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A relatively low blood concentration of testosterone in the older man may have adverse effects on atherosclerosis, and explain the higher incidence of coronary heart disease in the male
Death from coronary artery disease (CAD) varies by a factor of five in different populations in the world.1 However, despite these wide differences the ratio of male to female affected individuals remains reasonably constant at more than three to one,1 and is not explained by differences in the risk factor profile between the sexes.2 The lower incidence of CAD in females is particularly prominent in pre-menopausal women, and increases after the menopause.3 This observation spawned the idea that female sex hormones may be protective and that hormone replacement therapy (HRT) may be beneficial. Observational non-randomised epidemiological studies tended to confirm this,4 although case controlled studies were less conclusive.5 In two published randomised controlled trials,6,7 combined oestrogen and progestogen HRT was shown to have no benefit and indeed appeared …
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