Testosterone and Heart Disease

In recent research on testosterone supplementation, doctors suggest that testosterone may protect against heart disease in aging men. 

There is controversy surrounding the benefits of testosterone supplementation or testosterone replacement in aging men. If you are exploring this as a treatment option you probably know about this controversy from your primary care physician. One controversy surrounds how testosterone may impact or lessen the risk of cardiovascular disease. At the Magaziner Center for Wellness, hormone replacement is treated within a holistic understanding. For instance, studies (1) have demonstrated an association between low levels of testosterone and obesity, type 2 diabetes and metabolic syndrome – major risk factors for cardiovascular disease.  Low levels of testosterone are also associated with an increased risk of all-cause and cardiovascular mortality as biochemical evidence indicates that testosterone is involved in glucose and cholesterol utilization. This shows that you cannot simply offer testosterone replacement therapy without addressing all these co-factors. For many doctors, this association may be lost as they explore the “magic bullet,” understanding that testosterone is a single treatment that treats a single disorder. That is one reason that there is a controversy.

A side note on testosterone supplementation and men who already suffer from advanced cardiovascular problems. A July 2021 study in the journal Progress in Urology (2) offers these cautionary guidelines in treating men with advanced diseases with testosterone replacement therapies.

Here is the summary:

Testosterone deficiency’s most evocative or worrisome symptoms are: decrease in sexual desire, disappearance of nocturnal erections, fatigue, loss of muscle strength. Overweight, depressed mood, anxiety, irritability and malaise are also frequently found.

Testosterone deficiency is more common in cases of metabolic, cardiovascular, chronic, andrological (male health) diseases, and in cases of corticosteroid, opioid, antipsychotic, anticonvulsant, antiretroviral, or cancer treatment.

Contraindications to Testosterone are: progressive prostate or breast cancer, severe heart failure or recent cardiovascular event, polycytemia (an abnormal increase in red blood cells), complicated Benign prostatic hyperplasia.

It is possible (to supplement with testosterone) in cases of sleep apnea syndrome, psychiatric history, stable heart disease, prostate cancer under active surveillance and after one year of complete remission of a low or intermediate risk localized prostate cancer treated in a curative manner.”

Earlier in 2019, in the medical publication Sexual medicine reviews (3) doctors also suggested testosterone supplementation could help men with cardiovascular disease writing: “Treatment of Testosterone deficiency offers multiple benefits for sexual symptoms as well as for general health, without compelling evidence for increased risk of prostate cancer or cardiovascular events.”

“Testosterone replacement therapy may become a therapeutic reality for some of these disorders.”

In February 2020, (4) researchers acknowledged the controversy in the Journal of cardiovascular translational research but found testosterone beneficial for many test subjects. This is what they wrote:  “Cardiovascular diseases are one of the leading causes of death worldwide. Testosterone is an important sex hormone that triggers several genomic and non-genomic pathways (simply, the ability of genes to express messages and regulate normal body functions), leading to improvements of several cardiovascular risk factors and quality of life in men.”

They continue that at the vascular level, the key effect of Testosterone is vasorelaxation (a reduction in vascular stress or tension.) and that there is an association of testosterone with the main risks for cardiovascular disease, namely metabolic syndrome, type 2 diabetes mellitus, obesity, atherosclerosis, dyslipidaemia and hypertension. “Several studies have shown a correlation between low testosterone levels and an increased prevalence of several cardiovascular disease. These observations suggest that testosterone has beneficial effects on the cardiovascular system and that testosterone replacement therapy may become a therapeutic reality for some of these disorders.”

Men find treatment favorable and made them feel better

A study in Journal of cardiovascular pharmacology and therapeutics (5) found testosterone long-term testosterone us was well tolerated (by the study  subjects) with excellent adherence suggesting a high level of patient satisfaction. Mortality related to cardiovascular disease was significantly reduced in the testosterone treated group.

Researchers at the Intermountain Medical Center Heart Institute in Murray, Utah, which is the flagship facility for the Intermountain Healthcare system, studied 5,695 men between the ages of 53 and 71. The men, all patients at Intermountain Healthcare hospitals, had initial low testosterone levels. This research was published in the Annals of Pharmacotherapy.(6)

The researchers found that men who received testosterone supplementation to achieve normal or high testosterone levels had reduced overall rates of major adverse cardiac events at one and three years after their initial low levels of testosterone were measured, compared to other men who had persistently low levels of testosterone. The lower rate of cardiac events included a reduction in the adjusted risk of death and a reduction in heart attacks.

What does low testosterone levels do to the aging male heart?

As noted in the research above, coronary heart disease is a leading cause of premature death in men. Research has shown that a high prevalence of men with low serum testosterone levels are diagnosed with cardiovascular disease. Research (7) has also shown testosterone has beneficial effects on several cardiovascular risk factors, which include cholesterol, endothelial dysfunction and inflammation: key mediators of atherosclerosis. Testosterone deficiency plays a role chronic heart failure. As noted in the journal Endocrine (8), reduction in circulating testosterone level is a predictor of deterioration of functional capacity over time. This deterioration is seen as reduced muscle mass, abnormal energy handling, fatigue, dyspnea (shortness of breath) and, finally, cachexia (weakness, muscle loss).”

Cardiovascular disease and Erectile Dysfunction

Erectile dysfunction is an independent marker of increased cardiovascular disease risk including cardiovascular disease mortality (fatal coronary events), particularly in men aged 30-60 years old. Many doctors now use erectile dysfunction as a warning sign for cardiovascular disease as pointed out by clinical studies which have demonstrated that ED in men with no known cardiovascular disease often precedes a cardiovascular disease event by 2-5 years.(9)

The connection goes further, erectile dysfunction and cardiovascular disease share common risk factors. One common denominator if not the main one is endothelial dysfunction (a problem with the inner walls of the arteries).

