Testosterone and the Heart— A New Era?

[F.I.S.T.]

Testosterone and the Heart— A New Era?
By William Llewellyn


If you are a man, at some point in your life you are likely to be a candidate for hormone replacement therapy. As we age, our testosterone levels decline, and with them often a number of physical and psychological characteristics. It has long been understood that low testosterone levels can be linked to reduced libido, sexual dysfunction, diminished energy, and a reduced overall sense of well-being. For these reasons, replacement therapy with testosterone drugs is a strong and steadily growing area of medicine for aging men.

Beyond these basic facts, testosterone remains a controversial drug. Its abuse is linked to changes in the body that may increase the likelihood of cardiovascular disease, and partly because of this, the potential benefits and risks of testosterone replacement therapy have long been the subject of much debate. Is this therapy actually safe?

In recent years, evidence has been surfacing that testosterone replacement may actually reduce cardiovascular disease risk. Usually isolated in scope, these papers concern many favorable changes in cardiovascular health markers, such as the management of triglycerides and cholesterol. I believe I’ve discussed some of these papers in this column before. Hopefully, a paper published in the Journal of Andrology will further this discussion a great deal.

This 37-page report entitled “The Dark Side of Testosterone Deficiency” is the third in a series of papers covering the potential benefits of hormone replacement therapy in men.1 It specifically reviews the mounting evidence in favor of the use of testosterone for reducing heart disease risk, addressing the most detailed and relevant studies on the subject. This is the most extensive paper on testosterone therapy and heart disease to date, and covers several specific potential benefits.

 

[F.I.S.T.]

Serum Lipids

One of the first potential benefits of testosterone replacement therapy (TRT) reviewed in this paper is the management of triglyceride and cholesterol levels. As detailed in a growing number of studies, testosterone replacement therapy consistently improves the lipid profile in men with hormone deficiency. The most consistent endpoints of improvement appear to be a reduction in total cholesterol, a reduction in LDL (‘bad’) cholesterol, and a lowering of serum triglycerides. The improvements in lipid profile appear to be more pronounced in older men, although both young and old populations tend to show improvements in serum lipids when testosterone is given to correct a deficient state.

The effect of TRT on HDL (‘good’) cholesterol levels is less consistent. Studies giving testosterone gels, patches, or the longest-acting ester (testosterone undecanoate) tend to show improvement or no consistent effect on HDL. Studies with the more common esters such as cypionate and enanthate tend to show minor decreases in HDL during therapy, likely owing to the brief supraphysiological peaks for several days after administration. Note that HDL is often improved when TRT is combined with exercise and other lifestyle modifications.



Inflammatory Markers

Androgen deficiency is associated with an increase in certain inflammatory markers that can support the progression of atherosclerosis. Testosterone replacement therapy has been shown to reduce some of the same inflammatory mediators, specifically TNF-alpha (tumor necrosis factor-alpha) and IL-1B (interleukin-1beta).

Inflammation in the vascular system is an especially important concern with heart disease. For one, vascular inflammation is associated with the deposition of arterial plaque, a key component of this disease. Inflammation of the blood vessels may also damage the arteries, making them both thicker and weaker. Scarring may be noticed, and blood flow may be reduced. All of this can restrict blood flow and reduce the heart’s blood pumping capacity.

By helping to reduce the production of TNF-alpha and IL-1B, hormone replacement therapy may reduce inflammation, vascular damage, and the chance for atherosclerosis. Again, instead of seeing a neutral or ‘negative’ effect, we find a specific improvement in the cardiovascular disease risk profile with the administration of this drug.



Abdominal Obesity, Insulin Resistance

A growing number of studies have linked androgen deficiency to insulin resistance, as well as increased abdominal obesity. These two factors are also common with men suffering from cardiovascular disease, and may directly contribute to (among other things) endothelial cell dysfunction and vascular damage. Androgen substitution has been shown in several studies to reduce midsection fat deposits, increase glucose tolerance, and improve the overall metabolic state. It has additionally been postulated that due to the important role of testosterone in managing insulin sensitivity, androgen deficiency may be a contributing factor to adult-onset (type 2) diabetes. Likewise, the substitution of testosterone in aging men with hypogonadism might reduce the likelihood of developing diabetes.



Endothelial Function

The endothelium is a layer of cells that lines the blood vessels throughout the entire circulatory system. These cells are responsible for managing the passage of some materials in and out of the blood vessels, and supporting the flow of blood through the system. Endothelial cells play a role in vasoconstriction and vasodilation, they regulate certain inflammatory processes, and they’re involved in blood clotting and in supporting the formation of new blood vessels. Endothelial dysfunction is linked to androgen deficiency in men, and may result in elevated blood pressure (hypertension), vascular ‘stiffness,’ and significantly increased risk of cardiovascular disease. Likewise, replacement of testosterone in men with a deficiency has been shown to improve endothelial function, blood vessel dilation, arterial vasoreactivity, and blood flow.

