Recent News headlines have been reporting that Testosterone Replacement Therapy significantly increases a man’s risk of heart disease and stroke. The media is either not smart enough to see the flaws in the studies they report on, or they are pons in a competition for profits between the manufacturers of Viagra for Erectile Dysfunction and Androgel brand of Testosterone.
The results of the most recent Plos One Testosterone study run counter to a large body of literature of the last 20 years that supports testosterone treatment as an important therapy that can improve cholesterol levels, decrease blood sugar levels, reduce body fat and increase lean muscle mass, all factors that reduce the risk of heart disease.
I agree with Dr. Jen Landa, M.D., Ob/Gyn; Hormone Specialist; Chief Medical Officer of BodyLogicMD, who wrote the following:
“The media was again splattered with bad news about testosterone therapy this week. On Wednesday, Jan. 29, 2014, Finkle and colleagues published a study in the journal Plos One that exhibited an increased risk of heart attacks in testosterone users in the first 90 days of therapy, and the risk was higher in men who had had a history of cardiovascular disease. There are many problems with the data in this study and others like it that have lead to attention-grabbing headlines about how treatment of low testosterone levels may put men at undue risk. Similar to a November 2013 JAMA study of testosterone risks that I reviewed in a prior post, this current study has multiple flaws that make its conclusions essentially meaningless.
“Well over 100 studies were reviewed, and the authors concluded that low levels of testosterone are associated with higher rates of mortality and cardiovascular- related mortality, higher rates of obesity and diabetes. Additionally, the severity of disease correlated with the degree of testosterone deficiency.
“Testosterone therapy has been shown to relax coronary arteries and improve ability of patients with congestive heart failure to exercise. Testosterone therapy has been shown to lower blood sugar in diabetics and to lower body mass index in obese patients. Finally, studies have associated lower testosterone levels with thicker walls of some of the major blood vessels. This thickening increases the risk of atherosclerosis thus leading researchers to conclude that low levels of testosterone increase the risk for atherosclerosis. All of these factors point to the conclusion that optimal testosterone levels decrease the risk of cardiovascular disease.”
Testosterone Therapy Does Not Cause Heart Attacks!
At least 1 in 4 men over 30 have low testosterone and demonstrate such common symptoms as “reductions in motivation, initiative, self-confidence, concentration and memory, sleep quality, muscle bulk and strength, diminished physical or work performance, feeling sad or blue, depressed mood, mild anemia, and increased body fat and body mass index.” (Testosterone therapy in men with androgen deficiency syndromes: J Clin Endocrinol Metab, 2010;95:2536-2559.)
The most recent Plos One study, entitled “Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men,” is flawed in several significant ways:
- The study is not placebo controlled – instead it compared Testosterone to Viagra, which is known to provide an unfair advantage for a study of heart disease risk, in that it lowers blood pressure. Either the researchers were ignorant or the makers of Viagra paid them to use their drug as the control substance to persuade men to switch back to Viagra instead of taking Testosterone.
- The study did not assess the levels of the other hormones that need to be kept in balance when giving Testosterone, including Estradiol, DiHydroTestosterone, and Progesterone.
- The study is a review analysis of past studies and different delivery systems, including gel, oral, transdermal and injection and did not collect data as to whether or not the participants actually took the prescribed dose of Testosterone.
- The study did not address or compare the blood levels of the various methods of delivery to determine whether or not the treatment was achieving optimal levels.
In a separate article published in Life Extension News, Dr. Kira Schmid, ND, et al, report the following:
Flawed Testosterone Analysis Spurs Misleading Media Headlines
Over the years, several studies have shown that testosterone replacement therapy improves multiple measures of men’s vitality, especially related to cardio-metabolic health.1-11
Therefore, on November 5, 2013, we were startled to see headlines like “Testosterone Treatments Linked to Heart Risks” in the major news media. 12
This headline and others like it were prompted by a retrospective, observational study by Vigen and colleagues published in the September 5, 2013, issue of the Journal of the American Medical Association (JAMA). The study suggests testosterone therapy may increase risk of death and certain cardiovascular events.13 However, there are several significant shortcomings in the study’s design and methodology, and the results conflict with an existing body of research.
Woefully Inadequate Testosterone Replacement
The goal of testosterone restoration in most cases is to restore youthful blood levels of the hormone. Typically, Life Extension® suggests men target a blood level of testosterone between 700 and 900 ng/dL for optimal health.
In studies designed to assess the impact of testosterone replacement therapy, one of the most important considerations is to measure subjects’ blood levels of testosterone regularly throughout the study period. This allows the scientists conducting the study to make sure subjects are taking their testosterone as directed and that their blood levels are rising as expected.
