Cardiovascular Health, Erectile Dysfunction, and Testosterone Replacement: Controversies and Correlations

Erectile dysfunction and cardiovascular disease share a similar underlying pathophysiology, and low serum testosterone, known as hypogonadism, is a significant player in both conditions. Hypogonadism is a known risk factor for cardiovascular events and worsened mortality, thus influencing physicians to recommend testosterone replacement in hypogonadal men. However, at least 4 recent reports suggest that testosterone replacement may worsen cardiovascular risk, heightening hesitancy in the medical community to treat patients with hypogonadism with testosterone. This review highlights the triad of cardiovascular disease, erectile dysfunction, and testosterone therapy and provides the physician with some guiding principles for navigating these recent concerns.