Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial. A double-blind, placebo-controlled, randomized clinical trial of recombinant human chorionic gonadotropin on muscle strength and physical function and activity in older men with partial age-related androgen deficiency. Testosterone patches in the management of patients with mild/moderate systemic lupus erythematosus. Testosterone supplementation in men with type 2 diabetes, visceral obesity and partial androgen deficiency Effects of testosterone replacement in men with opioid-induced androgen deficiency: a randomized controlled trial Androgens and sexual function: a placebo-controlled, randomized, double-blind study of testosterone vs. dehydroepiandrosterone in men with sexual dysfunction and androgen deficiency Risk factors associated with cardiovascular events during testosterone administration in older men with mobility limitation. Randomized placebo‐controlled trial of testosterone replacement in men with mild Leydig cell insufficiency following cytotoxic chemotherapy Effects of androgen supplementation of hormone replacement therapy on the vascular reactivity of cerebral arteries. Usefulness of sex steroid hormone levels in predicting coronary artery disease in men. A randomized pilot study of monthly cycled testosterone replacement or continuous testosterone replacement versus placebo in older men. Testosterone Replacement in Androgen-Deficient Men With Ejaculatory Dysfunction: A Randomized Controlled Trial. A randomized prospective trial evaluating testosterone, haemoglobin kinetics and quality of life, during and after 12 months of androgen deprivation after prostatectomy: results from the Postoperative Adjuvant Androgen Deprivation trial Androgens as adjuvant treatment in postmenopausal female patients with rheumatoid arthritis. Testosterone therapy increases sexual desire in ageing men with low–normal testosterone levels and symptoms of androgen deficiency Low-Dose Transdermal Testosterone Therapy Improves Angina Threshold in Men With Chronic Stable Angina: A Randomized, Double-Blind, Placebo-Controlled Study Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial
AIMS Chronic heart failure is associated with maladaptive and prolonged neurohormonal and pro-inflammatory cytokine activation causing a metabolic shift favouring catabolism , vasodilator incapacity , and loss of skeletal muscle bulk and function . In men , and rogens are important determinants of anabolic function and physical strength and also possess anti-inflammatory and vasodilatory properties . METHODS AND RESULTS We conducted a r and omized , double-blind , placebo-controlled parallel trial of testosterone replacement therapy ( 5 mg And roderm ) at physiological doses in 76 men ( mean+/-SD , age 64+/-9.9 ) with heart failure ( ejection fraction 32.5+/-11 % ) over a maximum follow-up period of 12 months . The primary endpoint was functional capacity as assessed by the incremental shuttle walk test ( ISWT ) . At baseline , 18 ( 24 % ) had serum testosterone below the normal range and bioavailable testosterone correlated with distance walked on the initial ISWT ( r=0.3 , P=0.01 ) . Exercise capacity significantly improved with testosterone therapy compared with placebo over the full study period ( mean change + 25+/-15 m ) corresponding to a 15+/-11 % improvement from baseline ( P=0.006 ANOVA ) . Symptoms improved by at least one functional class on testosterone in 13 ( 35 % ) vs. 3 ( 8 % ) on placebo ( P=0.01 ) . No significant changes were found in h and grip strength , skeletal muscle bulk by cross-sectional computed tomography , or in tumour necrosis factor levels .  Testosterone therapy was safe with no excess of adverse events although the patch preparation was not well tolerated by the study patients . CONCLUSION Testosterone replacement therapy improves functional capacity and symptoms in men with moderately severe heart failure Despite partial and rogen deficiency , the safety and efficacy of  and rogen therapy in older men remains controversial because controlled studies of testosterone have given equivocal results . Human chorionic gonadotropin ( hCG ) can be conveniently and infrequently self-administered , and it increases not only circulating testosterone but also estradiol and other testicular steroids . We evaluated the efficacy and safety of 3 months of treatment with sc recombinant hCG ( r-hCG , Ovidrel ) on muscle mass , strength , mobility , and physical activity in ambulant , community-dwelling men more than 60 yr old having partial and rogen deficiency ( testosterone < or = 15 nmol/liter , twice ) . Forty eligible men ( mean age , 67 yr ; range , 60 - 85 yr ) were r and omized to receive r-hCG ( 5000 IU , 250 microg ) or placebo by twice weekly sc self-injection and were studied