Major Study: Cardiac mortality is doubled in men with “LOW T”
LOW TESTOSTERONE

Reported October 19, 2010 in Heart

This is the fourth epidemiologic study to have shown that low testosterone is a marker of early mortality

Of the 930 men studied for 7 years, 24% had LOW TESTOSTERONE.  These were men with coronary artery disease.

BOTTOM LINE: low testosterone more than doubled mortality

Adjusted all-cause and vascular mortality was more than doubled among those with low bioavailable testosterone (HR 2.2, p<0.0001 for all-cause mortality; HR 2.2, p=0.007 for vascular mortality) compared with those who had normal levels of the hormone.

Some still have concerns about replacing testosterone

Concerns dismissed: Testosterone like thyroid hormone

Dr. Channer  (senior author) also doesn’t understand what he sees as reluctance of some doctors to recognize testosterone as a potential therapy. “I’ve struggled to understand why endocrinologists don’t just accept that replacing testosterone is the same as replacing thyroid hormone, for example; what’s the matter with that?”

And he dismisses any concerns arising from a U.S. NIH study in elderly men, which was stopped early because testosterone treatment was associated with an increased risk of cardiovascular events; the paper was published in the New England Journal of Medicine earlier this year.

“We were very surprised that NEJM published that paper. The end points were very soft indeed,” he comments. “Yes, there were a few more deaths, but these were elderly men, and you wouldn’t expect in the duration of that study for the testosterone to have had that kind of effect.

We’ve been doing studies for 15 years with testosterone in men with known heart disease, angina, and heart failure, and we haven’t had any serious adverse reactions.”

Top 12 benefits of male hormone replacement therapy

The benefits of hormone replacement are substantial and may often include:

More strength and energy.

Improved well being.

Greater libido.

Reduced aches and pains.

Better quality of sleep.

Improved sexual performance.

Improved muscle mass.

Improved lipid and cholesterol levels.

Improved prostate health.

Improved blood sugar balance.

Improved mood and outlook.

Increased focus and concentration.

By 80, a man’s T may only be 80% of youthful levels, increasing the risk for obesity, diabetes, and heart disease

Low T can also lead to a number of disturbing symptoms, including loss of stamina and lean muscle mass, reduced libido, anxiety, depression, and cognitive decline.

Known as the andropause, these changes are the male equivalent of female menopause.

Unlike menopause, however, the drop in testosterone is so gradual that the symptoms of andropause appear over a longer period of time and are often ignored.

Low testosterone is associated with increased morbidity and mortality.

A recent study found that men with lower testosterone levels were more likely to die from cardiovascular disease and all causes compared with men who had higher levels. The authors concluded that low testosterone may be a predictive marker for those at high risk of cardiovascular disease. (1)

Another review from the Baylor College of Medicine reported that there is a higher prevalence of:

  • depression
  • coronary heart disease
  • osteoporosis
  • fracture rates
  • frailty
  • and dementia with low testosterone (2)

WHAT YOU NEED TO KNOW ABOUT CORRECTING LOW TESTOSTERONE IN AGING MEN

  • T is important for erectile function, mood, energy, and body fat
  • T slowly declines with age, starting at around 30
  • Low T has been linked to depression, fatigue, obesity, and cognitive decline (dementia)
  • Low T increases the risk for heart disease, heart failure, heart attacks, angina, all-cause mortality and cardiac mortality
  • Bioidentical testosterone has not been shown to have adverse effects on a healthy prostate gland, and may improve prostate health
  • Testosterone replacement is contraindicated in prostate cancer
  • Blood tests for testosterone, SHBG (testosterone is bound in the blood by sex hormone binding globulin), and estrogen can determine what type of replacement is best
  • Like anything with our health, a multifaceted approach is best: diet, nutrition, supplements to improve testosterone function, exercise, and testosterone replacement

An Overview of Testosterone and Cardiovascular Health

Many studies have shown a higher incidence of coronary artery disease. 3-5

A placebo-controlled crossover study in men with ischemic heart disease (blockage of the coronary artery blood flow leading to angina or chest pain) and low testosterone levels reported that:

  • exercise time (men could exercise longer)
  • time to development of CARDIAC STRESS TEST changes (called ischemia, meaning the heart is not getting enough oxygen) increased
  • quality of life improved (6)

Insulin Resistance or “prediabetes” is an epidemic in the U.S. and is a factor in obesity, dementia, depression, mortality, and heart failure – normalizing LOW T improves insulin resistance / diabetes

Major points:

  • Low T is linked to insulin resistance (prediabetes, metabolic syndrome, and diabetes)
  • 20-64% of men with diabetes have low T
  • Low T may be a predictor of diabetes

Correcting LOW T May:

  • improve insulin resistance (help insulin work better, thus lowering blood sugar)
  • reduce BELLY FAT
  • improve ED – Erectile Dysfunction

Low T and body composition, belly fat, and muscle

Key points:

  • T may block lipoprotein lipase which takes fat into fat cells (blocking this enzyme may decrease fat accumulation)
  • stimulate fat burning by increasing certain cell receptors
  • improve INSULIN, a hormone that tells the body to STORE FAT (reducing insulin, reduces fat)
  • may increase LEAN MUSCLE
    • A study in 1991 gave T for 6 weeks – lipoprotein lipase incresased dramatically – 9 of 11 men reduced waist and hip circumference
    • the greatest changes are in men with low baseline T, that supplement MORE THAN 1 YEAR

Testosterone and the Prostate Gland

Key Points:

  • The normal prostate gland:
    • 2002 study showed T is beneficial to the prostate gland in 187 of 207 men
      • improved prostate volume – decreased in size
      • PSA decreased
      • urinary symptoms decreased: frequency, urgency, dribbling, and getting up at night to urinate
    • A study in the Journal of the American Medical Association (JAMA) – randomized, controlled
      • Looking at the tissue changes microscopically
        • no bad tissue changes were observed
        • cells did not change
        • advanced biomarkers, including gene markers did not change
        • cancer incidence did not change
        • severity of cancer was not effected
        • prostate volume, PSA, and urinary symptoms did not change
    • Does T replacement CAUSE PROSTATE CANCER?
      • Landmark review in the New England Journal of Medicine
      • No evidence that testosterone replacement increases PROSTATE CANCER RISK
      • However, since T stimulates cell growth, it is possible that it can ACCELERATE AN EXISTING CANCER
      • T is contraindicated in PROSTATE CANCER
  • Low T and Depression

    Depression is the LEADING CAUSE OF DISABILITY WORLDWIDE.

    Recent study in Australia of 4,000 older men:

    • those w depression had lower T

    Treatment resistant depression is a major problem. Current depression treatments have relatively low success rates.  Ongoing studies are in progress to evaluate the benefit of replacing T in these patients.

    Low T and Cognitive (Mental) Abilities

    Key Points:

    • T replacement clearly benefits male mental and verbal function
    • Decreased T worsens verbal ability and verbal memory
    • Short term T, in one study:
      • improved spatial memory
      • improved verbal memory
      • improved cognitive ability in healthy men

    How to manage LOW T

    A multifaceted approach is best.  Diet, exercise, sleep, and supplements have a major effect on testosterone.

    Belly fat can turn testosterone into ESTROGEN (fat has the “aromatase” enzyme which converts testosterone into estrogen). So, belly fat needs to be reduced, estrogen levels measured periodically, etc.

    Lab testing:

    • Total testosterone – only part of the picture – is the testosterone active or bound to SHBG and thus inactive?
    • SHBG – binds T in the blood – if SHBG is too high, all of the T may be inactive
    • Estrogen – men, especially w/ high body fat, can CONVERT T to estrogen
    • PSA – should be measured and followed

    What forms of Testosterone are available?

    • there are many ways (IM shots, implanted pellets, under the tongue,etc), but a topical cream or gel is the most common
    • shots can be given that last longer
    • choice for topical skin gels and creams:
      • Prescription: Androgel and Testim – $200 – 400 / month
      • Compounded creams: $50-80 / month

    References

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