Do Testosterone Supplements Cause Coronary Heart Disease?

Men are subjected to the risks of coronary heart disease three times higher than women, and these figures show no mercy for geographical location.

Furthermore, men also develop coronary disease 10 years ahead of their female counterparts.

This is bad news, because coronary heart disease is when plaque lines the arteries and in turn reduced the area in which blood can flow, as the circumference of the artery reduces it makes the heart work harder to force the blood and increases blood pressure.

This means it is more difficult for your organs and muscles to receive the oxygen rich blood flow.

Moreover, testing and analysis of patients have shown that there appears to be a relationship between coronary heart disease and hormones.

The results ere toward the theory that female sex hormones actually offer a protective cardiovascular role.

Estrogen seems to be the protective hormone to help ward off the effects and prevent cardiovascular related illnesses.

Studies also note that when cardiovascular related disease affect women, it is during their menopausal stages which see a drop in estrogen levels.

To add more weight to these observations, there have been tests in mice which show that a deficiency in estrogen correlate with a rise in related symptoms of metabolic syndrome which include high blood pressure, abnormal cholesterol levels, excess fat gain around the waist, high blood sugar and it is these features which increase the risk of heart disease.

However, any post menopausal hormonal treatments have then resulted in other health issues which have then increased the risk of mortality.

Back to the men…

So what is the answer? Do Testosterone supplements lead to heart disease?

It seems like there is a strong and positive correlation between cardiovascular disease and hormones.

Therefore, piling men full of testosterone would seem like the plausible solution, wouldn’t it?

Yet, records of men who abuse anabolic steroids over time have shown a high risk to sudden death from cardiac arrest or a heart attack, usually because of a stop of blood flow.

No more does this seem evident than the high profile death of Rich Piana whereby his autopsy showed signs of significant heart disease and an enlarged heart.

[Sullivan ML, Martinez CM, Gennis P, Gallagher EJ. The cardiac toxicity of anabolic steroids. Prog Cardiovasc Dis. 1998;41:1–15.]

So, what next?

Considering that females appear to have protective abilities with higher levels of estrogen, one could theorize that increasing estrogen levels would be successful at prevent heart disease in men.

[Wingard DL, Suarez L, Barrett-Conor E. The sex differential in mortality from all causes and ischaemic heart disease. Am J Epidemiol. 1983;117:165–72.]

However, this did not offer positive results either.

When men were offered estrogen therapy after a heart attack then saw an increase in a second heart attack two times the rate normally. This obviously put the risk of mortality up.

[Bagatell CJ, Bremmer WJ. Androgens in men—uses and abuses. N Engl J Med. 1996;334:707–14.]

These sort of results cast aspersions over hormone replacement and also that the effectiveness of sex hormones as protection against cardiovascular diseases are gender specific.

Yet, if we want to muddy the waters moreso, while using hormones as a way of synthetically increasing testosterone levels has a detrimental effect on the heart, naturally occurring testosterone levels are not.

[Dickerman RD, McConathy WJ, Zachariah NY, Schaller F. Cardiovascular complications and anabolic steroids. Eur Heart J. 1996;17:1912–5.]

That is, higher levels of naturally produced testosterone are in fact beneficial for cardiovascular health according to current evidence that will be discussed later.

Issues faced regarding naturally occurring testosterone and cardiac health

When men age, their natural levels of testosterone reduce.
Men stop producing as much natural testosterone when then hit their thirties.
However, unlike the menopause experienced by women, the decline in testosterone is not sharp and sudden, it is a slow process that many men do not recognize.
There are many studies that prove this decline of the male sex hormone. Yet, it does affect some men more than others.
It can affect a man’s libido, bone density, energy levels, strength, muscle mass, fat distribution, focus, dry skin, reduced hair, puffy breast tissue growth and depression.
Much of these symptoms seem to just be related to the natural ageing process, as a result, very few men recognize it as hypogonadism (low testosterone).
Therefore, many people do not seek treatment, plus, with the risk of poor cardiovascular health surrounding hormone replacement, it is a difficult and confusing path to tread.
[Baker HW, Burger HG, de Kretser DM, Hudson B, O’Connor S, et al. Changes in the pituitary testicular system with age. Clin Endocrinol. 1976;5:349–72.]