before treatment , monthly during treatment , and 1 month after treatment . All completed the study , and treatment groups were well matched . r-hCG significantly increased body weight ( approximately 1 kg ; P < 0.05 ) and lean body mass ( approximately 2 kg ; P < 0.001 ) and reduced fat mass ( approximately 1 kg , P < 0.05 ) . However , anthropometric measures of skinfold thickness ( biceps , triceps , subscapular , suprailiac ) and circumferences ( midarm , waist , hip , and midthigh ) , including the waist-hip ratio , did not change significantly . Shoulder and knee strength ( peak torque ) , as measured by isokinetic and isometric dynamometry , was not significantly increased , nor was physical activity ( accelerometry and Physical Activity Scale for Elderly self-report ) or gait and balance ( modified Guralnik and Frailty and Injuries : Cooperative Studies of Intervention Techniques performance batteries ) altered . Total and free testosterone and estradiol were markedly ( 150 % ; P < 0.001 ) and stably increased , whereas LH , FSH , and urea were significantly decreased . Testis volume was significantly decreased ( approximately 5 ml ; P < 0.05 ) . There were no significant changes in hemoglobin , osteocalcin , or prostate-specific antigen , and the International Prostate Symptom Score did not change . Three men developed nipple tenderness that did not progress to gynecomastia . We conclude that 3 months of treatment with twice weekly r-hCG demonstrates sustained and rogenic effects on hormones and muscle mass but has no effect on muscle strength or physical functioning OBJECTIVES And rogen deficiency has been associated with the development of systemic lupus erythematosus ( SLE ) . The aim of this study was to test the efficacy of testosterone patches vs placebo in female SLE patients with baseline mild-to-moderate disease activity in a r and omized , double-blind , single-centre placebo-controlled trial . METHODS Patients received testosterone ( 150 microg ) or placebo transdermal patches for 12 weeks . Patients were assessed at 4-weekly intervals for disease activity using the Safety of Oestrogens in Lupus Erythematosus National Assessment -SLE Disease Activity Index ( SELENA-SLEDAI ) , Systemic Lupus Activity Measure-Revised ( SLAM-R ) and The British Isles Lupus Assessment Group ( BILAG ) indices , physician global assessment ( PGA ) , quality of life using the SF-36 survey and sexual functioning using the Derogatis score . Data were analysed using two sample t-tests to compare the mean difference from baseline to week 12 in the testosterone patch and placebo groups . RESULTS Thirty-four patients were recruited in to each group . There was no significant baseline difference between the groups in age , race or marital status . There was no significant difference between treatment groups in the mean change in SELENA-SLEDAI ( 0.547 + /- 3.72 , P > 0.60 ) , nor in PGA or BILAG system scores . The mean change in SLAM-R score was statistically different ( 2.06 , S.D. 3.3 , P = 0.01 ) but was not considered clinical ly meaningful . Health transition also showed a small change ( P < 0.03 ) . There was no significant difference in the Derogatis scores or toxicity . CONCLUSIONS Testosterone patches were safe but did not significantly affect disease activity , quality of life or sexual functioning . Increased use of steroids in the placebo group may have confounded the study results The objective of this study was to assess the effects of oral testosterone supplementation therapy on glucose homeostasis , obesity and sexual function in middle-aged men with type 2 diabetes and mild and rogen deficiency . Forty-eight middle-aged men , with type 2 diabetes , ( visceral ) obesity and symptoms of and rogen deficiency , were included in this open-label study . Twenty-four subjects received testosterone undecanoate ( TU ; 120 mg daily , for 3 months ) ; 24 subjects received no treatment .  Body composition was analyzed by bio-impedance . Parameters of metabolic control were determined . Symptoms of and rogen deficiency and erectile dysfunction were scored by self-administered question naires . TU had a positive effect on ( visceral ) obesity : statistically significant reduction in body weight ( 2.66 % ) , waist-hip ratio ( -3.96 % ) and body fat ( -5.65 % ) ; negligible changes were found in the control group . TU significantly improved metabolic control : decrease in blood glucose values and mean glycated hemoglobin ( HbA1c ) ( from 10.4 to 8.6 % ) . TU treatment significantly improved symptoms of and rogen deficiency ( including erectile dysfunction ) , with virtually no change in the control group . There were no adverse effects on blood pressure or hematological , biochemical and lipid parameters , and no adverse events . Oral TU