Figure 1: The lines connecting hypogonadism and atherosclerosis. Hypogonadism has been associated with several risk factors of atherosclerosis including obesity, Type II DM, dyslipidemia and hypertension. The relation of hypogonadism with Type II DM and obesity is most likely bidirectional. All risk factors are interrelated, and the ultimate result is increased atherosclerosis. This has been well studied in epidemiological studies, which associated low testosterone levels with increased IMT, a known marker or early atherosclerosis. Hypogonadism also contributes to the events leading to atherosclerosis by increasing inflammation and affecting endothelial function, and several other cellular mechanisms involved in the pathogenesis of atherosclerosis. In addition, low testosterone increases the susceptibility to myocardial ischemia. Erectile dysfunction is a symptom of hypogonadism, but also an end result of atherosclerosis and a predictor of CAD.