Evaluating the Evidence on Testosterone Replacement and Cardiovascular Outcomes
The relationship between testosterone and cardiovascular health is complex. What impacts one man may not affect another in the same way. Underneath this issue lies a more nuanced reality.
This article takes a closer look at how testosterone affects your cardiovascular health. By shedding light on how risks and benefits vary, our aim is to provide a clearer understanding of testosterone’s complex ties to heart health.
Testosterone’s Role in the Male Body
Testosterone is an integral hormone for male biological functions and physiological processes. Produced primarily in the testes, it regulates critical aspects of masculine development including muscle mass accrual, bone mineral density, facial and body hair growth, and sexual function. Sufficient levels of testosterone are necessary to maintain typical male phenotypic traits and characteristics.
Testosterone Therapy and its Purposes
Testosterone therapy is a treatment that involves the use of testosterone to address low levels of the hormone in the body. It is primarily used to treat symptoms of sexual dysfunction in both men and women, as well as hot flashes in women.
Here are some potential benefits and purposes of testosterone therapy:
Benefits in Men
- Increased libido
- Improved cognition and mood
- Increased sense of well-being
- Decreased erectile dysfunction
- Increased bone density
- Increased muscle strength and mass
- Improved energy levels
- Improved insulin sensitivity
Benefits in Women
Treatment for premature ovarian failure, Turner’s syndrome, HIV infection, or chronic corticosteroid use
Understanding Testosterone Levels
Normal Levels vs Testosterone Deficiency
The normal physiological range of testosterone differs according to the analytical method and lab used for assessment. In general, total serum testosterone levels between 300-1000 ng/dL are considered typical for young, healthy adult males.
A clinical deficiency, or hypogonadism, is diagnosed when levels fall persistently below the lower boundaries of this range after accounting for analytical variance.
Biological Functions Influenced by Testosterone
Testosterone plays a vital role in numerous biological functions integral to male phenotypic identity and well-being. Areas influenced include:
- Sexual maturation during puberty
- Libido and erectile capacity
- Protein synthesis and skeletal muscle hypertrophy
- Bone mineralization
- Production of red blood cells
- Distribution of adipose tissue
- Cognitive and mood factors
How to Measure Testosterone Levels
Serum Testosterone Levels, Bioavailable Testosterone, and Blood Tests
Several laboratory approaches are available for clinicians to quantify testosterone amount or activity in the body. The most standardized is measurement of total serum testosterone using mass spectrometry or competitive immunoassay. However, the bioavailable or free testosterone fraction, unbound to sex hormone binding globulin, may better correlate with clinical signs.
Additional tests analyzing related hormones like estradiol levels or blood cell counts can provide further clinical context. Together, such serum testosterone measures, blood tests, and considering lifestyle habits and medical history aid in diagnosis of androgen deficiency states.
Testosterone Therapy and Its Forms
Testosterone replacement therapy (TRT) seeks to restore serum testosterone levels to the normal physiological range in diagnosed cases of hypogonadism via administration of exogenous testosterone. Testosterone supplementation may similarly be employed for symptomatic relief, but without an established clinical deficit of the hormone.
Forms and Administration
There are several different forms of testosterone replacement therapy available, including:
| Forms | Description |
| Testosterone Injections | Common form of testosterone replacement therapy. Various types include testosterone enanthate, testosterone cypionate, and sustanon |
| Testosterone Gels and Creams | Applied topically to the skin. Different gels and solutions available with various application methods |
| Testosterone Patches | Applied to the skin for transdermal delivery of testosterone into the bloodstream |
| Testosterone Pellets | Small pellets inserted under the skin, typically in the hip or buttock area. Releases testosterone slowly over time |
Benefits of Testosterone Therapy
Several potential benefits have been reported with testosterone therapy when administered properly under medical supervision.
Improvement in Muscle Mass
Testosterone therapy can help increase lean muscle mass rather than overall broad muscle gains. This emphasizes building skeletal muscle tissue over increasing body fat percentage, improving functional strength and physical outcomes.
Enhancement in Sexual Function and Libido
Many patients experience boosted libido and more robust erectile capacity early in testosterone treatment courses. This can greatly enhance quality of life and intimacy.
Reduction in Risk of Diabetes and Other Metabolic Conditions
Some evidence suggests testosterone therapy may lower risks for type 2 diabetes by reducing fasting glucose, HbA1c levels over time for certain groups. It can also potentially improve other metabolic biomarkers.