One additional important ‘endpoint’ of improvement to this therapy appears to be an increase in endothelial progenitor cell activity, which helps repair damage to the vascular system.



Conclusion

Traditionally, most physicians are extremely cautious with testosterone drugs. Many family doctors are very willing to prescribe estrogens to their female menopausal patients complaining of symptoms such as sexual dysfunction, but when it comes to their male patients with similar complaints, the response is often different. Many of these same physicians are much more willing to prescribe a drug like Viagra than the basic male androgen testosterone. Some mistakenly consider testosterone to be ‘too dangerous’ to give most of their patients, and reserve its use for extreme cases. And when testosterone is considered, it is given only for a very narrow and specific set of psychological or physical symptoms.

Of course in the era of AndroGel, some physicians are much more enlightened. Still, the troubling common fear of this hormone remains. Perhaps this is changing, and perhaps the accepted set of symptoms and therapies for prescribing this hormone is changing.

It seems clear that we can no longer paint testosterone as simply a ‘bad’ hormone for the cardiovascular system. While excessive high-level elevations of this hormone may indeed damage an individual’s cardiovascular health, we have strong evidence that within a certain physiological range, it may also protect the cardiovascular system from some of the same health issues. As such, its replacement may indeed turn out to be very important medical intervention for millions of men across the country, helping us to not only live better— but also live longer.

After all this time, it appears that this very controversial hormone, the same steroid demonized in the media, might actually help reduce the risk of cardiovascular disease in aging male patients. The study we reviewed this month is, likewise, something all men should take to heart— literally.



Reference:

1. The Dark Side of Testosterone Deficiency: III. Cardiovascular Disease. Traish AM, Saad F et al. Journal of Andrology, April 2, 2009. ePub, Ahead of Print.

 

[SHINE]

HRT is a must for older guys with low T which is most.

Good stuff, thanks for posting.

 

[F.I.S.T.]

HRT is a must for older guys with low T which is most.

Good stuff, thanks for posting.

You're welcome brother.I couldn't agree more.When I was younger and newer to cycling I was a firm believer of the "time on = time off" logic but as I get older and my natural test levels are diminishing,my cycles have become longer and longer with bridging between cycles so basically "ON" at all times.Again,I would not recommend this for younger guys thats still have full production of test on their own.Only after years and years of doing cycles did I begin cycling this way.So basically self-prescribing TRT,only at higher doses.LOL

The facts are that as we age and our own male hormone production drops,age related health issues start to appear.Contrary to popular belief thanks to the media,its not taking these hormones that will cause health problems as we age,its the LACK of them that causes our bodies to break down.

 

[SHINE]

You're welcome brother.I couldn't agree more.When I was younger and newer to cycling I was a firm believer of the "time on = time off" logic but as I get older and my natural test levels are diminishing,my cycles have become longer and longer with bridging between cycles so basically "ON" at all times.Again,I would not recommend this for younger guys thats still have full production of test on their own.Only after years and years of doing cycles did I begin cycling this way.So basically self-prescribing TRT,only at higher doses.LOL

The facts are that as we age and our own male hormone production drops,age related health issues start to appear.Contrary to popular belief thanks to the media,its not taking these hormones that will cause health problems as we age,its the LACK of them that causes our bodies to break down.

I've seen first hand what it has done for my 68 year old dad, before hrt he was sluggish , extremely tired all the time just not the same.
on hrt and about a month in he was the guy I knew 35years ago, up at 5am and tearing the world up! lol

 

[F.I.S.T.]

Thats why so many aging men are subscribing to this now.Something that was made to be so bad and a taboo subject are now proving to be the very cure that has plagued so many for such a long time.GETTING OLD.

 

[HisAngriness]

excellent article FIST. as we speak this subject is being debated in the chat. i am of the belief that a moderate TRT or HRT dose does more good than harm especially as we get older and our natural levels start to diminish. i have seen it first hand too many times to ignore

 

[F.I.S.T.]

excellent article FIST. as we speak this subject is being debated in the chat. i am of the belief that a moderate TRT or HRT dose does more good than harm especially as we get older and our natural levels start to diminish. i have seen it first hand too many times to ignore

Thank you sir.Couldnt agree more.More and more people are seeing it everyday and learning the true value of AAS use really is.

 

[F.I.S.T.]

Bump for all to re-read.

 

[F.I.S.T.]

Here's another great study on AAS and your Heart from the HARVARD MEDICAL SCHOOL.......

Testosterone and the heart


Testosterone is responsible for men's deep voices, increased muscle mass, and strong bones. It also has crucial effects on male behavior, contributing to aggressiveness, and it is essential for the sex drive and normal sexual performance.

