Cardiometabolic effects of testosterone in older men

Several long-term studies have demonstrated that low levels of total and free testosterone are associated with increased cardiovascular and all-cause mortality in older men aged over 60 years. Low levels of testosterone are most commonly manifested by erectile dysfunction, reduced sexual desire, and loss of morning erections. Increasing numbers of older men demand treatment for these bothersome problems. Recent data suggest that testosterone replacement therapy may reduce cardiovascular mortality as well as improving multiple surrogate markers for cardiovascular events. The paradox preventing the routine measurement and treatment of low testosterone in the elderly is concern that treatment might actually increase cardiovascular risk. Thankfully concerns about long-term prostate safety have virtually disappeared.