Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms

Aims High androgen levels are presumed by many to explain the male predisposition to coronary artery disease. However, natural androgens inhibit male atherosclerosis[1]. Our aim was to determine whether levels of androgens differ between men with and without coronary artery disease. Methods and Results Ninety male subjects (60 with positive, and 30 with negative coronary angiograms) were recruited. Early morning, fasting blood samples were taken from each patient and free, total and bioavailable testosterone, sex hormone binding globulin, oestradiol, and lipids were measured. Bioavailable testosterone was assayed using a modified technique. Free androgen index was calculated. Men with coronary artery disease had significantly lower levels of free testosterone (mean (standard deviation)); 47·95 (13·77) vs 59·87 (26·05)pmol.l−1,P =0·027), bioavailable testosterone; 2·55 (0·77) vs 3·26 (1·18)nmol.l−1, P=0·005 and free androgen index; 37·8 (10·4) vs 48·47 (18·3), P=0·005, than controls. After controlling for differences in age and body mass index the differences in free androgen index and bioavailable testosterone remained statistically significant (P=0·008 and P=0·013, respectively). Conclusion Men with coronary artery disease have significantly lower levels of androgens than normal controls, challenging the preconception that physiologically high levels of androgens in men account for their increased relative risk for coronary artery disease.