Although testosterone acts directly on many tissues, some of its least desirable effects don’t occur until it is converted into another male hormone, dihydrotestosterone (DHT). DHT acts on the skin, sometimes producing acne, and putting hair on the chest but often taking it off the scalp. DHT also stimulates the growth of prostate cells, producing normal growth in adolescence but contributing to benign prostatic hyperplasia (BPH).

But while testosterone’s effects on many organs are well established, research is challenging old assumptions about how the hormone affects a man’s heart, circulation, and metabolism.

Early worries

A direct association between testosterone and heart disease has never been established, but for many years, doctors have suspected that a link exists. The reasoning goes like this: men have much more testosterone than women, and they develop heart disease about 10 years before their female counterparts. Like other muscle cells, cardiac muscle cells have receptors that bind male hormones. Animals that are given testosterone develop enlarged hearts. Athletes who abuse testosterone and other androgenic steroids have a sharply increased risk of high blood pressure, heart attack, and stroke. And in high doses, testosterone can have a negative effect on cardiac risk factors, including HDL (“good”) cholesterol levels.
The fact that large amounts of testosterone harm the heart and metabolism doesn’t necessarily mean that physiological amounts are also harmful. In fact, research is challenging these old dogmas.

Complex relationships

It’s hard for scientists to study possible new risk factors for heart disease. One reason is that there are so many cardiac risk factors, including family history, age, gender, blood pressure, cholesterol, blood sugar, obesity, smoking, exercise, and personality.(Once again,there are so many factors that effect these health concerns that EVERYTHING has a huge part in their appearing or not appearing,not just AAS use F.I.S.T.)
It’s also hard for scientists to study testosterone. There is an exceptionally wide range of normal values. Healthy men can have testosterone levels between 270 and 1,070 nanograms per deciliter (ng/dL).

Heart disease and testosterone are mighty complex on their own, and studies that evaluate the two together are more complex still. Scientists who undertake these daunting investigations must account for all the things that influence heart disease and all the variables that affect testosterone.
With all these pitfalls, it’s not surprising that more research is needed to fill in all the blanks. Still, even if current information can’t tell us if testosterone can protect a man’s heart, it can dispel fear that physiologic levels of the hormone are toxic.

Testosterone and cardiac risk factors

In high doses, androgens tend to raise LDL (“bad”) cholesterol levels and lower HDL cholesterol levels. That’s one of the things that gave testosterone its bad reputation. But in other circumstances, the situation is very different. Men who receive androgen-deprivation therapy for prostate cancer drop their testosterone levels nearly to zero, and when that happens, their cholesterol levels rise. Even within the normal range, men with the lowest testosterone levels tend to have the highest cholesterol levels.
Diabetes is another important cardiac risk factor. Prostate cancer treatments that lower levels of testosterone produce insulin resistance and increase the risk of diabetes. Obesity increases the risk of both diabetes and heart disease. Men with low testosterone have more body fat and more of the abdominal fat that’s most harmful than men with higher hormone levels, but since obesity itself reduces testosterone, it’s not clear which is the cause and which the effect.
Peripheral artery disease (PAD) is an important form of atherosclerosis in its own right, and it also signals an increased risk for heart disease. A Swedish study of over 3,000 men with an average age of 75 linked low testosterone levels to an increased risk of PAD. At present, the hormone does not appear linked to hypertension or inflammatory markers.

Testosterone therapy and cardiovascular function

Low testosterone levels have been linked to various cardiac risk factors, but that doesn’t prove that low levels actually cause heart disease. Still, if testosterone therapy could help men with heart disease, it would bolster the argument that testosterone may be safe for the heart. Only a few small, short-term studies have been published to date, and the results offer mixed support for this theory.

Testosterone tinkering

As men age, it's not just heart disease they need to worry about. They also begin to lose muscle mass and bone density; red blood cell counts sag; sexual ardor declines; mood, energy, and memory drift down; and body fat increases. In theory, at least, testosterone therapy might blunt or reverse each of these woes.(The important thing to note here is that as men age rbc's lower so in fact using test will help combat this problem,not hurt it F.I.S.T.) But the theoretical benefits should be balanced against the theoretical risks.

The most serious long-term complications of testosterone therapy include an increased risk of benign prostate disease (BPH). Although some doctors worry that testosterone treatments might increase the risk of prostate cancer, the evidence for this is small. Indeed, there is evidence that men with low testosterone levels (who therefore might benefit from testosterone treatment) have a higher risk of developing prostate cancer.

Do the potential gains of testosterone treatment outweigh the possible pains? Nobody knows. To date, only small, short-term studies have been completed. More research is needed to learn how testosterone affects the heart and the rest of a man’s body and mind.

The best advice is to protect your heart and your body by taking care of known risk factors, such as cholesterol, blood pressure, diabetes, obesity, and tobacco exposure. And don’t forget that diet and exercise remain the keys to reducing the risk of heart disease.