Testosterone Increases Heart Attacks: Fact or Fiction


Categories: Research| Testosterone

Testosterone Increases Heart Attacks: Fact or Fiction

Headlines screamed in 2013 after a study in the Journal of the American Medical Association (JAMA) reported increased cardiovascular risk in men given testosterone replacement. The study compared the incidence of heart disease in 8709 low testosterone men in the Veterans Administration health system who underwent coronary angiography. Their data showed that the testosterone-treated group had a 25.7% absolute rate of stroke, heart attack and death compared to 19.9% in the untreated group. These findings received enormous media attention and were repeated in a widely quoted accompanying editorial.
However, it was later found that the statistical analysis was incorrect and instead the number of adverse evens was lower by one-half in the testosterone-treated group! In March 2014, JAMA published a second correction of additional data errors involving more than 1000 individuals. Furthermore, it was revealed that the “all-male” study population actually comprised nearly 10% women. To date, 29 medical societies have called for the retraction of the original article, arguing that the data are not credible.

In clinical practice, when giving testosterone to men with deficient levels, we routinely see improvement in sex drive, sexual function, muscle mass, bone density and reduced fat mass.

With regard to the cardiovascular system, a review article of several dozen studies, revealed:
Untreated low testosterone is associated with increased mortality, generalized hardening of the arteries and heart disease;
Mortality is reduced by one half in testosterone deficient-men treated with testosterone therapy compared with untreated men;
Exercise capacity is increased with testosterone treatment compared to placebo in men with know heart disease.
Testosterone replacement compared to placebo results in uniform improvement in cardiovascular risk factors (fat mass, waist circumference, insulin resistance).

The media tends to sensationalize the news. When you read headlines warning about risks from a hormone, you need to pause and use some common sense. Does it really make sense that a hormone that’s part of your body’s design suddenly becomes dangerous when you give it to someone who’s deficient? Each hormone plays a vital role in your body. The whole specialty of endocrinology is devoted to evaluating and treating diseases caused by hormones that are deficient or in excess.

As a board-certified endocrinologist who’s been in practice for over 25 years, I’ve learned to have a healthy respect for the body’s ability to self-heal. When I see men with low testosterone, before rushing in with testosterone replacement, I first want to determine WHY
a man is deficient in testosterone. Does he have a treatable underlying condition that’s interfering with his body’s ability to produce testosterone? For example, testosterone is primarily produced during sleep. Does he have a correctable condition like sleep apnea that’s causing his low testosterone state? If I can get his body to restore its own testosterone production, that’s better than anything I can prescribe! If testosterone levels are deficient and testosterone replacement is needed, it’s important to avoid excessive levels because those can lead to adverse events. Hormones are powerful therapies and it’s always best to respect the wisdom of the body.
Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310;1829-1836

Cappola AR. Testosterone therapy and risk of cardiovascular disease in men. JAMA. 2013;310:1805-1806.

Correction. Incorrect number of excluded patients reported in the text and figure. JAMA. 2014;311:967. http://jama.jamanetwork.com/article.aspx?articleid=1835478

Traish AM, Guay AT, Morgentaler A. Death by testosterone? We think not! J Sex Med. 2014;11:624-629.

Morgentaler A, Lunenfeld B. Testosterone and cardiovascular risk: world’s experts take unprecedented action to correct misinformation. Aging Male. 2014;17:63-65

Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015;90:224-251.

Corona G, Isidori AM, Buvat J, et al. Testosterone supplementation and sexual function: a meta-analysis study. J Sex Med. 2014;11:1577-1592

Isidori AM, Giannetta E, Greco EA, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf). 2005;63:280-293.

Tracz MJ, Sideras K, Boloña ER, et al. Testosterone use in men and its effects on bone health. A systematic review and meta-analysis of randomized placebo-controlled trials. J Clin Endocrinol Metab 2006;91:2011-2016

Chronic Insomnia and Hormones


Categories: Insomnia

Chronic Insomnia and Hormones

Bonnie had always been able to enjoy a good nights sleep in the past. No matter how stressed she might be, she could count on laying her head on her pillow, falling asleep and waking up the next morning refreshed and rejuvenated. However, when she reached her mid 40’s, her periods started changing and she began experiencing sleep problems. First, she would just have insomnia the night before starting her period. As her periods became more irregular, she started waking up in the middle of the night around 2 or 3 am and would find herself wide awake and unable to go back to sleep. With so little sleep, she would be exhausted the next morning. 

Over-the-counter sleep aids would make her feel sluggish the following day. By the afternoon and early evening, she would be crashing. She came to see me on maximal doses of prescription sleep medicine and still was sleeping poorly.

Bonnie suffered from a very common sleep disorder that occurs at the time of perimenopause or menopause. It’s caused by declining levels of estrogen and/or progesterone. It is characterized by wakefulness in the middle of the night and can be very debilitating when it continues long-term. The typical patient with this type of insomnia often becomes addicted to prescription sleeping pills. Bonnie’s insomnia totally resolved after her estrogen and progesterone levels were normalized.

