Low Testosterone: How It Affects Heart Health

Testosterone is the quintessential male hormone; it drives a man’s energy levels, muscle growth, and of course sexual function. If some testosterone is good, more must be better—right?

Testosterone levels and aging

Testosterone levels naturally decrease as a man ages. In 2006, a study reported that men’s testosterone levels, on average, decrease by at least one percent per year. In general, doctors have encouraged patients to realize that these drops in testosterone levels can be part of the natural aging process and do not necessarily mean that one has a problem or a “disorder.”

But now “low T” is the new fad. By turning low-T into a disease, without consideration of why testosterone is low, could we be harming ourselves more than we are helping?

Treating low-T

American men have tripled their testosterone prescriptions since 2001. In 2011, around one out of every 25 men in their 60s was taking testosterone. Testosterone replacements are now available in at least five forms, including patches, gels, and injections. The availability and attractiveness of testosterone-boosting drugs are a key reason sales are projected to increase from $2 billion in 2012 to $5 billion in 2017.

Testosterone levels and lifestyle

The most important message of this blog is that testosterone levels are also a function of lifestyle. Middle-aged men, listen up! A man's testosterone levels decrease more markedly with increasing body fat (particularly belly fat!), physical inactivity, and type 2 diabetes. Quite simply, the so-called metabolic syndrome can rob a man of, well, his manliness. 

Such men commonly notice symptoms associated with having the low-testosterone syndrome, which typically includes decreases in erectile function, libido, and energy. Therefore, it is no surprise that so many men are looking to testosterone therapy to solve many of their problems.

Just because something is low, however, does not necessarily mean that the first thing you do is replace it with a pill! Didn’t we already learn this lesson with hormone replacement therapy in women?

Cardiologists are saying “Not so fast!”

Physicians have become increasingly concerned that testosterone replacements make no mention of heart disease risk on their labels or in advertising. For instance, testosterone is known to increase blood clots.

In a recent large study, researchers found that prescription testosterone therapy raised the risk of heart attacks in older men and middle-aged men who had a history of heart disease.

In this study, 56,000 men were studied, first before they began taking a testosterone replacement, and then for three months after they had started, to determine any differences in heart attack rates. The men aged 65 years and older, and the men younger than 65 but who had existing heart disease, had double the heart attacks as those men who were not taking testosterone replacements. Some observers hypothesized that this increased risk could be caused by increased libido, and therefore more strenuous sexual activity. Researchers appeared to put that idea to rest, however, by showing that men who filled prescriptions for Viagra and Cialis, but who were not taking testosterone, did not have more heart attacks.

These studies remain controversial, but they are not the first studies warning of increased cardiovascular risk when taking testosterone replacements. In November, researchers showed that older men with heart disease had a 30 percent greater risk of mortality, heart attacks, and strokes with testosterone. And in 2009, a clinical trial of unrelated effects of testosterone replacements was cut short because of a sharp increase in heart attacks.

What is the real problem?

Testosterone therapy is only approved for men with hypogonadism, an endocrine disorder that causes a testosterone deficiency. And yet, studies report that around 25 percent of men prescribed testosterone from a physician do not ever have their levels tested.

Testosterone deficiency can be very real, and it takes the expertise and commitment of a trained physician to properly and safely treat it. For those men who need testosterone therapy because blood tests prove that they are deficient (without another obvious cause of the low levels), there is help. Testosterone therapy does improve erectile function and heart health for those with an endocrine disorder that is causing them to be severely deficient.

What I suggest

For those men who are just looking to regain their youthfulness, here is what I suggest. Ask yourself, why might your testosterone be low? If it is because your lifestyle choices—weight gain, poor diet, and little exercise—all of which are known to lower testosterone levels? If so, treat your lifestyle and not your testosterone!

First and foremost, losing weight is a proven way to naturally boost testosterone levels. Obese men who lost on average 17 pounds saw their testosterone levels increase by 15 percent!

Diet also helps. Try reducing the amount of alcohol you consume and increase the amount of healthy vegetables (try cruciferous veggies like broccoli). Another great way to boost testosterone and increase male well-being? Exercise, most notably with strength training.

The bottom line

Testosterone therapy is not a fountain of youth. Most of you with low-T symptoms should first and foremost try eating right, working out, and talking with your physician about the safest plan to truly diagnose and combat this issue.

©1996-2014, Johns Hopkins University. All rights reserved. Disclosure: The information provided here is compiled by The Johns Hopkins University School of Medicine with editorial supervision by one or more of the members of the faculty of the School of Medicine pursuant to a license agreement with Yahoo! Inc. under which the School of Medicine and its faculty editors receive licensing fees and payment for services rendered within the scope of the License Agreement. Johns Hopkins subscribes to the HONcode principles of the Health on the Net Foundation.

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