Testosterone Increases Heart Attacks: Fact or Fiction

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.
References:
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

Testosterone: Achieving a Delicate Balance

Testosterone and women

 

When a woman goes through menopause and her ovaries stop producing estrogen and progesterone, the pituitary responds by increasing FSH, a hormone from the pituitary gland that has regulated these hormones throughout her reproductive life. However, when all the eggs have been depleted, no further estrogen or progesterone can be produced. Nonetheless, the pituitary, which is “hard-wired” to respond to low estrogen, continues to make increasingly higher levels of FSH.

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The Endocrine Symphony

Dr. Johnson discusses the Endocrine Symphony

To make the proper choice regarding hormone replacement, it’s important to understand the basic function of the endocrine system, that complex and elegant chemical enterprise within the body that controls and coordinates such functions as reproduction, metabolism, behavior, growth and development. Replenishing and rebalancing of this system are the goals of hormone replacement and the focus of Endocrinology.

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Why Low Cholesterol is Not Always The Answer

Why Low Cholesterol Isn't Always the Answer

 

Understanding the biology and physiology of estradiol, progesterone, and testosterone gives us insight on how critical they are to the optimal function of the body. When they are deficient, as in menopause, it’s preferable, whenever possible, to utilize pharmaceutical bioidentical hormones to restore the very same hormones which have been in your body since you went through puberty. Cholesterol, which some people regard as something “bad”, is actually the basic building block for all the hormones made by the ovaries and the adrenal glands. Care should be taken to not aggressively lower cholesterol to extremely low levels with cholesterol lowering drugs because it can cause marked disruption in production of these vital hormones.

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Why Is It Important To Measure Estrogen Blood Levels? Part 2 of 2

Why Is It Important To Measure Estradiol Blood Levels?

 

3. YOU CAN’T JUST GO BY “HOW YOU FEEL!”

I strongly endorse monitoring estradiol and testosterone blood levels to ensure appropriate dosage and effectiveness of hormone therapy. Monitoring estradiol levels in thousands of women since 1986 has led me to develop more precise hormone regimens producing blood levels comparable to a low physiologic range. As noted earlier, monitoring blood levels is especially important with topical therapy. Most post- menopausal women who see me initially have NEVER had their estrogen level checked!

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Why Is It Important To Measure Estrogen Blood Levels? Part 1 of 2

Why Is It Important To Measure Estradiol Blood Levels?

 

Many women who initially see me for menopause have never had their estradiol level checked. Their previous physician may have diagnosed menopause with an elevated FSH, but usually no further tests are done. I’d like to go through various reasons why I believe it is important to monitor estradiol levels.

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An Endocrinologist Explains Sexual Dysfunction

 

SEXUAL DYSFUNCTION

Eleanor is a 48 year old woman who enjoyed a healthy sexual relationship with her husband.  However, since her total hysterectomy five years ago, she has noted a sharp decline in her sex drive. It has also become uncomfortable to have sex and it’s causing problems in her marriage. Her husband is very loving and tries to be understanding but she worries that he will lose patience with her. She wonders if she is just too old to still enjoy sex as she once did.

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Low Testosterone may just be Male Menopause

ANDROPAUSE

John is 56 years and has always enjoyed good health but in the last few years he has noted that despite any obvious health problems, he is fatigued by mid-afternoon. He has just had an executive physical and was told that everything was normal.Life is good but he seems to be having bouts of depression for no good reason.He is getting a little spare tire around his middle. He is not sleeping well and has become more irritable with his family. His sex life is not what it used to be and this is causing all kinds of problems with his wife. He thinks he is just getting older.

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