Testosterone Therapy May Actually Increase Your Risk of Stroke, Heart Attack and Death
November 22, 2013 |
By Dr. Mercola
After age 30, a man’s testosterone levels begin to decline and continue to do so as he ages, leading to symptoms such as decreased sex drive, erectile dysfunction, depressed mood, and difficulties with concentration and memory
Conventional treatment for low testosterone revolves around synthetic testosterone hormone replacement therapy, using either a testosterone cream, gel or patch
Recent research has raised a red flag, warning men that testosterone therapy may increase your risk of dying from a sudden stroke or heart attack
The study found that testosterone use was associated with a 29 percent increased risk for an adverse event—regardless of whether they had underlying coronary heart disease or not
Dietary and exercise changes, particularly limiting sugar/fructose, eating healthy saturated fats and engaging in high-intensity exercises, Power Plate, and strength training, can be very effective at boosting testosterone levels naturally
While primarily associated with the notion of “manhood” and the attributes this word conjures up, the androgenic sex hormone testosterone plays an important role in a man’s health and wellbeing over and beyond those related to sexual prowess.
For example, testosterone helps your body maintain muscle mass, bone density, optimal lipid profiles and levels of red blood cells, and can impart a general sense of vigor and “youthfulness.”
Around the age of 30, testosterone levels begin to decline. Symptoms of declining testosterone levels in men include decreased sex drive, erectile dysfunction, depression, poor concentration and impaired memory. Men with low testosterone levels may also experience weight gain, breast enlargement, and problems urinating.
Conventional treatment for low testosterone revolves around synthetic testosterone hormone replacement therapy, using either a testosterone cream, gel or patch.
However, recent research1 has raised a red flag, warning men that testosterone therapy may increase your risk of dying from a sudden stroke or heart attack. The study in question does have limitations however, and more research is likely needed before any definitive conclusions can be drawn.
That said, I believe it’s worth noting that there’s almost always going to be a significant difference between taking a synthetic hormone versus encouraging your body to produce more of a hormone naturally. I personally do not believe the risks are in any way comparable between these two strategies—both of which I’ll address below.
Are Men Putting Themselves at Risk by Misusing Testosterone?
I know first-hand that low testosterone is not an automatic outcome of aging, provided you incorporate certain lifestyle strategies that can naturally boost your testosterone levels.
Moreover, I firmly believe that naturally boosting your body’s production of testosterone (and other hormones) through lifestyle strategies such as exercise and diet will not be as likely to have negative impacts on your heart or longevity. On the contrary, these strategies are part and parcel of an overall healthy lifestyle, so they also automatically reduce your risk of most chronic disease, including heart- and cardiovascular disease.
Unfortunately, many men who feel they’ve “lost the spring in their step” opt for the quick and easy route of hormone replacement therapy. Data from the US Food and Drug Administration (FDA) shows annual prescription rates for testosterone have increased more than five-fold between 2000 and 20112, 3. An estimated 5.3 million testosterone prescriptions were written in 2011.
This dramatic increase is causing researchers to question whether men may be abusing the hormone,4, 5, 6 as professional guidelines only recommend testosterone replacement therapy for men who have symptomatic testosterone deficiency.
According to the Endocrine Society, which is responsible for setting the clinical guidelines for testosterone replacement therapy, testosterone should only be given to men with persistent symptoms and “unequivocally low testosterone levels,” a condition known as hypogonadism. To determine this, you have to actually test your testosterone level, which is done with a blood test—ideally more than once, as your testosterone level can rise and fall during each day. Recent findings7 indicate that 25 percent of men given a prescription for testosterone did not have their levels tested prior to receiving a prescription, and of the remaining 75 percent, it was unclear as to how many actually had a testosterone deficiency.
Testosterone Therapy May Increase Mortality, Study Says
The featured study,8 published in JAMA, noted that “a recent randomized clinical trial of testosterone therapy in men with a high prevalence of cardiovascular diseases was stopped prematurely due to adverse cardiovascular events.” To further assess this potential link between testosterone therapy and heart attack, stroke and all-cause mortality, the researchers looked at more than 8700 men who underwent a coronary angiography9 (a test that checks for blocked arteries). They wanted to determine whether having underlying coronary artery disease might modify the outcome in men taking testosterone.
Perhaps it’s just more risky to take testosterone if you already have heart disease? That did not turn out to be the case, overall... All of the participants had a total testosterone level of less than 300 ng/dL. Of the 1,223 patients who started testosterone therapy after their coronary angiography, nearly 26 percent of them suffered an adverse event (stroke, heart attack and/or death) within three years. In the group that did not take testosterone, less than 20 percent had an adverse event.
