Effects of Testosterone Use on Fat Distribution, Insulin Sensitivity and Atherosclerosis Progression

In spite of the widespread belief that testosterone supplementation increases the risk of atherosclerotic heart disease, evidence to support this premise is lacking, say the authors of an article in the September 2003 issue of Clinical Infectious Diseases.

Although supraphysiological doses of testosterone, such as those used by athletes and recreational body builders, decrease plasma high-density lipoprotein (HDL) cholesterol concentrations, replacement doses of testosterone have had only a modest or no effect on plasma HDL in placebo-controlled trials.

In epidemiological studies, serum total and free testosterone concentrations have been inversely correlated with intra-abdominal fat mass, risk of coronary artery disease, and type 2 diabetes mellitus.

Cross-sectional studies of middle-aged men have found a direct, rather than an inverse, relationship between serum testosterone levels and plasma HDL cholesterol concentrations, as well as an inverse correlation between serum testosterone levels and visceral fat volume. Testosterone supplementation in middle-aged men who have truncal obesity is associated with a reduction in visceral fat volume, serum glucose concentration, and blood pressure and an improvement in insulin sensitivity.

These data suggest that serum testosterone levels in the range that is midnormal for healthy young men are consistent with an optimal cardiovascular risk profile at any age and that testosterone concentrations either above or below the physiologically normal male range may increase the risk of atherosclerotic heart disease.

In light of these data, the present study discusses the rationale for the use of testosterone supplementation in HIV-infected men with fat redistribution syndromes.

Similarly, testosterone replacement retards atherogenesis in experimental models of atherosclerosis.

However, the long-term risks and benefits of testosterone administration in HIV-infected men with fat redistribution syndrome have not been studied in randomized clinical trials.

Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University of Medicine Science, University of CaliforniaLos Angeles School of Medicine.

03/03/04

Reference
S Bhasin and others. Effects of Testosterone Administration on Fat Distribution, Insulin Sensitivity, and Atherosclerosis Progression. Clinical Infectious Diseases 37: S142-S149. September 2003.