treatment of type 2 diabetic men with and rogen deficiency  improves glucose homeostasis and body composition ( decrease in visceral obesity ) , and improves symptoms of and rogen deficiency ( including erectile dysfunction ) . In these men , the benefit of testosterone supplementation therapy exceeds the correction of symptoms of and rogen deficiency and also includes glucose homeostasis and metabolic control Abstract Symptomatic and rogen deficiency is common in patients taking opioid analgesics , as these drugs potently suppress the hypothalamic – pituitary – gonadal axis . However , the efficacy of testosterone replacement in this setting remains unclear . The objective of this trial was to evaluate the efficacy of testosterone replacement on pain perception and other and rogen-dependent outcomes in men with opioid-induced and rogen deficiency . We conducted a r and omized , double-blind , parallel placebo-controlled trial at an outpatient academic research center . Participants were men aged 18 to 64 years on opioid analgesics for chronic noncancer pain , and total testosterone levels were < 350 ng/dL. Participants were r and omly assigned to 14 weeks of daily transdermal gel that contained 5 g of testosterone or placebo . Primary outcomes were changes in self-reported clinical pain and objective ly assessed pain sensitivity . Sexual function , quality of life , and body composition were also assessed . The mean age was 49 years . The median total and free testosterone levels at baseline were 243 ng/dL and 47 pg/mL and 251 ng/dL and 43 pg/mL in the testosterone and placebo arm , respectively . Of the 84 r and omized participants , 65 had follow-up data on efficacy outcomes . Compared with men assigned to the placebo arm , those assigned to testosterone replacement experienced greater improvements in pressure and mechanical hyperalgesia , sexual desire , and role limitation due to emotional problems . Testosterone administration was also associated with an improvement in body composition . There were no between-group differences in changes in self-reported pain . In conclusion , in men with opioid-induced and rogen deficiency , testosterone administration improved pain sensitivity , sexual desire , body composition , and aspects of quality of life Purpose . Supplemental administration of and rogens has been advocated for men with sexual dysfunction ( SD ) and hypo and rogenism . The preponderance of evidence indicates that most delivery forms of testosterone ( T ) are effective but the role of dehydroepi and rosterone ( DHEA ) is controversial . A placebo-controlled , r and omized trial of oral and rogen ( T versus DHEA ) supplementation was carried out to determine their efficacy . Material s and methods . Eighty-six men with SD and decreased levels of serum T and /or DHEA , participated in a study receiving oral T undecanoate ( OTU ) ( n = 29 ) 80 mg twice daily , DHEA ( n = 28 ) 50 mg twice daily , or placebo ( n = 29 ) . Outcomes included evaluation of sexual performance by the International Index of Erectile Function ( IIEF ) , the And rogen Deficiency in the Aging Male ( ADAM ) , Aging Male Symtom Scale ( AMS ) , and Global Assessment Question naire ( GAQ ) question naires . Biochemical evaluations included measurement of T and DHEA , prolactin , gonadotropins , and PSA . Results . Seventy-nine men completed the study . There were no significant differences in outcomes as assessed by four different instruments : the ADAM , IIEF , AMS , and GAQ in regard to sexual interest or erectile function . Biochemically , a significant increase in serum DHEA between baseline and final visit was documented in the group receiving DHEA . The levels of T , on the other h and , increased insignificantly between entry and final visit in the T cohort . No biochemical changes were observed in the placebo group . Levels of PSA remained stable in all three groups . Conclusions . This study did not suggest a clinical benefit of OTU or DHEA supplementation in men with hypo and rogenism and SD . The recommended dose of OTU may have been inadequate or poorly absorbed . Increased doses or an alternative T delivery form may result in a different response BACKGROUND Testosterone in Older Men with Mobility Limitations Trial found an increased incidence of  cardiovascular events in men r and omized to testosterone  , result ing in enrollment cessation by trial 's Data and Safety Monitoring Board . We evaluated changes in gonadal hormones and markers of inflammation and coagulation to eluci date risk factors associated with cardiovascular events . METHODS Men aged 65 years or more , with mobility limitation , total testosterone 100 - 350 ng/dL , or free testosterone less than 50 pg/mL  , were r and omized to placebo or 10 g testosterone gel daily for 