Testosterone is the most abundant hormone made by both men and women and is the most biologically active. This amazing hormone has over 3,000 functions in the human body.
When normal physiologic levels are achieved with replacement, testosterone has been shown to decrease the risk of cardiovascular disease, heart attack, stroke, and mortality.
Why the persistent reluctance of physicians to test for deficiency and then replace testosterone, if indicated? First of all, a study was published in 2004 on 32 bodybuilders who were abusing testosterone, taking doses much much higher than recommended. 3 of the men also had a history of cocaine abuse. There was an increased incidence of heart stiffening (causes the heart to not work as well). Secondly, despite over 100 studies showing that testosterone is beneficial to the heart, there are 4 studies that show the opposite. Of course, it is those 4 studies that have attracted the most media outcry and attorney attention and led the FDA to impose restrictions on the pharmaceutical companies.
But, 2 out of these 4 studies were criticized for flawed methodology. There were also problems with the remaining 2 studies. It is worthwhile to look at one of the studies. The study concluded that men taking testosterone had a 29% increase risk of heart attack, stroke, and death as compared to men not taking testosterone. However in the group using testosterone, only 10.1% suffered an adverse event. There were 21.2% adverse events in the non testosterone group! It is not surprising that 29 International medical societies and 160 MD researchers requested that JAMA (Journal of the American Medical Association) retract this article!
In actuality, the majority of the literature has shown that testosterone deficiency is associated with an increased risk of cardiovascular disease and that testosterone replacement decreases the risk of cardiovascular disease. Testosterone decreases cardiac ischemia or poor oxygenation to the heart and decreases the frequency of angina. Replacement with testosterone improves function in patients with Congestive Heart Failure or CHF in multiple ways such as increasing cardiac output, decreasing peripheral vascular resistance, decreasing preload to the heart and increasing heart muscle strength. Both systolic and diastolic blood pressure can decrease. The hematocrit (volume percentage of red blood cells in our bloodstream) is increased with testosterone therapy, helpful in patients with anemia.
The incidence and severity of Atherosclerosis as well as CAD or Coronary Artery Disease is decreased with testosterone therapy. Testosterone may even decrease the amount of calcium in the coronary arteries. The blood flow through the coronary arteries increases with testosterone and the heart muscle strengthens.
Testosterone replacement may improve the cholesterol profile. Lean body mass increases as muscle mass increases and the amount of total body fat and abdominal fat decreases. Insulin resistance (increased in prediabetics and diabetics) has been found to decrease along with blood sugars and hemoglobin A1c.
Certain chemicals made by our body cause chronic inflammation and can make Atherosclerosis and Congestive Heart Failure worse. Testosterone decreases the production of these substances.
If all of that isn’t enough, exercise capacity increases and there is improved ventilation in the lungs. Testosterone also has anti-arrhythmic effects and can decrease the risk of sudden cardiac death. Replacement of testosterone has been shown to decrease the incidence of MACE or Major Adverse Cardiac Events, the risk of Stroke, Mortality from heart disease and all cause Mortality!
In a 7 year study by AM Traish, the incidence of heart attack, stroke and death was compared between patients using testosterone replacement and patients not on testosterone. There were 2 deaths in the Testosterone group, neither were from cardiovascular causes. There were no non-fatal heart attacks and no non-fatal strokes. In the group not using testosterone, there were 21 deaths, 19 from cardiovascular disease. There were also 26 non-fatal heart attacks and 30 non-fatal strokes.
In April 2016, the American College of Cardiology presented a study done by Intermountain Medical Center in Salt Lake City. 755 men with SEVERE Coronary Artery Disease were either given testosterone replacement or no hormone replacement. The men treated with testosterone had a marked decrease of MACE or Major Adverse Cardiac Events.
Prior to receiving testosterone replacement, men and women should have their testosterone levels measured, as well as other levels, which may include an estradiol, TSH, PSA, CBC, and FSH. Assays performed from the blood are the most accurate. If patients are found to be deficient, testosterone can be replaced to physiologic levels, preferably by a physician or provider who is an expert in hormone replacement. An up to date evaluation by the patient’s primary physician or gynecologist is advised prior to therapy.
Bioidentical testosterone is preferred over the other synthetic forms of testosterone. Bioidentical testosterone has the exact same chemical structure and 3 dimensional shape as the body’s natural testosterone. There are receptors or “gates” to testosterone in almost every tissue and organ in the body. Bioidentical testosterone will fit into the testosterone receptor like a key into a lock and can then properly give instructions to the cell. Synthetic testosterone, for example, testosterone given by injection, cannot join to the receptor properly and may have negative effects. Testosterone injections lead to a rapid rise in testosterone levels which are higher than the body considers optimal, or “supraphysiologic”. Levels of testosterone then fall rapidly leading patients to request injections more frequently than indicated. Chronic supraphysiologic levels may cause heart muscle stiffening.
Research has shown that the best way to receive testosterone therapy is in the form of pellets which are placed under the skin into the fatty layer. Pellets are always bioidentical. The dosing is individualized and very accurate. Testosterone from a pellet, is very slowly released into the bloodstream and constantly available to the body. Physiologic or optimal levels are achieved in 4 weeks and are maintained 4-6 months. Pellets are obtained through a compounding pharmacy that should carry a “503B” designation, for compounding hormone pellets. These pharmacies are DEA/FDA inspected. Patients should always make sure their providers are using a “503B” pharmacy such as Wells pharmacy. Hormone pellets are placed easily under the skin by a simple office procedure under local anesthesia.
