Low testosterone is considered a risk factor for cardiovascular disease in men, but doctors have been saying that testosterone replacement therapy isn’t the answer. Instead of preventing heart attack and stroke, they say studies show that testosterone supplements can put you at risk for them. But a team from the Intermountain Medical Center Heart Institute at the University of Utah decided to take another look at the impact of testosterone supplements on cardiovascular health in men—and they came up with a different answer about testosterone therapy.
Their findings may be lifesaving.
A RAY OF HOPE
The researchers looked through 15 years of their institute’s patient records to identify men given a diagnosis of low testosterone. They found 5,700 of them, of whom 28% had diabetes and 22% had coronary artery disease. The team then tracked the records of each of these men, whose average age was 62, for three years from the time of their low-testosterone diagnoses to see how many ultimately had a heart attack or stroke and how many died (either of cardiovascular disease or any cause). They also recorded and compared the men’s testosterone levels and supplementation statuses over the three-year period.
The results: First, the researchers discovered that the overall rate of heart attack and stroke after three years was 9% and the overall death rate was 6%. From there, the researchers found that the men given testosterone replacement therapy whose testosterone levels increased to the normal range had a 55% reduced risk of heart attack and stroke and a 43% reduced risk of death compared with the men who had persistently low testosterone levels (either because they weren’t on testosterone supplements or weren’t responding to them strongly enough). The researchers cautioned that higher-than-normal testosterone levels, however, were associated with risk of heart attack or stroke.
PROCEED WITH CAUTION
This is good news for men with low testosterone. But the findings probably also mean that men should use testosterone supplements under careful supervision to make sure that they—and their doctors—know what their testosterone levels actually are and that they are taking the right amount of testosterone to get those levels to normal.
Unlike this study, studies showing a link between testosterone supplements and cardiovascular risk didn’t always define why study participants were taking the supplements or whether their testosterone levels were being properly monitored. For example, a doctor might have prescribed a testosterone supplement to a man because the fellow was feeling tired and depressed and had sexual performance problems—but never have checked the man’s testosterone level to make sure it was the reason for those symptoms. Or a doctor could have prescribed testosterone to a patient and never seen him again until side effects drove that patient back to his office. And testosterone supplementation does come with side effects, which can include breast enlargement and enlarged prostate and, as mentioned, high levels are associated with cardiovascular risks.
The bottom line is to not to fear testosterone replacement therapy, but to use it wisely. Rather than self-treat with testosterone supplements, get a full health work-up from your doctor. If he or she thinks a testosterone supplement is right for you, discuss whether a bioidentical or a synthetic formulation is best—and make sure that he or she tests and keeps track of your testosterone levels while you are using the supplement.