6 months . Changes in total and free testosterone , estradiol and estrone , C-reactive protein , interleukin 6 , fibrinogen , plasminogen activator inhibitor-1 , and pro-brain naturetic peptide were compared between groups and within the testosterone group between subjects who experienced cardiovascular events and those who did not . RESULTS Of 209 men r and omized ( mean age 74 years ) , gonadal hormones and biomarkers were available in 179 men . Baseline body mass index , gonadal hormones , lipids , Framingham risk scores , and other biomarkers were similar in the two treatment groups . Within the testosterone group , the 6-month increase in free testosterone was significantly greater in men who experienced cardiovascular events than in those who did not [ mean ( 95 % confidence interval ) , 10.6 ( 4.6 - 16.7 ) vs 5.2 ( 3.0 - 7.5 ) ng/dL , p = .05 ] . In multivariable logistic regression analysis , the change in the serum levels of free testosterone was associated with cardiovascular events . CONCLUSION Mobility-limited older men who experienced cardiovascular events had greater increases in serum free testosterone levels than those who did not OBJECTIVE Testosterone deficiency is associated with significant morbidity , and and rogen replacement in overt hypogonadism is clearly beneficial . However , there are few data concerning the response to therapy in young men with mild testosterone deficiency OBJECTIVE To determine the effect of the and rogen supplementation of hormone replacement therapy ( HRT )  on the vascular reactivity of cerebral arteries . DESIGN Open r and omized study . SETTING Healthy volunteers in an academic research environment . PATIENT(S ) Forty postmenopausal women who were treated with sequential HRT ( transdermal E2 50 microg/d + medroxyprogesterone acetate 10 mg/d for 12 days every other month ) for > or = 1 year and < or = 5 years . INTERVENTION(S ) Testosterone undecanoate ( 40 mg/d , p.o . ) was r and omly administered to 20 patients during ongoing HRT ;  the other 20 served as controls . Doppler evaluations of the internal carotid and middle cerebral arteries were performed together with lipid levels assessment s. A visual analogue scale ( VAS ) was used to evaluate various parameters relating to sexual life and well-being . MAIN OUTCOME MEASURE(S ) Pulsatility index ( PI ) of the arteries , VAS assessment of psychophysical well-being . RESULT ( S ) The administration of testosterone undecanoate during HRT induced an increase in the PI of the middle cerebral artery and a reduction of high-density lipoprotein cholesterol . Sexual desire and satisfaction were greatly improved . CONCLUSION ( S ) In postmenopausal women , and rogen supplementation during HRT can partially counteract the beneficial effects of estrogens on cerebral vascular reactivity and lipid profiles , but sexual desire and satisfaction are greatly improved The relation between sex hormone levels and subsequent risk of a major coronary event was studied in a nested case-control study among 163 men in the Multiple Risk Factor Intervention Trial who later had a major coronary event and in 163 controls . Cases and controls were matched for age , serum cholesterol level , r and omization group , r and omization date and clinic . Blood sample s were collected at baseline before r and omization and frozen at -70 degrees C. Follow-up extended over 6 to 8 years . Sixty-one patients had a nonfatal acute myocardial infa rct ion and 102 fatal infa rct ion .  Total and free testosterone , total and free estradiol , and rostenedione and estrone concentrations were measured . There were no significant differences between cases and controls for any sex hormone level . There was also no difference in the ratio of testosterone to estradiol . Controlling for other cardiovascular risk factors did not change these results . These results do not support previous case-control studies of a relation between sex hormone levels and risk of heart attack among men CONTEXT Cycling and rogens has been reported by athletes to improve physical performance by enhancing muscle mass and strength , a paradigm that has not been studied , and may have clinical value in older men being treated with testosterone .  