Unbelievably, in the flawed analysis by Vigen, only 60% of study subjects receiving testosterone had a follow-up blood test to assess their testosterone levels. Among them, average testosterone levels rose from a very low level of 175.5 ng/dL at baseline to a still far-from-optimal level of 332.2 ng/dL during testosterone therapy.
Raising testosterone levels from a paltry 175.5 ng/dL to only 332.2 ng/dL is unlikely to deliver robust health benefits. In fact, research has shown that restoring testosterone levels to 500 ng/dL or higher is associated with pronounced health benefits, whereas benefits may be less evident at lower levels. 5,6
Higher Testosterone Levels Provide Clear Cardiovascular Benefits
Testosterone restoration is an important step aging men can take to retain good health.
In a revealing study, researchers identified 2,416 men (aged 69-81 years) who were not on any kind of testosterone-affecting treatment. These men were subjected to a battery of blood tests that included total testosterone and estradiol.
The first observation was that men with increasing levels of testosterone had a decreased prevalence of diabetes, hypertension, and body fat mass. Compared to men with the highest testosterone levels, those with low testosterone were twice as likely to have a history of cardiovascular disease. It was also observed that men with the highest testosterone levels were the most physically active.5
This large group of men was followed for an average of 5.1 years. Men in the highest quartile of total testosterone (above 550 ng/dL) had a 30% lower risk of cardiovascular events. Any level of total testosterone below 550 ng/dL resulted in significantly increased risk, thus helping establish a minimal baseline as to where total testosterone should be to guard against heart attack or stroke.
Estradiol levels measured in this group appeared to be mostly in safe ranges and did not impact incidence of cardiovascular events.
Data was tabulated based on hospital reports and/or death certificates for:
- Acute myocardial infarction (heart attack)
- Unstable angina (chest discomfort caused by a lack of oxygen flow to the heart)
- Revascularization procedure (bypass surgery or stenting)
- Transient ischemic attack (mini-stroke)
The four Categories of total testosterone in this large group of older men were:
- Quartile 1: Total testosterone below 340 ng/dL
- Quartile 2: Total testosterone between 341 and 438 ng/dL
- Quartile 3: Total testosterone between 439 and 549 ng/dL
- Quartile 4: Total testosterone above 550 ng/dL
Of interest was the finding that Quartiles 1, 2, and 3 had about the same risk of cardiac adverse events. It was only in Quartile 4 (when total testosterone exceeded 550 ng/dL) that the 30% reduction in cardiovascular events occurred.
This finding showed that it did not matter if these men’s total testosterone was very low (below 340 ng/dL) or moderately low (up to 549 ng/dL) … they all had a similar increased risk for suffering a cardiovascular event. Only when total testosterone exceeded 550 did cardiovascular risk plummet.
This finding remained consistent for cerebrovascular disease incidence, where men with the highest total testosterone (Quartile 4) had a 23% reduced risk of transient ischemic attack or full blown stroke. The researchers noted this association with reduced cerebrovascular risk remained after adjustment for traditional risk factors.
The conclusions by the researchers who conducted this study were:
“Higher serum testosterone levels are associated with a reduced risk of fatal and non-fatal cardiovascular events in community dwelling elderly men.” 5
Sources: Life Extension News
Dr. Hansen’s Rx
Testosterone is essential for life for both men and women. Maintaining optimal levels equivalent to the age of a healthy 30-35 year old will protect your heart, arteries, muscles and bones. It will boost your mood, energy and your sex drive. The Testosterone that I prescribe is the natural Bio-Identical Testosterone, which is based on testing all the associated hormones and a prescription that combines Testosterone with an optimal balance of all the associated synergistic hormones necessary to produce optimal results and reduce or eliminate risk.
Most physicians are simply not trained in the use of balanced hormone prescribing. I have studied with the world’s leading hormone experts for the past 15 years. Last March 2013, Dr. Thierry Hertoghe, M.D. and the World Society of Anti-Aging Medicine made me a Diplomat of Anti-Aging Medicine upon completion of the Advanced Fellowship in Anti-Aging Medicine and Bio-Identical Hormone Therapy, in Brussels Belgium.
Expert research indicates that the optimal level of Testosterone required to protect your heart, bones, muscle & mood is in a range of 700-900 ng/dl for men. This is the level that I typically prescribe for men. Women need 10 times less and because it is so much smaller can take a sub-lingual (under the tongue) dose, whereas men typically require an intramuscular injection of Bio-Identical Testosterone once per week to achieve this level.
More research continues to confirm the benefits of Testosterone every month. The latest Testosterone study published online February 19, 2014, by the School of Public Health (B.H., R.G.C.), University of Sydney, Sydney, New S Wales, Australia, confirms that Testosterone levels are directly proportional to Self-rated health and health-related quality of life, which are inversely associated with increased morbidity and mortality.