When your patient asks about his “low T”
Naji Hamdan, M.D.
Cardiologist, Providence Heart and Vascular Institute
Published Oct. 6, 2014
Testosterone has been described as man’s fountain of youth, which may explain why prescriptions for testosterone therapy, or TT, have tripled in the past 10 years.
TT patches, gels or injections are approved by the Food and Drug Administration to treat males with hypogonadism, which can be caused by age, belly fat, drugs, Type 2 diabetes or chemicals such as bisphenol A, which is found in plastics.
Because TT increases muscle mass and strengthens health in older males – and now is widely advertised on television – it’s also being prescribed for men with normal testosterone levels and, in some cases, with no testosterone testing at all.
Yet research is finding a link between testosterone therapy and an increased risk of heart attack. In January, a study funded by the National Cancer Institute and published in PLOS ONE, tracked nearly 55,600 elderly and middle-aged men treated with TT between 2008 and 2010.
The study specifically looked at the men’s rate of myocardial infarction in the year before receiving their new prescription for TT and in the three-month period after starting the treatment.
The rate of MI doubled in males 65 and older and in men younger than 65 with a history of coronary artery disease. The study found no increased risk in younger males with no history of coronary artery disease.
The cohort study also compared men using TT to a separate group of older or middle-age males who took Viagra or Cialis. In the latter group, no increase in the rate of heart attack was noted.
Six months after the study was published, the FDA issued a warning that testosterone products have been associated with an increased risk of deep vein thrombosis and pulmonary embolism.
Large-scale, prospective, randomized controlled trials are needed to fully evaluate the risks and benefits of testosterone therapies. But in the meantime, we should talk with our patients about the potential of cardiovascular risk involved with TT, especially those 65 or older or with a history of coronary artery disease.
We also can encourage natural, non-pharmacologic remedies, including:
- Losing weight. Obese males who lost an average of 17 pounds saw their testosterone rise by 15 percent, according to findings presented at the Endocrine Society’s annual meeting last year.
- Exercising routinely
- Quitting smoking
- Consuming less alcohol, which lowers testosterone levels
- Eating cruciferous vegetables, such as broccoli, cauliflower, brussels sprouts, kale, bok choy and cabbage
Each of these remedies has been shown to both increase testosterone levels and decrease the risk of cardiovascular disease.