Published: 2021-12-28

Male sex hormone as a correlate of endothelial function in middle-aged Indian males: a cross-sectional prospective observational study

Chandra Mohan, Kunal Gururani, Anurag Rawat, Mansi Kala


Background: Data on relationship between serum testosterone and endothelial dysfunction measured by brachial artery flow-mediated dilatation (BAFMD) in Indian subset are scarce. The present study was envisaged to assess the correlation between serum testosterone and endothelial dysfunction measured by BAFMD.

Methods: From October 2013 till September 2014, 92 Indian male patients aged 40-60 years who underwent investigation of flow-mediated dilatation of the brachial artery using ultra sonography were included. The association between serum testosterone and BAFMD percent-measured endothelial dysfunction was examined.

Results: Multivariate regression analysis in 92 Indian male patients (mean age 53.12±6.3 years) revealed that low levels of total serum, serum free and serum bioavailable testosterone were significantly associated with BAFMD% and were independent of age, hypertension, diabetes, body mass index (BMI), current smoking and hyperlipidaemia (p<0.001). The total serum, serum free and serum bioavailable testosterone were positively correlated with BAFMD% with Pearson correlation coefficients of r=0.572, r=0.525 and r=0.547, respectively (p<0.001).

Conclusions: Low levels of total serum, serum free and serum bioavailable testosterone were significantly associated with BAFMD%-measured endothelial dysfunction, irrespective of cardiovascular risk factors.


Brachial artery, Dysfunction, Endothelium, Risk factor, Testosterone

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Yeboah J, Crouse JR, Hsu FC, Burke GL, Herrington DM. Brachial flow-mediated dilation predicts incident cardiovascular events in older adults: the Cardiovascular Health Study. Circulation. 2007;115(18):2390-7.

Favero G, Paganelli C, Buffoli B, Rodella LF, Rezzani R. Endothelium and its alterations in cardiovascular diseases: life style intervention. Biomed Res Int. 2014;2014:801896.

Moreau KL, Babcock MC, Hildreth KL. Sex differences in vascular aging in response to testosterone. Biol Sex Differ. 2020;11(1):1-14.

Gururani K, Jose J, George PV. Testosterone as a marker of coronary artery disease severity in middle aged males. Indian Heart J. 2016;68:16-20.

Peretz A, Leotta DF, Sullivan JH, Trenga CA, Sands FN, Aulet MR, et al. Flow mediated dilation of the brachial artery: an investigation of methods requiring further standardization. BMC Cardiovasc Disord. 2007;7(1):1-8.

Mil AC. Examining endothelial function in humans in vivo: improving guidelines and exploring novel measures. United Kingdom: Liverpool John Moores University; 2018.

Antonopoulos AS, Antoniades C. Mechanisms of testosterone deficiency-related endothelial dysfunction: invited commentary for the Hellenic Journal of Cardiology on: Tsikas et al.“Associations between asymmetric dimethylarginine, nitrite-dependent renal carbonic anhydrase activity and plasma testosterone levels in hypogonadal men”. Hellenic J Cardiol. 2018;59(4):207-8.

Aversa A, Bruzziches R, Francomano D, Natali M, Gareri P, Spera G. Endothelial dysfunction and erectile dysfunction in the aging man. Int J Urol. 2010;17(1):38-47.

Akishita M, Hashimoto M, Ohike Y, Ogawa S, Iijima K, Eto M, et al. Low testosterone level is an independent determinant of endothelial dysfunction in men. Hypertens Res. 2007;30(11):1029-34.

Empen K, Lorbeer R, Dörr M, Haring R, Nauck M, Gläser S, et al. Association of testosterone levels with endothelial function in men: results from a population-based study. Arterioscler Thromb Vasc Biol. 2012;32(2):481-6.

Sader MA, Griffiths KA, Skilton MR, Wishart SM, Handelsman DJ, Celermajer DS. Physiological testosterone replacement and arterial endothelial function in men. Clin Endocrinol. 2003;59(1):62-7.

Ebenbichler C, Sturm W, Gänzer H, Bodner J, Mangweth B, Ritsch A, et al. Flow-mediated, endothelium-dependent vasodilatation is impaired in male body builders taking anabolic-androgenic steroids. Atherosclerosis. 2001;158(2):483-90.

Sader MA, Griffiths KA, McCredie RJ, Handelsman DJ, Celermajer DS. Androgenic anabolic steroids and arterial structure and function in male bodybuilders. J Am Coll Cardiol. 2001;37(1):224-30.

Sansone A, Rastrelli G, Cignarelli A, Ponce M, Condorelli RA, Giannetta E, et al. Effect of treatment with testosterone on endothelial function in hypogonadal men: a systematic review and meta-analysis. Int J Impot Res. 2020;32(4):379-86.

Ong PJ, Patrizi G, Chong WC, Webb CM, Hayward CS, Collins P. Testosterone enhances flow-mediated brachial artery reactivity in men with coronary artery disease. Am J Cardiol. 2000;85(2):269-72.

Webb CM, McNeill JG, Hayward CS, DeZeigler D, Collins P. Effects of testosterone on coronary vasomotor regulation in men with coronary heart disease. Circulation. 1999;100(16):1690-6.

Dalal J, Low LP, VanPhuoc D, Rahman AR, Reyes E, Soenarta A, et al. The use of medications in the secondary prevention of coronary artery disease in the Asian region. Curr Med Res Opin. 2015;31(3):423-33.

Kang SM, Jang Y, Kim JY, Chung N, Cho SY, Chae JS, et al. Effect of oral administration of testosterone on brachial arterial vasoreactivity in men with coronary artery disease. Am J Cardiol. 2002;89(7):862-4.