OBJECTIVE We investigated the efficacy of a monthly cycled testosterone regimen that uses half the testosterone dose as the current st and ard of care continuous therapy on body composition and muscle strength in older men . DESIGN , SETTING , AND PATIENTS Twenty-four community-dwelling older men 70 ± 2 yr of age with total testosterone levels below 500 ng/dl were r and omized at the Institute for Translational Sciences- Clinical Research Center into a 5-month double-blind placebo-controlled trial . INTERVENTION Subjects were dosed weekly for 5 months , receiving continuous testosterone ( TE , n = 8 ; 100 mg testosterone enanthate , i m injection ) , monthly cycled testosterone ( MO , n = 8 ; alternating months of testosterone and placebo ) , or placebo ( PL , n = 8) . MAIN OUTCOME MEASURES Main outcomes included body composition by dual-energy x-ray absorptiometry and upper and lower body muscle strength . Secondary outcomes included body weight , serum hormones , and mixed-muscle protein fractional synthesis rate ( FSR ) . RESULTS Total lean body mass was increased and percent fat was reduced after 5 months in TE and MO ( P < 0.05 ) . Upper body muscle strength increased in TE , and lower body muscle strength increased in TE and MO ( P < 0.05 ) . FSR increased in TE and MO ( P < 0.05 ) but not in PL . CONCLUSIONS Cycled testosterone  improved body composition and increased muscle strength compared with placebo and increased FSR similarly to continuous testosterone CONTEXT Low T levels have been associated with  ejaculatory dysfunction ( EjD ) in cross-sectional studies ; however , the efficacy of T replacement in improving EjD has not been studied in a r and omized controlled trial . OBJECTIVE To evaluate the efficacy of T replacement in and rogen-deficient men with EjD. DESIGN A multicenter , double-blind , r and omized , placebo-controlled , 16-week trial with T solution 2 % versus placebo . SETTING Medical centers in the United States , Canada , and Mexico . PATIENTS OR OTHER PARTICIPANTS Seventy-six men with one or more EjD symptoms , including delayed ejaculation , anejaculation , reduced ejaculate volume , and /or reduced force of ejaculation , and two total T levels < 300 ng/dL ( < 10.41 nmol/L ) measured with liquid chromatography t and em mass spectrometry . INTERVENTIONS Sixty milligrams of T solution 2 % or placebo applied to the axillae for 16 weeks . MAIN OUTCOME MEASURES The primary outcome was a change in the score of the three-item Male Sexual Health Question naire-Ejaculatory Dysfunction-Short Form ( MSHQ-EjD-SF ) ; secondary outcomes included measured ejaculate volume , scores of the bother/satisfaction item of the MSHQ-EjD-SF , the orgasmic function domain of the International Index of Erectile Function Question naire , and the sexual activity log . RESULTS Seventy-six participants were r and omized ; 66 completed the study . Baseline demographic and clinical characteristics were comparable between the treatment arms . T replacement improved the MSHQ-EjD-SF score ( mean score change , + 3.1 ) ; however , this effect was not statistically different from placebo ( mean score change , + 2.5 ; P = .596 ) . No differences were seen in any of the secondary outcomes or frequency of adverse events . CONCLUSION T replacement was not associated with significant improvement in EjD in and rogen-deficient men To assess testosterone and haemoglobin kinetics in the  Postoperative Adjuvant And rogen Deprivation ( PAAD ) trial , and correlate these with quality of life ( QoL ) in this prospect i ve r and omized study OBJECTIVE : To examine the possible beneficial effect of and rogens in postmenopausal women with active rheumatoid arthritis . METHODS : 107 women participated in a double blind placebo controlled trial to evaluate the effect of 50 mg testosterone propionate intramuscularly every two weeks for one year . RESULTS : An improvement in ESR , Dutch health assessment question naire , and pain was noted . In addition , 21 % of patients treated with testosterone fulfilled the ACR improvement criteria after one year , versus only 4 % of the placebo group . The treatment was well tolerated . CONCLUSIONS : Testosterone may improve the general wellbeing of postmenopausal women with active rheumatoid arthritis Although decline in sexual function is a common reason for ageing men to seek advice regarding testosterone therapy , placebo-controlled trial data have been unable to show a consistent , beneficial role for testosterone . The objective of this study was to determine the effect of testosterone therapy on sexual function in non-obese ageing men with symptoms of and rogen deficiency and low – normal serum testosterone levels . A total of 60 men aged 55 years or older in good general health with total testosterone ( TT ) levels < 15 nM , and with symptoms suggestive of and rogen deficiency , were r and omized in a double-blinded protocol to transdermal testosterone patches or placebo for 12 months  . Sexual function was assessed using the International Index of Erectile Function at weeks 0 , 26 and 52 . In men receiving testosterone TT levels increased by 30 % ( P=0.01 ) and luteinizing hormone decreased by 50 % ( P<0.001 ) . Relative to placebo , testosterone therapy improved sexual desire ( P=0.04 ) ; however other parameters of sexual function including erectile function were