V. The Effects of Aging and Testosterone on Lipids and Cardiovascular Risk

IN prepubertal children plasma levels of lipoproteins and triglycerides show no gender difference. During puberty plasma levels of HDL decline in boys, while plasma triglycerides and LDL increase slightly. The adult male generally has lower levels of HDL cholesterol and higher levels of LDL and triglycerides than does the premenopausal woman (1). After menopause HDL levels in females tend to remain approximately the same, but plasma LDL levels increase considerably (1), contributing to the greater incidence of coronary artery disease in postmenopausal women. In contrast, large epidemiological studies show that plasma HDL levels in elderly men are actually slightly higher than in middle-aged men (2). One explanation for this phenomenon is that individuals with lower HDL levels succumb to atherosclerotic disease earlier in life so that, by a process of elimination, men with higher levels of HDL cholesterol tend to survive to older age. Alternatively, higher HDL levels in older men could be associated with the age-related decline in circulating androgens. Again, in contrast to the pattern seen in women, LDL levels in men increase slowly but progressively from the late teenage years to the mid 50’s, at which point they become relatively constant. In the Lipid Research Prevalence study (2), mean LDL levels in women over the age of 60 were in fact slightly higher than mean levels seen in men of the same age.