Heart Disease and Testosterone: Just the Facts
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!