unaffected by the treatment . Ageing men in good general health and with symptoms of and rogen deficiency and low – normal serum testosterone levels receiving 12 months of transdermal testosterone therapy experienced , relative to placebo , improved sexual desire but no effect on other parameters of sexual function Background Experimental studies suggest that and rogens induce coronary vasodilatation . We performed this pilot project to examine the clinical effects of long-term low-dose and rogens in men with angina . Methods and Results Forty-six men with stable angina completed a 2-week , single-blind placebo run-in , followed by double-blind r and omization to 5 mg testosterone daily by transdermal patch or matching placebo for 12 weeks , in addition to their current medication . Time to 1-mm ST-segment depression on treadmill exercise testing and hormone levels were measured and quality of life was assessed by SF-36 at baseline and after 4 and 12 weeks of treatment . Active treatment result ed in a 2-fold increase in and rogen levels and an increase in time to 1-mm ST-segment depression from ( mean±SEM ) 309±27 seconds at baseline to 343±26 seconds after 4 weeks and to 361±22 seconds after 12 weeks . This change was statistically significant compared with that seen in the placebo group ( from 266±25 seconds at baseline to 284±23 seconds after 4 weeks and to 292±24 seconds after 12 weeks;P = 0.02 between the 2 groups by ANCOVA ) . The magnitude of the response was greater in those with lower baseline levels of bioavailable testosterone ( r = −0.455 , P < 0.05 ) . There were no significant changes in prostate specific antigen , hemoglobin , lipids , or coagulation profiles during the study . There were significant improvements in pain perception ( P = 0.026 ) and role limitation result ing from physical problems ( P = 0.024 ) in the testosterone-treated group . Conclusions Low-dose supplemental testosterone treatment in men with chronic stable angina  reduces exercise-induced myocardial ischemia Objective This study aims to determine the dose-dependent effects of testosterone on sexual function , body composition , muscle performance , and physical function in hysterectomized women with or without oophorectomy . Methods Seventy-one postmenopausal women who previously underwent hysterectomy with or without oophorectomy and had total testosterone levels less than 31 ng/dL or free testosterone levels less than 3.5 pg/mL received a st and ardized transdermal estradiol regimen during the 12-week run-in period and were r and omized to receive weekly intramuscular injections of placebo or 3 , 6.25 , 12.5 , or 25 mg of testosterone enanthate for 24 weeks .  Total and free testosterone levels were measured by liquid chromatography – t and em mass spectrometry and equilibrium dialysis , respectively . The primary outcome was change in sexual function measured by the Brief Index of Sexual Functioning for Women . Secondary outcomes included changes in sexual activity , sexual distress , Derogatis Interview for Sexual Functioning , lean body mass , fat mass , muscle strength and power , and physical function .  Results Seventy-one women were r and omized ; five groups were similar at baseline . Sixty-two women with analyzable data for the primary outcome were included in the final analysis . The mean on-treatment total testosterone concentrations were 19 , 78 , 102 , 128 , and 210 ng/dL in the placebo , 3-mg , 6.25-mg , 12.5-mg , and 25-mg groups , respectively . Changes in composite Brief Index of Sexual Functioning for Women scores , thoughts/desire , arousal , frequency of sexual activity , lean body mass , chest-press power , and loaded stair-climb power were significantly related to increases in free testosterone concentrations ; compared with placebo , changes were significantly greater in women assigned to the 25-mg group , but not in women in the lower-dose groups . Sexual activity increased by 2.7 encounters per week in the 25-mg group . The frequency of and rogenic adverse events was low . Conclusions Testosterone administration in hysterectomized women with or without oophorectomy for 24 weeks was associated with dose and concentration-dependent gains in several domains of sexual function , lean body mass , chest-press power , and loaded stair-climb power . Long-term trials are needed to weigh improvements in these outcomes against potential long-term adverse effects
Currently available evidence weakly supports the inference that testosterone use in men is not associated with important cardiovascular effects .
OBJECTIVE To conduct a systematic review and meta- analysis of r and omized trials that assessed the effect of testosterone use on  cardiovascular events and risk factors in men with different degrees of and rogen deficiency .