Despite several studies showing an inverse correlation of total testosterone with endothelial damage, the effect of testosterone replacement therapy (TTh) on endothelial function has been scarcely investigated. In order to systematically assess the relationship between endothelial dysfunction and TTh, we performed a review and meta-analysis of available prospective and cross-sectional studies. A thorough research was performed on MEDLINE for hypogonadism and endothelial dysfunction. We retrieved 28 papers, among which 23 were excluded for different reasons: five papers accounting for six studies (two crossover randomized clinical trial (RCT), three observational, one placebo controlled RCT) were therefore included in analysis. Overall, 86 patients with hypogonadism were included in analysis (mean age 49.57 ± 8.85 years). Baseline total testosterone serum levels were 8.11 ± 2.42 nmol/L and significantly increased while undergoing TTh (standard mean difference (SMD) 2.93 nmol/L, 95% confidence interval (CI) 1.89:3.97, p < 0.001). Due to the paucity of studies available, flow-mediated dilation (FMD) was chosen as the best surrogate marker of endothelial dysfunction. FMD did not significantly change after testosterone administration (SMD −0.22, 95% CI −1.29:0.84, I² = 90%); acute testosterone administration was associated with an increase in FMD, whereas a reduction in FMD emerged following chronic treatment, but statistical significance was not reached for both effects. This is the first meta-analysis study assessing the influence of TTh on endothelial function; however, results are far from conclusive, as proven by the high heterogeneity.

尽管有几项研究表明总睾丸激素与内皮损伤呈负相关，但很少研究睾丸激素替代疗法（TTh）对内皮功能的影响。为了系统地评估内皮功能障碍与TTh之间的关系，我们对现有的前瞻性和横断面研究进行了回顾和荟萃分析。在MEDLINE上对性腺功能减退和内皮功能障碍进行了深入研究。我们检索了28篇论文，其中23篇因不同原因被排除在外：五篇论文占六项研究的两项分析（两项交叉随机临床试验（RCT），三项观察性研究，一项安慰剂对照RCT）被纳入分析。总共纳入了86例性腺机能减退患者（平均年龄49.57±8.85岁）。p  <0.001）。由于可用的研究较少，因此选择了血流介导的扩张（FMD）作为内皮功能障碍的最佳替代指标。施用睾丸激素后，FMD无明显变化（SMD -0.22，95％CI -1.29：0.84，I ²  = 90％）；急性睾丸激素的施用与口蹄疫的增加有关，而慢性治疗后口蹄疫的减少却出现了​​，但两种作用均未达到统计学意义。这是第一项评估TTh对内皮功能影响的荟萃分析研究；但是，高异质性证明了结果远非定论。