Testosterone and Heart Health: Studies About Cardiovascular Disease

Testosterone is more than a sex hormone, exerting its influence throughout the body and the brain, including critical effects on the cardiovascular (CV) system. It is no wonder that the increase in all-cause mortality and cardiovascular risk coincides as testosterone levels decline. Low testosterone increases coronary artery disease (CAD) risk, as well as the health issues of type 2 diabetes and metabolic syndrome. In this comprehensive review of testosterone and heart health, we look at these concerns and examine the research on testosterone and heart disease. We want to start by answering some of the most commonly asked questions about testosterone replacement and heart disease:

Is there a connection between testosterone therapy and heart attacks?

For many years, doctors warned that testosterone replacement therapy (TRT) could increase the risk of heart attacks. Studies have shown the opposite to be true. Further down, we will examine the research that confirms that not only is testosterone therapy safe for the heart but that it also improves CV risk factors and reduces the risks of heart attacks and mortality.

If I have low testosterone and heart problems, can I still use testosterone therapy?

Yes, most adults with cardiovascular issues can benefit significantly from testosterone therapy when diagnosed with Low T. The doctor will look at many factors when determining the appropriate treatment.

There is a significant connection between maintaining normal levels of testosterone and heart health.

Testosterone Deficiency Impact on Heart Health and Coronary Artery Disease

Testosterone deficiency causes many problems for the adult body. Low T interferes with proper metabolic actions which can result in any or all of the following:

• Weight gain
• Insulin resistance
• High blood sugar levels
• Low HDL cholesterol (the good kind)
• Elevated total and HDL cholesterol (the bad kind)

These issues can lead to metabolic syndrome, obesity, high blood pressure, renal failure, atherosclerosis, and type 2 diabetes – all markers that increase the risk of cardiovascular disease, mortality, and morbidity. However, the risks go even further, as testosterone has actions of its own directly on the heart. The relationship between testosterone and heart health is shown below:

• Testosterone stimulates erythropoiesis – the production of red blood cells necessary for proper circulation
• Inflammation markers increase (including c-reactive protein) when testosterone levels decline
• Testosterone has a direct impact on carotid intima-media thickness (IMT), diastolic function, and ejection fraction (EF)
• Testosterone exerts positive effects on peripheral arterial stiffness and peripheral vasomotion
• High estrogen and low testosterone levels increase the risk of CV and CVD mortality

Estrogen dominance, a condition that occurs when estrogen levels are higher than normal as compared to testosterone levels being lower increases not only CVD risk, but also prostate cancer in men, breast cancer in women, and weight gain in all adults. One example of issues surrounding testosterone and heart functions can be seen in patients with prostate cancer (PC) who received androgen deprivation therapy (ADT). Multiple studies have demonstrated an increased risk of CVD in men who received gonadotropin-releasing hormone (GnRH) agonists for the treatment of PC. The result of ADT is a significant lowering of testosterone levels. In one study, PC patients receiving ADT had a 38% increase in nonfatal CVD compared to those who did not receive that treatment.

Is there a link between low testosterone and heart disease in women?

Postmenopausal women experience CAD as a leading cause of death, which is often linked to low free testosterone levels. Both high and low free testosterone are markers for increased CVD risk in postmenopausal women, supporting the need for balancing of any abnormal hormone levels.

Maintaining normal levels of testosterone and heart health go hand in hand as adults age.

Study Findings of the Effects of Testosterone Therapy on Heart Health

In addition to the previously mentioned studies of testosterone and heart health, we want to provide some other crucial fact-based research:

• 2010: Study showed that elderly women with low testosterone and heart failure (chronic heart failure – CHF) improved insulin resistance, functional capacity, and muscle strength
• 2012: Meta-analysis showed that CHF patients receiving testosterone therapy had improvements in 6-minute walk test, fasting insulin, fasting glucose, and insulin resistance
• 2016: Men with both CVD and low testosterone experienced improvements in blood pressure, pulse pressure, heart rate, cardiometabolic risk factors such as weight loss, lipid patterns, and body mass index (BMI) reduction
• 2017: Study of elderly men with low testosterone experienced 66 to 92 percent reduction in mortality from testosterone therapy, as well as less myocardial infarction (MI) and stroke
• 2017: Another study reported that men over age 40 with low testosterone experienced fewer CV events

To help put aside the concerns over heart attack and testosterone usage, the majority of the well-accepted studies have shown that there is no increased risk of cardiovascular events with TRT. Quite the opposite, testosterone therapy reduces the incidence of CV issues.

Many studies have shown positive research for testosterone and heart health for adults receiving treatment for Low T.

Benefits of Testosterone Therapy for Heart Health and Cardiovascular Risk

Current guidelines for men with symptomatic hypogonadism recommend the use of supplemental TRT. Because of the reduced risk linking testosterone replacement and heart disease, as shown in extensive research, it is relatively safe to say that both men and women can safely receive TRT to improve their overall health. In one study of 656 men, where 360 received testosterone and 296 did not (control group), the TRT group saw only 2 deaths (not related to CVD) compared to 21 in the control group (19 associated with CVD). The control group also experienced 26 nonfatal MIs and 30 nonfatal strokes, compared to none in the group receiving testosterone therapy. These numbers show the significance of testosterone therapy for individuals with increased risks of cardiovascular concern. Studies such as these, that focus on testosterone therapy and heart health, demonstrate the importance of testosterone for the cardiovascular system. When we look at research on testosterone replacement therapy and heart problems, we find that benefits such as increased coronary blood flow, better exercise capacity, and improve coronary vasodilation help improve heart health and quality of life. Testosterone therapy helps reduce body fat mass, improve lean muscle mass, lower LDL and total cholesterol, and support insulin sensitivity and glucose uptake. These factors reduce the risk of obesity, type 2 diabetes, high blood pressure, and metabolic syndrome – contributing factors to cardiovascular diseases. To learn more about testosterone and heart health or hormone therapy in general, please contact Kingsberg Medical for a free consultation by phone.
Brian Leeber