Testosterone, SHBG and cardiovascular health in postmenopausal women
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Cardiovascular disease (CVD) affects men and women differently with women having a lower incidence and later onset of disease. Research has recently refocused interest into the cardiovascular role of androgens. The purpose of this review is to summarize the evidence available on the association between testosterone and cardiovascular health in postmenopausal women. Published studies relating testosterone and sex-hormone binding globulin (SHBG) levels to cardiovascular disease and its risk factors were reviewed. Studies included in this review suggest that increased androgenicity, characterized by high testosterone and low SHBG levels, has a neutral to adverse effect on cardiovascular health in postmenopausal women. However, long-term data on cardiovascular effects of endogenous and exogenous testosterone are scarce and many studies are limited by the use of insensitive and inaccurate testosterone assays. Large-scale, longitudinal studies relating testosterone and SHBG levels to cardiovascular risk factors and endpoints are needed to determine the temporal relationship between androgenicity and cardiovascular risk and to ascertain the efficacy and safety of testosterone therapy in postmenopausal women.