Anawalt Bradley D, Yeap Bu B
Division of Medicine, University of Washington School of Medicine, Seattle, Washington 98195, United States.
School of Medicine, University of Western Australia, Perth, Western Australia 6009, Australia.
Asian J Androl. 2018 Mar-Apr;20(2):152-153. doi: 10.4103/aja.aja_7_18.
In this issue of (AJA), several experts have reviewed the latest data on the potential and known effects of endogenous and exogenous testosterone (T) on cardiovascular risk. In the review by Meyer and Wittert, low endogenous serum T appears to be associated with higher risk of cardiovascular disease and overall mortality in certain populations such as Klinefelter syndrome and older men, but not in men with congenital hypogonadotropic hypogonadism. Whether this association is causal or whether low serum testosterone is a marker of other risk factors for cardiovascular disease such as obesity, diabetes mellitus, or other systemic disease is unknown. In Yeap's review of the relationship between circulating endogenous testosterone and its major metabolites, dihydrotestosterone, and estradiol, he raises the provocative hypotheses that there might be differential effects on cardiovascular and cerebrovascular risk related to endogenous testosterone and dihydrotestosterone concentrations. Based on the same epidemiological studies, Yeap postulates that there might be a U-shaped curve for circulating endogenous androgen concentrations such that lower and higher concentrations might confer greater risk of cardiovascular events and all-cause mortality than midrange concentrations. Shores demonstrates in a carefully done review of studies of large prescription databases (including >200 000 men) that testosterone therapy is not associated with overall mortality, myocardial infarction, stroke, or deep venous thrombosis events.
在本期《美国老年医学会杂志》（AJA）中，几位专家回顾了内源性和外源性睾酮（T）对心血管风险的潜在及已知影响的最新数据。在迈耶和威特特的综述中，低内源性血清睾酮似乎与某些人群（如克兰费尔特综合征患者和老年男性）患心血管疾病及全因死亡的较高风险相关，但在先天性低促性腺激素性性腺功能减退的男性中并非如此。这种关联是否具有因果关系，或者低血清睾酮是否是心血管疾病其他风险因素（如肥胖、糖尿病或其他全身性疾病）的标志物尚不清楚。在叶普对循环内源性睾酮与其主要代谢产物双氢睾酮和雌二醇之间关系的综述中，他提出了一个具有启发性的假设，即内源性睾酮和双氢睾酮浓度可能对心血管和脑血管风险有不同影响。基于相同的流行病学研究，叶普推测循环内源性雄激素浓度可能呈U形曲线，即较低和较高浓度可能比中等浓度带来更大的心血管事件风险和全因死亡率。肖尔斯在对大型处方数据库（包括超过20万名男性）研究的精心综述中表明，睾酮治疗与全因死亡率、心肌梗死、中风或深静脉血栓形成事件无关。
