Introduction>
There is a debate in effect of testosterone on cardiovascular disease. The combination of the male preponderance of coronary artery disease, the protective effects of estrogen in premenopausal women, and the increased incidence of coronary vascular death in men abusing anabolic steroids led to the belief that testosterone is deleterious to the male heart. Contrary, there are recent studies that normal physiologic levels of testosterone are beneficial to the male cardiovascular system and that testosterone deficiency is associated with increased coronary disease risk
Case report>
A 49 year old male with history of multiple cardiovascular events, hypertension, diabetes mellitus came to our outpatient clinic for cardiac rehabilitation. According to his medical report, First myocardial infarction was in 2010 and he received PCI at left circumflex artery, right coronary artery. Second event was in 2013. Third event was in 2015 and he received proximal segment of left anterior descending artery, plain old balloon angioplasty for ramus intermedius. Last event was in 2016 and he received PCI for proximal right coronary artery.
He participated in 3-week inpatient cardiac rehabilitation program. After cardiac rehabilitation program, he showed improvement in maximal oxygen consumption, but he presented exercise intolerance, fatigue in addition to erectile dysfunction and depression. We did laboratory testing including early morning of serum testosterone. Testosterone level was 1.63 ng/mL (normal range : 2.20-7.16 ng/mL). After consultation to urologist, he received testosterone replacement therapy and he participated in 8 more sessions of cardiac rehabilitation program. After hormonal replacement and rehabilitation program, testosterone elevated to 3.59(ng/mL) and showed further improvement in maximal oxygen consumption. In addition symptoms\ related to testosterone deficiency improved.
Discussion>
At the present time, the issue of the cardiovascular safety of testosterone remains controversial. But considering recent studies that testosterone may have a role in treating angina/myocardial ischemia, we think is worth to check serum testosterone if patient with cardiovascular disease presents symptoms related with testosterone deficiency and consider testosterone treatment.
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