Testosterone and cardiovascular risk in patients with erectile dysfunction
Corona G, Rastrelli G, Balercia G, Sforza A, Forti G, Maggi M. J Endocrinol Invest. 2011 Nov 8. [Epub ahead of print]


Sexual Medicine and Andrology and Unit, Department of Clinical Physiopathology, University of Florence, Florence Italy.


Background. The relationship between cardiovascular (CV) diseases (CVD) and testosterone (T) levels in men has not been completely clarified. Aim. To evaluate the association between T levels and CV risk in subjects with erectile dysfunction (ED) and to verify whether their body mass index might (BMI) represents a possible confounder in testosterone-related CV stratification. Material and Methods. A consecutive series of 2269 male patients attending the Outpatient Clinic for ED was studied. The assessment of CV risk was evaluated using the engine derived from the Progetto Cuore study. Results. After adjustment and for BMI and associated morbidities, sex hormone binding globulin bound (SHBG) and unbound T levels decreased as a function of CV risk assessed thorough Progetto Cuore risk engine. In addition, a higher prevalence of hypogonadism related symptoms and signs was associated with a higher CV risk. Among factors included in the Progetto Cuore risk engine age, total and HDL cholesterol and diabetes were all significantly associated with CV riskdependent modification of total and calculated free-T levels. When the relationship between SHBG bound and unbound testosterone and CV risk was evaluated as a function of obesity (BMI > 30 kg/m2), all the aforementioned associations were confirmed only in non obese patients. Conclusions. Hypogonadism could be associated either with an increased or reduced CV risk, depending on the characteristics of subjects. Low T observed in obese patients might represent the result of higher CV risk rather than a direct pathogenetic mechanism.