Do men with cardiovascular health problems show signs of low testosterone?

It is a hard theory to grasp that those who take anabolic steroids and other forms of testosterone therapy can increase cardiac risk, yet, those with naturally occurring levels of testosterone seems to show cardioprotective symptoms.
Yet, those men who have coronary heart disease do have much lower testosterone levels than those men who do not have coronary heart disease.
[Mendoza SG, Osuna A, Zerpa A, Gartside PS, Glueck CJ. Hypertriglyceridemia and hypoalphalipoproteinemia in azoospermic and oligospermic young men: relationships of endogenous testosterone to triglyceride and high density lipoprotein cholesterol metabolism. Metabolism. 1981;30:481–6]
Studies continually repeat these findings. In particular one study which included over 900 men showed that those with lower testosterone levels had coronary heart disease compared to those men who had higher levels of testosterone and without coronary heart disease.
[Bremner WJ, Prinz PN. A loss of circadian rhythmicity in blood testosterone levels with aging in normal men. J Clin Endocrinol Metab. 1983;56:1278–81.]
The difference in testosterone levels was reported to be significant.

Can increased naturally produced testosterone offer cardiac protection?

Studies have shown that low levels of testosterone are related to adverse lipid profiles.
That means…
Testosterone has a strong an positive relationship with good cholesterol known as HDL which is the high density lipoprotein. This HDL clears out the build up of the bad cholesterol (LDL) which is responsible for the build up of plaque which lines the arteries.
As a result, men who register a low level of testosterone have a much higher risk of developing metabolic syndrome.
Men who suffer from low testosterone should see this as a warning sign as a precursor to possible cardiovascular problems.
[Simon D, Charles MA, Nahoul K, Orssaud G, Kremski J, et al. Association between plasma total testosterone and cardiovascular risk factors in healthy adult men: The Telecom Study. J Clin Endocrinol Metab. 1997;82:682–5.]

Does this mean low testosterone causes cardiovascular health problems or vice versa?

Is the risk of a heart attack or other cardiovascular related issues due to the levels of low testosterone in men or is it a case of these conditions that have a negative effect on hormonal levels?
Studies would suggest it is not chronic disease such as coronary artery disease that causes low testosterone and actually low testosterone which can be the catalyst to chronic disease.
[Caron P, Bennet A, Camare R, Louvet JP, Boneu B, et al. Plasminogen activator inhibitor in plasma is related to testosterone in men. Metabolism. 1989;38:1010–5.]
Why?
Because, regardless of the severity of chronic disease the patients testosterone levels always remain low at a consistent level rather than varying according to severity of the disease.
The theory that low testosterone levels are a result of coronary heart disease it would be expected that those who are experiencing more severe symptoms of the disease would also experience lower levels of testosterone than those who are suffering from milder symptoms of the disease.
A theory or expectation that has not been associated or proven.
It also has to be noted that studies on animals show that post a castration procedure there has been an accelerated build up of fatty deposits in the arteries.
This condition is then reversed once the animal receives hormone replacement.

Then there are all the side effects of the metabolic syndrome which are all closely  associated with coronary heart disease and  lower levels of testosterone.

[Kupelian V, Page ST, Araujo AB, Travison TG, Bremner WJ, et al. Low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men. J Clin Endocrinol Metab. 2006;91:843–50.]

Furthermore, once the male sex hormones are revived to a healthy levels all associated factors of metabolic syndrome are improved and the risk of mortality reduced.

To add further weight to the theory that heart disease and all related factors are subject to testosterone levels, upon a patients exposure to testosterone repressive therapy coronary heart disease was noted to increase rapidly.

This is highlighted by a study involving 70,000 men who had to endure testosterone suppressive therapy for treatment of prostate cancer resulted in a 44% increase of the risk of metabolic syndrome and its associated diseases.

These negative effects became apparent as early as 1 month after the treatment had started.

Does testosterone have an effect on blood flow?

Put simply, yes.

A side effect of low testosterone is erectile dysfunction whereby the blood vessels within the penis are not filled with enough blood at a high enough pressure.

