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Does Low Testosterone Affect Heart Health?
How does low testosterone affect heart health? Several meta-analyses have confirmed that low testosterone (low-t) increases the risk of major cardiovascular events as well as the mortality due to cardiovascular diseases and all causes.
I was diagnosed with a blood cancer called multiple myeloma in early 1994. I underwent the FDA standard-of-care therapy plan including an autologous stem cell transplant. A side effect of agressive, high dose chemotherapy from an ASCT is low serum levels (blood) of testosterone.
How does low testosterone affect heart health?
Low testosterone levels can have several effects on heart health, some of which are complex and interrelated. Here are the key points:
- Increased Cardiovascular Risk Factors:
- Obesity: Low testosterone is associated with increased body fat, particularly visceral fat, which is linked to higher cardiovascular risk.
- Diabetes: Low testosterone can lead to insulin resistance and an increased risk of type 2 diabetes, which is a significant risk factor for heart disease.
- Dyslipidemia: Low testosterone levels can lead to an unfavorable lipid profile, including higher levels of LDL (bad) cholesterol and lower levels of HDL (good) cholesterol.
- Atherosclerosis:
- Low testosterone levels are associated with increased arterial stiffness and the development of atherosclerosis (the buildup of plaques in the arteries), which can lead to heart attacks and strokes.
- Blood Pressure:
- Low testosterone can contribute to higher blood pressure, another significant risk factor for cardiovascular disease.
- Inflammation:
- Low testosterone levels are linked to higher levels of inflammatory markers, which play a role in the development of cardiovascular diseases.
- Endothelial Function:
- Testosterone helps in maintaining the function of the endothelium (the inner lining of blood vessels). Low levels of testosterone can impair endothelial function, leading to poorer vascular health.
- Metabolic Syndrome:
- Metabolic syndrome, which includes a cluster of conditions like high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels, is more common in men with low testosterone and is a major risk factor for heart disease.
- Direct Cardiac Effects:
- Testosterone has direct effects on the heart muscle and its ability to contract efficiently. Low levels may impair heart function.
- Mood and Energy Levels:
- Low testosterone can lead to fatigue, depression, and decreased physical activity, all of which can negatively impact heart health.
Low-T was a short-term side effect that resulted from my high-dose chemo. In early 2011 I was diagnosed with chemotherapy-induced cardiomyopathy. I wondered what affect testosterone would have on my deminished heart function.
I am writing this post in an effort to document what I have found out about heart health and testosterone.
If you would like to learn more about evidence-based non-conventional heart health therapies such as CoQ10 or omega-3 fatty acids, email me at David.PeopleBeatingCancer@gmail.com
Thanks,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
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Is Testosterone Replacement Safe in Men with Cardiovascular Disease?
“Patients with low testosterone who are symptomatic should be treated with testosterone replacement therapy (TRT) once the diagnosis has been confirmed. The goal of treatment is to improve the symptoms including the physical, sexual, and cognitive health with the aim being to keep the testosterone in the mid-normal limit of the reference range.
Male hypogonadism has been increasingly diagnosed and treated in elderly males since the last decade. A proportionate increase in the prescription of testosterone has been seen as well. The relationship of testosterone levels with cardiovascular (CV) outcomes is challenging and has shown conflicting results.
Moreover, in patients with established CV disease, those with high CV risk factors including diabetes, or those with significant risk factors for atherosclerotic CV disease (ASCVD), the benefits of TRT should be weighed against the risks of replacement. Risks and benefits of TRT should be discussed with every patient prior to starting or restarting the procedure…”
Ischemic Stroke
“Ischemic stroke (see the image below) is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke…”
Atherosclerosis
“Atherosclerosis is a disease in which the inside of an artery narrows due to the build up of plaque.[7] Initially, there are generally no symptoms.[1] When severe, it can result in coronary artery disease, stroke, peripheral artery disease, or kidney problems, depending on which arteries are affected.[1] Symptoms, if they occur, generally do not begin until middle age.[3]…”
The Association of Serum Testosterone Levels With Recurrence and Mortality After Acute Ischemic Stroke in Males
“The current study aimed to investigate whether low testosterone predicted the recurrence and clinical outcomes after acute ischemic stroke (AIS) in males…
The cumulative incidence, overall survival, length of hospital stay, and the percentage of previous stroke were compared between subjects with testosterone <440 ng/dl and >440 ng/dl.
- The median age was 62 years (range, 35–93 years).
- The median serum testosterone at admission was 438 [203] ng/dl (range, 44–816 ng/dl);
- 55 patients (50%) had testosterone <440 ng/dl and were considered as low testosterone.
- The 1-year and 3-year cumulative recurrence rate were 8.3% and 11.9%, respectively;
- the 1-year and 3-year overall survival were 96.3% and 84.6%, respectively.
- The cumulative recurrence rates were similar between the two testosterone groups (log-rank test, p = .88).
Low testosterone was associated with poor survival with marginal significance (log-rank test, p = .079). Men with low testosterone had a higher percentage of previous stroke (29.1% versus 12.7%, p = .035). The mean lengths of hospital stay were similar between the two testosterone groups (16.6 ± 15.8 days versus 14.0 ± 10.6, p = .31).