After adjusting for other differences between the groups, testosterone use was associated with a 29 percent increased risk for an adverse event—regardless of whether they had underlying coronary heart disease or not. The authors concluded that:
“Among a cohort of men in the VA health care system who underwent coronary angiography and had a low serum testosterone level, the use of testosterone therapy was associated with increased risk of adverse outcomes. These findings may inform the discussion about the potential risks of testosterone therapy.”
Other research10 published earlier this year found that testosterone replacement therapy did not appear to have any positive effects on the cardiovascular health of men who took it, noting that the “cardiovascular risk-benefit profile of testosterone therapy remains largely evasive.” Interestingly, the analysis does suggest that low testosterone and heart disease might both be caused by “poor overall health,” as stated by lead researcher, Dr. Johannes Ruige.11 This, again, is why I recommend focusing your efforts on healthy lifestyle strategies such as exercise rather than taking synthetic hormone replacement, the risk/benefit ratio of which is still largely unknown...
Estrogen May Be Equally Important as Testosterone in Men
Another thing to think about is this: Recent research12 has found that there are significant individual variations in the amount of testosterone required for any particular man to maintain lean body mass, strength, and sexual function. Knowing this, it makes logical sense to allow your body to normalize and make what it needs for optimal health, rather than supplying it with an arbitrary dose of hormone thought to be ideal for men in general.
Furthermore, researchers have now discovered that estrogen also plays an important role in many of the processes previously thought to be relegated to testosterone alone.13, 14 For example, they’ve determined that, in men, testosterone deficiency accounts for decreases in lean mass, muscle size and strength, while estrogen deficiency was the primary culprit when it came to increases in body fat. Both testosterone and estrogen were found to be important for sexual function, and a deficiency in either had a negative impact on the men’s libido. According to the lead author, Dr. Joel Finkelstein, an endocrinologist at Harvard Medical School:
“Some of the symptoms routinely attributed to testosterone deficiency are actually partially or almost exclusively caused by the decline in estrogens.”
Despite individual variations, Dr. Finkelstein’s research offers valuable insight into the function and behavior of estrogen and testosterone at different levels in a man’s body. For example, they found that less testosterone is actually needed for muscle maintenance than previously thought. They also found that:
In young men, the average testosterone level is about 550 nanograms per deciliter (ng/dl)
Muscle size and strength does not become adversely affected until testosterone levels drop below 200 ng/dl, which has previously been considered extremely low
Fat accumulation, however, increases at testosterone levels of 300-350 ng/dl, due to its impact on estrogen
Libido increases steadily with simultaneous increases in testosterone and estrogen
Please note that men are NOT advised to take estrogen replacement therapy, as this could cause feminization, such as enlarged breasts. As your testosterone levels rise, your body will automatically produce more estrogen, so the key is to maintain your testosterone level—ideally by incorporating the strategies I discuss below.
You Can Raise Your Testosterone- and HGH Levels Naturally
Personally, I do not recommend using testosterone hormone replacement. If you indeed have low testosterone, you can consider trans rectal DHEA cream. DHEA is the most abundant androgen precursor prohormone in the human body, meaning it’s the largest raw material your body uses to produce other vital hormones, including testosterone in men and estrogen in women. However, I believe most men don’t even need that, were you to take full advantage of your body’s natural ability to optimize hormones like testosterone and human growth hormone (HGH). Testosterone production follows a similar decline with age as HGH illustrated below.
Just like testosterone, your HGH levels also sharply decline after the age of 30. Both of these hormones are boosted in response to short, intense exercise. I personally do not take any hormone or prohormone supplements; rather I’ve been doing Peak exercises for just over three years, and at the age of 59, my testosterone- and HGH levels (listed below) are still well within the normal range for a young adult male without the aid of ANY prescriptions, hormones and hormone precursor supplements, clearly demonstrating it is possible to normalize these hormones using these natural strategies:
My total testosterone: 982 ng/dl (normal test range: 250-1,100 ng/dl)
My free testosterone: 117 pg/ml (normal test range: 35-155 pg/ml)
My HGH: 14,000 pg, more than three times the normal test range of 1,000-4,000 pg/24 hours
To Raise Your Hormone Levels, Exercise Intensely, but Briefly
Below is a summary and video demonstration of what a typical high-intensity Peak Fitness routine might look like. This type of exercise—short intervals of high intensity exertion followed by periods of rest—emulate the daily physical actions and movements of ancient man. This, researchers say, is what your body is hard-wired for. Keep in mind that high intensity interval training is the only type of exercise that will help boost your testosterone- and HGH levels. A slow one-hour jog will not have this effect, so it’s critical to make sure you’re exercising correctly if you want to affect your hormone levels. The entire workout is only 20 minutes, and 75 percent of that time is warming up, recovering or cooling down. You're really only working out intensely for four minutes. It's hard to believe if you have never done this, that you can actually get that much benefit from only four minutes of intense exercise, but that's all you need!