So when a man presents erectile dysfunction to his doctor, the doctor can identify a window of opportunity for cardiovascular disease risk management.

But what if the high blood pressure medications are causing erectile dysfunction?

High blood pressure medication and erectile dysfunction have been linked. It has been noted in many studies including a June 2020 study in the journal Vascular health and risk management (10). “Incidence of erectile dysfunction has been related not only to chronic diseases such as diabetes mellitus, metabolic syndrome, hyperlipidemia, psychiatric diseases or urinary tract diseases, but also to hypertension and especially to antihypertensive treatments.”

Yet a 2021 study (11) suggests differently, suggesting: “All antihypertensive medication classes seem to exert neutral or insignificant effects on erectile function. (BUT) Further high-quality studies are needed to better explore the effects of antihypertensive medication on erectile function.”

The question of whether treating hypertension with pharmaceuticals causes or does not cause testosterone deficiency related erectile dysfunction can be considered a moot point if part of the patient’s treatment program was to remove them safely from these medications by changing their lifestyle.

At the Magaziner Center for Wellness we use a functional medicine approach to treat heart disease naturally. Using a series of extremely thorough tests, we work to determine the root cause of the blood pressure problem and develop an individualized plan of treatment based on each patient’s unique needs and contributing factors. No two patients are identical so we look at each patient’s lifestyle, stressors, environment, heavy metals, diet, health history, and the level of vitamins and minerals or any toxins present in the body to determine the specific and unique factors contributing to the imbalance. Using methods such as chelation therapy, various nutrients and nutraceuticals to improve heart function, and anti-inflammatory based-diet and lifestyle, stress reduction techniques and controlled exercise, we treat the cause of the imbalance, rather than the symptoms, helping the body to return to a state of optimal health—fully and naturally.

Testosterone supplementation under physician supervision

Doctors wrote this in the Journal of geriatric cardiology (12): “Testosterone replacement therapy in middle aged obese men with partial androgen deficiency appeared safe and might have promoted the effects of a weight reduction diet and daily exercise program as long as an adequate physician supervision and follow up was granted. The combination therapy significantly reduced coronary risk factors such as glucose intolerance and hyperlipidemia.”

Is Testosterone replacement therapy right for you?

This is a question best answered after an office visit, some testing, and evaluation of you present health.

If you would like to explore more information, please contact our office so we can start a conversation with you.

Related articles

Do Painkillers Cause Less Testosterone? Research Says Yes

Thyroid Disorders and Low Testosterone Levels

How Does Vitamin D Improve Heart Health?

What is Subclinical Hypothyroidism And How Does it Affect Your Heart?

References

1 Huhtaniemi I. Late-onset hypogonadism: current concepts and controversies of pathogenesis, diagnosis and treatment. Asian journal of andrology. 2014 Mar;16(2):192.
2 Burte C, Lejeune H, Faix A, Desvaux P, Almont T, Cuzin B, Huyghe E. Practical recommendations for the management of testosterone deficiency. Progres en Urologie: Journal de L’association Francaise D’urologie et de la Societe Francaise D’urologie. 2021 May 23.
3 Morgentaler A, Traish A, Hackett G, Jones TH, Ramasamy R. Diagnosis and treatment of testosterone deficiency: updated recommendations from the Lisbon 2018 International Consultation for Sexual Medicine. Sexual medicine reviews. 2019 Oct 1;7(4):636-49.
4 Lorigo M, Mariana M, Oliveira N, Lemos MC, Cairrao E. Vascular pathways of testosterone: clinical implications. Journal of Cardiovascular Translational Research. 2019 Dec 9:1-8.
5 Traish AM, Haider A, Haider KS, Doros G, Saad F. Long-term testosterone therapy improves cardiometabolic function and reduces risk of cardiovascular disease in men with hypogonadism: a real-life observational registry study setting comparing treated and untreated (control) groups. Journal of cardiovascular pharmacology and therapeutics. 2017 Sep;22(5):414-33.
6 Baillargeon J, Urban RJ, Kuo YF, Ottenbacher KJ, Raji MA, Du F, Lin YL, Goodwin JS. Risk of myocardial infarction in older men receiving testosterone therapy. Annals of Pharmacotherapy. 2014 Sep;48(9):1138-44.
7. Kelly DM, Jones TH. Testosterone: a vascular hormone in health and disease. J Endocrinol. 2013 May 7;217(3):R47-71. doi: 10.1530/JOE-12-0582. Print 2013 Jun.
8 Volterrani M, Rosano G, Iellamo F. Testosterone and heart failure. Endocrine. 2012 Oct 1;42(2):272-7.
9 Jackson G, Nehra A, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham G, Goldstein I, Guay AT, Hackett G. The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician. International journal of clinical practice. 2013 Nov;67(11):1163-72.
10 Hernández-Cerda J, Bertomeu-González V, Zuazola P, Cordero A. Understanding erectile dysfunction in hypertensive patients: the need for good patient management. Vascular Health and Risk Management. 2020;16:231.
11 Farmakis IT, Pyrgidis N, Doundoulakis I, Mykoniatis I, Akrivos E, Giannakoulas G. Effects of major antihypertensive drug classes on erectile function: a network meta-analysis. Cardiovascular Drugs and Therapy. 2021 May 4:1-2.
12 Schwarz ER, Willix RD Jr. Impact of a physician-supervised exercise-nutrition program with testosterone substitution in partial androgen-deficient middle-aged obese men. J Geriatr Cardiol. 2011 Dec;8(4):201-6. doi: 10.3724/SP.J.1263.2011.00201.