Mitigating Cardiometabolic Risks Associated with Hypogonadism

Friday, October 14 at 11 am

Estimates show hypogonadism occurs in 12%-38% of men over age 45, with up to 40% prevalence in men with diabetes mellitus.

“The impact of hypogonadism is significant and extends well beyond the effects on libido and sexual function with physical, emotional, and mortality effects,” said Pamela Ellsworth, MD, professor of urology, University of Massachusetts Medical School in Worcester. “Deficiency of testosterone has been associated with an increased risk of mortality, yet controversy exists with cardiovascular benefits/risks of testosterone therapy, supporting cautious evaluation and treatment.”

Dr Ellsworth will dive into this topic on Friday during her session “Testosterone Replacement Therapies: Mitigating Cardiometabolic Risks Associated with Hypogonadism.”

The diagnosis of hypogonadism resides in the patient history, physical examination, and laboratory evaluation, she said. The presence of an unequivocally low testosterone, along with signs and symptoms of hypogonadism, establishes the diagnosis.

A variety of therapies exist for the management of hypogonadism, she said. Each has unique advantages and disadvantages. A familiarity with the different therapies may lead to improved compliance and improvement in symptoms.

High-risk populations include those with type 2 diabetes mellitus and metabolic syndrome, with increasing evidence supporting a bidirectional relationship between these conditions and hypogonadism, Dr Ellsworth said. “Thus, the impact of testosterone therapy in these conditions may extend well beyond management of side effects and, rather, may affect disease progression.”

The use of testosterone therapy has increased significantly over the years, leading some to speculate use for age-related changes in testosterone. “This coupled with the controversy regarding cardiovascular effects of testosterone therapy should not prevent its use in appropriate individuals,” Dr Ellsworth said. “In fact, recent position statements indicate a direct link between testosterone therapy and heart attack and stroke has not been established.”

Future clinical trials aim to further investigate this relationship, she noted.

—Mike Bederka