Warm up for three minutes
Exercise as hard and fast as you can for 30 seconds. You should feel like you couldn't possibly go on another few seconds
Recover at a slow to moderate pace for 90 seconds
Repeat the high intensity exercise and recovery 7 more times
More Ways to Boost Testosterone and HGH
Besides high intensity exercise, there are several other strategies that will also boost your testosterone levels naturally. These are appropriate for virtually anyone, male or female, as they carry only beneficial "side effects." I’ve listed four of my favorite strategies below. For even more tips, check out the slide show. More details can also be found in my previous article, 9 Body Hacks to Naturally Increase Testosterone.
Weight training. When you use strength training to raise your testosterone, you’ll want to increase the weight and lower your number of reps. Focus on doing exercises that work a wider number of muscles, such as squats or dead lifts. You can take your workout to the next level by learning the principles of Super-Slow Weight Training. For more information on how exercise can be used as a natural testosterone booster, read my article “Testosterone Surge After Exercise May Help Remodel the Mind.”
Whole body vibration training (WBVT) using a Power Plate. In addition to the Peak Fitness exercises I do 10 minutes of Power Plate training twice a day and this likely also improved my hormones. WBVT in some ways simulate high intensity exercise by stimulating your white (fast-twitch) muscle fiber. This kick-starts your pituitary gland into making more growth hormone, which helps you build lean body mass and burn fat.
Address your diet. This is critical for a number of reasons. First of all, if you're overweight, shedding the excess pounds may increase your testosterone levels, according to recent research.15 Testosterone levels also decrease after you eat sugar. This is likely because sugar and fructose raises your insulin level, which is another factor leading to low testosterone. Ideally, keep your total fructose consumption below 25 grams per day. If you have insulin resistance and are overweight, have high blood pressure, diabetes or high cholesterol, you’d be well advised to keep it under 15 grams per day.
The most efficient way to shed excess weight and normalize your insulin levels at the same time is to strictly limit the amount of sugar/fructose and grains in your diet, and replacing them with vegetables and healthy fats, such as organic pastured egg yolks, avocado, coconut oil, butter made from raw grass-fed organic milk, and raw nuts. Saturated fats are in fact essential for building testosterone. Research shows that a diet with less than 40 percent of energy as fat (and that mainly from animal sources, i.e. saturated) lead to a decrease in testosterone levels.16 My personal diet is about 70-80 percent healthy fat, and other experts agree that the ideal diet includes somewhere between 50-70 percent fat. I've detailed a step-by-step guide to this type of healthy eating program in my optimized nutrition plan.
Intermittent fasting. Another effective strategy for enhancing both testosterone and HGH release is intermittent fasting. It helps boost testosterone by improving the expression of satiety hormones, like insulin, leptin, adiponectin, glucacgon-like peptide-1 (GLP-1), cholecystokinin (CKK), and melanocortins, which are linked to healthy testosterone function, increased libido, and the prevention of age-induced testosterone decline.
If you're overweight, shedding the excess pounds may increase your testosterone levels, according to research presented at the Endocrine Society's 2012 meeting. Overweight men are more likely to have low testosterone levels to begin with, so this is an important trick to increase your body's testosterone production when you need it most.
Do You Really Need Testosterone Therapy?
For most men, the answer to declining testosterone levels comes not from a prescription hormone replacement, but in the form of a healthy, active lifestyle. If you’re still deficient in testosterone after implementing high intensity exercise and strength training, along with the recommended modifications to your diet and, ideally, intermittent fasting, then you could try trans-mucosal DHEA. DHEA is a precursor hormone that is crucial for the creation of vital hormones, including testosterone and other sex hormones.
For information on DHEA supplementation, please see my previous article Testosterone Decline: How to Address This Challenge to 'Manhood'. In it, you can also learn more about other helpful dietary supplements, and how endocrine-disrupting chemicals in your home and environment may adversely affect your hormonal balance. Personally, I’ve been able to maintain both testosterone and HGH levels comparable to that of men half my age, simply by implementing high intensity exercise and intermittent fasting, along with my standard dietary recommendations, which apply to everyone, regardless of age or sex.
Clearly, low testosterone is not an inevitable fate for aging men, and you don’t have to risk your health by experimenting with synthetic hormones in order to maintain youthful levels. Even if you believe the risks to your heart are small (although I personally would not consider a nearly 30 percent increased risk to be negligible), I encourage you to consider the big picture.
Using exercise and diet will allow your body to optimize testosterone, HGH and other hormones to levels that are ideal for you, and will have countless synergistic beneficial effects on your health. By opting for hormone therapy as your first line of treatment, you’re cheating yourself out of most, if not all, of those benefits—and you may even end up doing more harm than good.