Heart Dis­ease and Testos­terone: Just the Facts

Starkville Daily News - - LIFE & STYLE - THOMAS

Grow­ing up, I had a brother 2 years younger than me. We fought ev­ery now and then, and for ex­cel­lent rea­sons, like un­equal candy dis­tri­bu­tion or whether or not Nolan Ryan is the great­est pitcher in his­tory (and he is, of course). Freddy, my brother, was tough…un­til Mom came around. He could tan­gle with me on my best day but if Mom started com­ing down the hall, he’d look at me, grin, then start cry­ing! It was em­bel­lished at best and thus I wrongly got ac­cused of many things grow­ing up be­cause he knew how to fake a cry on the spot and I didn’t.

How does that re­late to heart dis­ease and testos­terone? Well, hor­mones in gen­eral have been mis­rep­re­sented ever since the WHI study came out in 2002. As a so­ci­ety, we’ve been the mom who as­sumes one child tends to be more at fault. We (pa­tients and health­care providers) don’t have all the facts and thus make bi­ased con­clu­sions based on per­cep­tion and lack of fac­tual knowl­edge. I want to chal­lenge you to­day to read on. I’m go­ing to ob­jec­tively and with­out bias fill you in on testos­terone’s im­pact on heart dis­ease risk for both men and women. I love liv­ing in Mis­sis­sippi – the peo­ple, the cul­ture, the hospitality - but it is the most un­healthy state in the na­tion. Any­thing I can do to pos­i­tively im­pact this makes my heart leap for joy.

Let’s talk about low testos­terone lev­els first. There’s an es­tab­lished low testos­terone range for men and women. Here’s what you need to know, though: men and women with low testos­terone lev­els have ap­prox­i­mately a 40% in­creased mor­bid­ity and mor­tal­ity rate, which is pri­mar­ily tied to heart dis­ease. An­other way of say­ing that is folks who in­her­ently have nor­mal testos­terone lev­els tend to live longer and have less heart dis­ease. This is pretty straight for­ward and has been il­lus­trated in sev­eral stud­ies – es­pe­cially over the last 20-30 years.

How about lev­els that con­sis­tently av­er­age higher than the nor­mal testos­terone range? Same thing – we see an in­creased risk of heart dis­ease. Higher than nor­mal lev­els in folks aren’t seen of­ten un­less they’re tak­ing steroids (pic­ture those body builders from the ‘70’s). Low testos­terone lev­els are way more com­mon in our pop­u­la­tion and it’s un­der­diag­nosed. Symp­toms sug­gest­ing you may have low testos­terone in­clude fa­tigue, de­creased li­bido, erec­tile dys­func­tion (for men), mood changes and/or de­creased mus­cle strength to name a few. If you have any of these, ask a health­care provider who spe­cial­izes in hor­mones to check it out fur­ther.

Al­right. Let’s say you do have low testos­terone lev­els. Now what? Should you get the lev­els back up? How will that af­fect heart dis­ease risk? What we’re learn­ing is that for pa­tients who do not have heart dis­ease al­ready, they should op­ti­mize their testos­terone level. It will lower their risk for pro­gress­ing to heart dis­ease, and it will ben­e­fit their health long term across the board. For guys and girls, the win­dow of op­por­tu­nity is more re­lated to heart dis­ease sta­tus than gener­i­cally re­lated to age. Ev­ery­one’s dif­fer­ent.

How about if you do have a his­tory of heart dis­ease? Are you doomed to 13 med­i­ca­tions, fa­tigue, de­pres­sion and fear of do­ing any ex­er­cise for the rest of your life?! No! Let’s talk about this. The lit­er­a­ture on testos­terone op­ti­miza­tion af­ter it has been low and you’ve de­vel­oped heart dis­ease is still mixed. We need more stud­ies to bet­ter un­der­stand this – specif­i­cally look­ing at dif­fer­ent meth­ods of de­liv­er­ing testos­terone and how that changes risk fac­tors long term. Right now, the data for this sce­nario ranges from still a ben­e­fit (i.e. a low­er­ing of heart dis­ease pro­gres­sion risk) of up to ~10% to a dou­bling of the risk of heart dis­ease pro­gres­sion. That sounds scary right? Well, let’s look at it a dif­fer­ent way: The Amer­i­can Heart As­so­ci­a­tion cur­rently puts the preva­lence of heart fail­ure in men at 2.4% of the pop­u­la­tion. Let’s say, ab­so­lute worst case, this risk dou­bles. That would in­crease your odds of heart fail­ure by 2.4% which, at least to me, doesn’t sound scary at all con­sid­er­ing the other ben­e­fits re­ceived from nor­mal­iz­ing testos­terone lev­els. An­other thing to con­sider is that the study pub­lished in JAMA in 2013 that caused such a stir about the im­pact of testos­terone on heart dis­ease risk ac­tu­ally showed that pa­tients treated with testos­terone op­ti­miza­tion had half the rate of events in­clud­ing stroke, heart at­tack, and death com­pared to the group that had low testos­terone lev­els and didn’t get them re­placed! Granted, ev­ery­one’s dif­fer­ent, but I think it’s fairly safe to say that even if you have heart dis­ease, if you make life­style changes in­clud­ing diet and ex­er­cise mod­i­fi­ca­tions then you could ben­e­fits from a nor­mal­iza­tion of your hor­mone lev­els.

In the end, you have to weigh the risks and ben­e­fits of hor­mone op­ti­miza­tion. It’s not just about heart dis­ease but you need to at least have an aware­ness of how that im­pacts the big pic­ture. Hor­mones are very ben­e­fi­cial for the vast ma­jor­ity of peo­ple when mon­i­tored cor­rectly. Seek out a health­care provider who can help you here. Hor­mones are a piece of the puz­zle that paints the pic­ture for bet­ter health!

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