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Effect of treatment with testosterone on endothelial function in hypogonadal men: a systematic review and meta-analysis

International Journal of Impotence Research volume 32, pages 379–386 (2020)Cite this article

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Abstract

Despite several studies showing an inverse correlation of total testosterone with endothelial damage, the effect of testosterone replacement therapy (TTh) on endothelial function has been scarcely investigated. In order to systematically assess the relationship between endothelial dysfunction and TTh, we performed a review and meta-analysis of available prospective and cross-sectional studies. A thorough research was performed on MEDLINE for hypogonadism and endothelial dysfunction. We retrieved 28 papers, among which 23 were excluded for different reasons: five papers accounting for six studies (two crossover randomized clinical trial (RCT), three observational, one placebo controlled RCT) were therefore included in analysis. Overall, 86 patients with hypogonadism were included in analysis (mean age 49.57 ± 8.85 years). Baseline total testosterone serum levels were 8.11 ± 2.42 nmol/L and significantly increased while undergoing TTh (standard mean difference (SMD) 2.93 nmol/L, 95% confidence interval (CI) 1.89:3.97, p < 0.001). Due to the paucity of studies available, flow-mediated dilation (FMD) was chosen as the best surrogate marker of endothelial dysfunction. FMD did not significantly change after testosterone administration (SMD −0.22, 95% CI −1.29:0.84, I2 = 90%); acute testosterone administration was associated with an increase in FMD, whereas a reduction in FMD emerged following chronic treatment, but statistical significance was not reached for both effects. This is the first meta-analysis study assessing the influence of TTh on endothelial function; however, results are far from conclusive, as proven by the high heterogeneity.

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Author notes

  1. These authors contributed equally: Andrea Sansone, Giulia Rastrelli

Authors and Affiliations

  1. Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy

    Andrea Sansone & Elisa Giannetta

  2. Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” Andrology, Women’s Endocrinology and Gender Incongruence Unit, University of Florence, Florence, Italy

    Giulia Rastrelli & Elisa Maseroli

  3. Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Moro, Italy

    Angelo Cignarelli

  4. Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy

    Maurizio de Rocco Ponce

  5. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

    Rosita Angela Condorelli

  6. Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S., University of Pavia, Pavia, Italy

    Sara Pinto

  7. Unit of Endocrinology, Dipartimento di Medicina Clinica e Chirurgia, Federico II University Medical School of Naples, Naples, Italy

    Ciro Salzano

  8. Department of Biomedical, Metabolic and Neural Sciences, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, Italy

    Daniele Santi

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Correspondence to Angelo Cignarelli.

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Sansone, A., Rastrelli, G., Cignarelli, A. et al. Effect of treatment with testosterone on endothelial function in hypogonadal men: a systematic review and meta-analysis. Int J Impot Res 32, 379–386 (2020). https://doi.org/10.1038/s41443-019-0163-6

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