Studies have shown that testosterone increases artery dilation and therefore blood flow is also increased.

This is as effective for those men who have and do not have coronary heart disease.

These findings correlate with increased cardiovascular output and performance due to less restriction for blood flow.

[Deenadayalu VP, White RE, Stallone JN, Gao X, Garcia AJ. Testosterone relaxes coronary arteries by opening the large-conductance, calcium-activated potassium channel. Am J Physiol. 2001;281:H1720–7.] 

Is there a relationship between low testosterone and heart failure?

Heart failure is caused by a number of different factors and combined conditions which correlate with lower levels of testosterone.

Furthermore, testosterone can oppose these multiple factors.

And, increased testosterone levels can then increase the positive cardiac output in men who have suffered heart failure.

In fact, increased testosterone levels can have a very strong and positive effect on a man’s cardiac performance with increases in exercise capacity.

[Pugh PJ, Jones TH, Channer KS. Acute haemodynamic effects of testosterone in men with chronic heart failure. Eur Heart J. 2003;24:909–15.]

With the widely discovered positive effects of increased testosterone levels in men will testosterone booster supplements help those who suffer from heart disease?

There have been long standing thoughts that increases in testosterone from supplementation may promote coronary heart disease and related metabolic syndrome symptoms.

However, we can clearly see that this is not the case from the studies and in fact the studies point towards the healthy relationship between increased testosterone levels and improved cardiovascular health and a reduction of the symptoms of metabolic syndrome.

Yet, evidence also demonstrates that for those who have lower levels of testosterone, their levels need to be raised to ‘normal’ levels for best results rather than increasing testosterone to chronic levels. Ie. way and above the normal healthy levels.

[Traish AM, Saad F, Feeley RJ, Guay A. The dark side of testosterone deficiency: III. Cardiovascular disease. J Androl. 2009;30:477–94.]

Will testosterone booster supplements increase the risk of prostate cancer?

Because hormonal suppressive therapy is an effective way to successfully treat prostate cancer the common train of thought is that increasing testosterone levels will cause prostate cancer.

Thankfully this is not the case.

Contemporary studies have yet to find a close relationship or association with testosterone levels and the development of prostate cancer.

No studies have yet to prove that lower than normal natural testosterone levels are able to protect against the development of prostate cancer. 

[Stattin P, Lumme S, Tenkanen L, Alfthan H, Jellum E, et al. High levels of circulating testosterone are not associated with increased prostate cancer risk: a pooled prospective study. Int J Cancer. 2004;108:418–24]

Scientific analysis is yet to prove an association between testosterone supplementation with a risk of developing prostate cancer.

Moreso, it is now suggested that any therapy used to suppress testosterone levels in elderly men is to be withheld even with prostate cancer because doing so would shorten their life expectancy further.

[Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, et al. Survival following primary androgen deprivation therapy among men with localized prostate cancer. JAMA. 2008;300:173–81.]

Is taking a testosterone supplement going to benefit overall health and reduce the risk of cardiovascular related illness?

The studies clearly show that a significant proportion of men suffering from coronary heart disease will also be suffering from low levels of testosterone (hypogonadism).

[Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, et al. Low serum testosterone and increased mortality in men with coronary heart disease. Heart. 2010;96:1821–5.]

Furthermore, there is now demonstrative evidence that proves men who suffer from low levels of testosterone are at a higher risk of developing or worsening the effects of cardiovascular illness that can lead to death.

[Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, et al. Low serum testosterone and increased mortality in men with coronary heart disease. Heart. 2010;96:1821–5.]

Plus, when hypogonadism has been identified and testosterone supplementation has been administered the patients have seen a reduction of the effects of metabolic syndrome and have experienced an increased overall quality of life ranging from improved cardiovascular performance to increased muscle mass, increased energy and fat reduction.

[Malkin CJ, Pugh PJ, Morris PD, Kerry KE, Jones RD, et al. Testosterone replacement in hypogonadal men with angina improves ischaemic threshold and quality of life. Heart. 2004;90:871–6.]

Then, with the popular archaic theories of an increased risk of prostate cancer being squashed by contemporary studies proving no relationship it is deemed safe to supplement with a testosterone booster as long as this does not lead to an abuse.

 

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