While menopause occurs in all women, insomnia does not uniformly affect all women and
therefore, women may not recognize that this is a low estrogen symptom. Furthermore, if the
insomnia has gone on for many years, other secondary conditions such as depression, anxiety,
chronic fatigue, fibromyalgia, sleep apnea and obesity may also develop.
 Patients are often
prescribed prescription medications such as antidepressants, Xanax, and Adderal for these
conditions! Antidepressants can lead to weight gain and Xanax and Adderal are addictive!
Doesn’t it make more sense to correct the underlying hormone imbalance that’s causing these

It’s important to emphasize that insomnia can result from endocrine problems in both men and
women. Disorders of thyroid hormone, testosterone, cortisol, and growth hormone can all
cause sleep disorders. Detecting a subtle endocrine imbalance may sometimes be difficult
requiring the expertise of an endocrinologist.
Sleep is a mysterious bodily process that is
absolutely essential to good health. We should not have to rely on a drug to make us sleep! We
do not have to be “taught” how to sleep. Every member of the animal kingdom has an
obligatory need for sleep. If humans go much more than 18 hours without sleep, they start
experiencing “microsleep” where they “zone out” from a few seconds to minutes. In fact, many
accidents occur when people are sleep-deprived – such as the infamous Exxon Valdez disaster
and the Chernobyl nuclear accident. Falling asleep while driving is responsible for at least
100,000 crashes, 40,000 injuries, and 1550 deaths per year.
People can also develop insomnia
from poor lifestyle choices. Overzealous Americans intent on squeezing more work, more fun,
more family time and more sheer activity into their lives often short-change their sleep.

What are ways to promote a good night’s sleep?

Try going to bed at the same time each night
and getting up at the same time. The body likes a regular schedule. Sleep in a cool, dark room –
use nightshades, white noise or a sleep mask if necessary. Avoid spicy food or caffeine-
containing foods in the evening. Finish eating at least 3 hours before bedtime. Many individuals
find that heavy intake of sugar or alcohol at dinner leads to restless sleep. Start winding down in
the evening. Do not engage in heavy exercise late at night. Don’t watch the 10 o’clock news or
read grisly books which cause mental over-stimulation. Individuals who can’t function without a
large dose of coffee in the morning are usually sleep-deprived.

Just how much sleep is enough sleep?

Individuals who consistently get less than seven or eight
hours of sleep per night are often sleep-deprived. Interestingly, people who need MORE than
eight hours of sleep may also have a sleep disorder. They need more than eight hours of sleep
because the sleep they are getting is poor quality sleep. People do not have less need for sleep
with aging. It’s just that sleep disorders are so common in older people that many think this is
“normal.” Most sleeping pills “knock you out” but do not promote normal sleep architecture.

If you are experiencing persistent insomnia, consider seeing an endocrinologist, a physician who
specializes in hormone disorders. Establishing hormone balance can lead to normal, refreshing
sleep which is the body’s own way of healing a myriad of health problems.

Sugar-Free, Chocolate Macaroon Truffles


Categories: Recipes

Sugar-Free, Chocolate Macaroon Truffles


1 cup Raw, organic, cocoa powder*

1 cup Raw, organic, cocoa butter*

3⁄4 cup Full-fat coconut milk (Native ForestR has BPA-free can) 2/3 cup Raw, organic Yacon syrup**

2 tsp Lo Han sweetener***

1 tbsp Organic vanilla extract

1⁄2 tsp Kosher salt, to taste

1 cup Unsweetened, organic shredded coconut (Let’s Do OrganicR)

2 cups Raw, organic, sprouted walnuts, finely-chopped*

* Can be purchased at https://www.bluemountainorganics.com ** Can be purchased at https://www.thrivemarket.com

***Can be purchased at http://www.swansonvitamins.com/swanson-premium- purelo-lo-han-sweetener-monk-fruit-2-8-oz-80-grams-pwdr

Makes: 42 small truffles

1. Add water to a Dutch oven pot and bring to boil on stove top. Measure out cocoa butter into a large 4-cup Pyrex measuring cup. Place Pyrex cup into boiling water and turn down heat to low-medium. Cocoa butter will melt in about 10 minutes. After fully melted, mix in cocoa powder, Lo Han and then add coconut milk. Stir in the vanilla, salt and Yacon syrup. Blend well to dissolve any clumps. Add in the shredded coconut.

2. Scoop mixture into a bowl and place in the freezer for 30 minutes. Stir with a spoon to break up the hardened spots and place in the refrigerator for 45 minutes to firm up further.

3. Form one-inch balls with your fingers and shape them in your palms. After making 10-12 balls, your hands will become very sticky with the mixture and you’ll need to wash your hands. This is the best time to roll each ball in the finely- chopped walnuts for a nutty coating.

4. Store in refrigerator in a covered glass dish until ready to enjoy!

Look & Feel Younger with Estrogen


Categories: Menopause


Look & Feel Younger with Estrogen

The beginning of the new year is a time when many women want to lose weight and improve their appearance. Why not do this by restoring deficient hormones that occur with aging? It often starts with telltale signs like fine wrinkles around the eyes or mouth and dry, sagging skin. Menopausal women often deny themselves estrogen because they’re fearful of breast cancer. Yet, they’re not informed there are more risks from NOT taking estrogen! Heart disease and strokes kill more women each year (400,000) than the next sixteen causes of death including diabetes, all forms of cancer, AIDS and accidents! Estrogen decreases Alzheimer’s and dementia by 50% and osteoporosis by 40%. I wrote my book, “Outliving Your Ovaries: An Endocrinologist Reviews the Risks and Rewards of Treating Menopause with Hormone Replacement Therapy,” to give women a guidebook for evaluating and selecting the safest forms of estrogen.

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The content of this website is for informational purposes only and is not intended to be a substitute for professional medical advice,diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. This website may discuss nutritional products and protocols that have not been evaluated by the U.S. Food and Drug Administration. These products or the information contained on this website is not intended to diagnose, treat, cure or prevent any disease.