TY - JOUR
T1 - New Horizons
T2 - Testosterone or Exercise for Cardiometabolic Health in Older Men
AU - Green, Daniel J.
AU - Chasland, Lauren C.
AU - Naylor, Louise H.
AU - Yeap, Bu B.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Middle-aged and older men have typically accumulated comorbidities, are increasingly sedentary, and have lower testosterone concentrations (T) compared to younger men. Reduced physical activity (PA) and lower T both are associated with, and may predispose to, metabolically adverse changes in body composition, which contribute to higher risks of cardiometabolic disease. Exercise improves cardiometabolic health, but sustained participation is problematic. By contrast, rates of T prescription have increased, particularly in middle-aged and older men without organic diseases of the hypothalamus, pituitary, or testes, reflecting the unproven concept of a restorative hormone that preserves health. Two recent large randomized trials of T, and meta-analyses of randomized trials, did not show a signal for adverse cardiovascular (CV) events, and T treatment on a background of lifestyle intervention reduced type 2 diabetes by 40% in men at high risk. Men with both higher endogenous T and higher PA levels have lower CV risk, but causality remains unproven. Exercise training interventions improve blood pressure and endothelial function in middle-aged and older men, without comparable benefits or additive effects of T treatment. Therefore, exercise training improves cardiometabolic health in middle-aged and older men when effectively applied as a supervised regimen incorporating aerobic and resistance modalities. Treatment with T may have indirect cardiometabolic benefits, mediated via favorable changes in body composition. Further evaluation of T as a pharmacological intervention to improve cardiometabolic health in aging men could consider longer treatment durations and combination with targeted exercise programs.
AB - Middle-aged and older men have typically accumulated comorbidities, are increasingly sedentary, and have lower testosterone concentrations (T) compared to younger men. Reduced physical activity (PA) and lower T both are associated with, and may predispose to, metabolically adverse changes in body composition, which contribute to higher risks of cardiometabolic disease. Exercise improves cardiometabolic health, but sustained participation is problematic. By contrast, rates of T prescription have increased, particularly in middle-aged and older men without organic diseases of the hypothalamus, pituitary, or testes, reflecting the unproven concept of a restorative hormone that preserves health. Two recent large randomized trials of T, and meta-analyses of randomized trials, did not show a signal for adverse cardiovascular (CV) events, and T treatment on a background of lifestyle intervention reduced type 2 diabetes by 40% in men at high risk. Men with both higher endogenous T and higher PA levels have lower CV risk, but causality remains unproven. Exercise training interventions improve blood pressure and endothelial function in middle-aged and older men, without comparable benefits or additive effects of T treatment. Therefore, exercise training improves cardiometabolic health in middle-aged and older men when effectively applied as a supervised regimen incorporating aerobic and resistance modalities. Treatment with T may have indirect cardiometabolic benefits, mediated via favorable changes in body composition. Further evaluation of T as a pharmacological intervention to improve cardiometabolic health in aging men could consider longer treatment durations and combination with targeted exercise programs.
KW - aging
KW - androgens
KW - exercise training
KW - blood pressure
KW - vascular function
KW - FMD
KW - AMBULATORY BLOOD-PRESSURE
KW - ALL-CAUSE MORTALITY
KW - MIDDLE-AGED MEN
KW - AUSTRALIA POSITION STATEMENT
KW - VIGOROUS PHYSICAL-ACTIVITY
KW - HORMONE-BINDING GLOBULIN
KW - ENDOGENOUS SEX-HORMONES
KW - ISCHEMIC-HEART-DISEASE
KW - FLOW-MEDIATED DILATION
KW - ENDOTHELIAL FUNCTION
UR - https://www.webofscience.com/wos/woscc/full-record/WOS:000969262700001
U2 - 10.1210/clinem/dgad175
DO - 10.1210/clinem/dgad175
M3 - Review article
C2 - 36964918
SN - 0021-972X
VL - 108
SP - 2141
EP - 2153
JO - Journal of Clinical Endocrinology & Metabolism
JF - Journal of Clinical Endocrinology & Metabolism
IS - 9
M1 - 175
ER -