Total testosterone at admission fails to predict stroke recurrence. However, men with low testosterone at admission are more likely to have previous stroke and may have a higher all-cause mortality rate after AIS…
Stroke is the leading cause of death and chronic disability all over the world (Lozano et al., 2012), and the epidemiological data identified that the number of new events continues to increase in the past two decades (Feigin et al., 2014). A substantial percentage, around 6% to 12%, of patients with recent ischemic stroke would have a second episode in the following 1 year (Amarenco et al., 2018; Bergström et al., 2017; Dhamoon, Sciacca, Rundek, Sacco, & Elkind, 2006)…
Low testosterone is associated with multiple risk factors for atherosclerosis, such as
- obesity,
- diabetes,
- hypertension, and
- dyslipidemia (Corona, Monami, et al., 2011; Ho et al., 2015).
Low testosterone is associated with increased systemic inflammation (Liao et al., 2016) and endothelial dysfunction (Corona, Bianchini, Sforza, Vignozzi, & Maggi, 2015), both of which contribute to atherosclerosis.
Epidemiological studies demonstrated that low testosterone independently predicts the development of atherosclerosis (Hak et al., 2002; Hougaku et al., 2006).
Several meta-analyses have confirmed that low testosterone increases the risk of major cardiovascular events as well as the mortality due to cardiovascular diseases and all causes (Corona et al., 2018a; Ruige, Mahmoud, De Bacquer, & Kaufman, 2011).
A recent meta-analysis further demonstrated that testosterone therapy may have a beneficial effect on cardiovascular mortality in select subjects (Corona et al., 2018b)…
This finding generally confirmed previous studies that low testosterone increases the risk of death due to all cause, cardiovascular disease, and cancer in the general population (Araujo et al., 2011; Corona, Monami, et al., 2010; Corona et al., 2018a; Corona, Rastrelli, et al., 2011; Khaw et al., 2007; Ruige et al., 2011). These results suggest that testosterone can be viewed as a marker for general health and a predictor for survival in either general male population or stroke survivors.
Conclusion- In the current study, total testosterone levels at admission failed to predict recurrence after AIS in male patients. Men with low testosterone at admission have a higher chance of previous stroke and may have a higher all-cause mortality rate.
Testosterone and Heart Health
Low Testosterone levels are also associated with chronic medical conditions such as metabolic syndrome, diabetes, dyslipidemia, hypertension, renal failure, frailty, malignancy, and cardiovascular (CV) events.
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Testosterone and the Heart
“Testosterone (T) has a number of important effects on the cardiovascular system. In men, T levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk.
Low T levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes. Reduced T levels in men with congestive heart failure (CHF) portends a poor prognosis and is associated with increased mortality.
Studies have reported a reduced CV risk with higher endogenous T concentration, improvement of known CV risk factors with T therapy, and reduced mortality in T-deficient men who underwent T replacement therapy versus untreated men. Testosterone replacement therapy (TRT) has been shown to improve myocardial ischemia in men with CAD, improve exercise capacity in patients with CHF, and improve serum glucose levels, HbA1c, and insulin resistance in men with diabetes and prediabetes.
There are no large long-term, placebo-controlled, randomized clinical trials to provide definitive conclusions about TRT and CV risk. However, there currently is no credible evidence that T therapy increases CV risk and substantial evidence that it does not. In fact, existing data suggests that T therapy may offer CV benefits to men…
Definition- Testosterone deficiency (TD) is a well-established major medical condition that negatively impacts male sexuality, general health, and quality of life. Symptoms include decreased libido, erectile dysfunction, decreased energy, depressed mood, irritability, and decreased sense of well-being.
In the correct clinical setting, the diagnosis of TD is usually confirmed by low serum concentrations of total T (e.g., < 200 ng/mL) drawn in the early morning. However, there is no specific value that reliably distinguishes men who experience signs and symptoms of TD from those who do not nor those who will likely respond to treatment…
Low T levels are also associated with chronic medical conditions such as metabolic syndrome, diabetes, dyslipidemia, hypertension, renal failure, frailty, malignancy, and cardiovascular (CV) events. Several meta-analyses and systematic reviews have clearly associated TD with increased CV disease and mortality…
Emerging evidence indicates that congestive heart failure (CHF) is more than just a syndrome affecting a failing heart. It is becoming clear that the pathophysiology of CHF involves other pathways as well, including the skeletal muscles and the endocrine system.
Jankowska et al. studied 208 men with CHF and 366 healthy male controls. Low T levels were found in all NYHA classes of heart failure.12 It has also been shown that reduced T levels in men with CHF portends a poor prognosis and is associated with increased mortality.13…
Congestive Heart Failure-Testosterone replacement therapy has been shown to significantly improve exercise capacity without affecting left ventricular ejection fraction (LVEF). Given emerging evidence from basic-science models, it is reasonable to assume that TRT positively affects the exercise capacity of CHF patients via a peripheral mechanism, such as promoting increased type I muscle fiber proliferation.27 Four authors have investigated the effects of TRT on exercise capacity in men with CHF…
Prostate Cancer- In 2005, Calof et al. published a meta-analysis of 19 randomized placebo-controlled trials that included 651 men who received TRT and 433 men who received placebo. They reported two major differences between the groups. The TRT group had a significantly greater incidence of all prostate-related adverse events, with a pooled odds ratio of 1.78. Combined prostate events included all instances of prostate biopsies, prostate cancer, prostate-specific antigen (PSA), increase in PSA during the study period, increased International Prostate Symptom Score, and acute urinary frequency.
However, none of the individual prostate-related adverse events significantly differed between groups, including incident prostate cancer, which showed no difference between the TRT group and placebo…
Similar to the previous reports, TRT resulted in a significant increase in hemoglobin levels.36…
It is clear that testosterone is an active hormone in many aspects of cardiovascular health, and TD is clearly associated with poor cardiovascular outcomes. However, the effect of TRT remains unclear at this time….”