Cardiometabolic Risk Improvement
Research links higher testosterone to reduced abdominal fat storage and markers favoring cardiovascular health promotion. Therapy may optimize these cardiometabolic indicators.
Positive Changes in Terms of Diet and Inclination Towards Healthier Food
Anecdotal reports note patients adopting healthier dietary patterns focused on whole foods instead of processed fare after testosterone supplementation initiation.
Testosterone Therapy and Cardiovascular Health
Cardiovascular disease remains a major cause of illness and mortality worldwide. Conditions like congestive heart failure and increases in coronary artery plaque volume over time potentially elevate risk. Both chronic and acute cardiac events from this pathology include heart attacks, strokes, and arrhythmias.
Effects of Testosterone Therapy on Blood Pressure and Cardiovascular Risk Factors
Testosterone therapy has been shown to have positive effects on blood pressure and cardiovascular risk factors in men. Specifically:
- Reduced cardiovascular risk: A prospective cohort study in Germany found that testosterone therapy reduced cardiovascular risk among hypogonadal men. This is likely due to the fact that low serum testosterone concentrations are associated with increased cardiovascular risk and mortality.
- Improved blood pressure: Testosterone therapy has been shown to improve blood pressure in men with hypogonadism. This is important because hypertension is a major risk factor for cardiovascular disease.
- Improved lipid profile: Testosterone therapy has been shown to improve lipid profiles in men with hypogonadism, including reducing total cholesterol and LDL cholesterol levels. Dyslipidemia is another major risk factor for cardiovascular disease.
- Improved glycemic control: Testosterone therapy has been shown to improve glycemic control in men with hypogonadism. This is important because diabetes is a major risk factor for cardiovascular disease.
Risk Factors and Adverse Events
| Risk Factor | Adverse Events |
| Risk of Heart Attack and Stroke | Patients on testosterone therapy may face an increased risk of heart attack and stroke. Athletes abusing testosterone and other androgenic steroids have elevated risks of high blood pressure, heart attack, and stroke. High testosterone doses can negatively impact cardiac risk factors, including HDL cholesterol levels. |
| Effects on Blood Cell Production and Complications | Testosterone therapy increases hemoglobin and hematocrit levels, as shown in systematic reviews and meta-analyses. This can lead to side-effects such as polycythemia, where the body produces too many red blood cells. Monitoring for related complications is advised for men on testosterone therapy. |
| Risk of Prostate Cancer and its Association with Testosterone Therapy | Men with untreated prostate and breast cancer are advised against testosterone therapy. Monitoring prostate-specific antigen (PSA) levels and prostate abnormalities is essential for men undergoing testosterone therapy to ensure early detection of potential risks and changes. |
Special Populations and Considerations
There are several important subgroups and risk factors to ponder when investigating testosterone therapy. Namely:
- Non-testosterone-therapy patients vs patients on long-term testosterone replacement therapy. Men not on testosterone therapy have testosterone levels that vary naturally over time. Men taking testosterone for a long time have their levels regulated by the medication.
- Patients with pre-existing coronary artery disease. Men who already have problems with their heart arteries are at higher risk.
- Hormone levels in androgen-deficient men vs average testosterone levels. Men with low testosterone naturally have different levels than men with average amounts.
HRT versus TT
Hormone replacement therapy (HRT) and testosterone therapy (TT) are two different types of treatments that can be used to address hormonal imbalances.
| Criteria | Hormone Replacement Therapy (HRT) | Testosterone Therapy (TT) |
| Primary Usage | Primarily used to treat symptoms of menopause in women. | Prescribed to treat hypogonadism in men, resulting in low testosterone. |
| Key Benefits | – Alleviates menopausal symptoms such as hot flashes, vaginal dryness, and mood swings. – Prevents osteoporosis and fractures. | -Addresses symptoms like reduced libido, erectile dysfunction, and fatigue. -Enhances muscle mass, bone density, and cognitive function. |
| Contraindications | Not advisable for women with a history of breast cancer, blood clots, or stroke. | Should not be used in men with untreated prostate or breast cancer. |
Considering Testosterone Therapy?
Physicians Rejuvenation Centers specialize in personalized assessment and management of testosterone replacement therapy. Our team of board-certified doctors understand the nuances of balancing risks and benefits based on individual health profiles and goals.
By taking a comprehensive medical history, monitoring hormone levels, and addressing any pre-existing conditions, we will determine if you are an appropriate candidate for the treatment,
If you’ve been experiencing signs of low testosterone and want to learn more about treatment options, consider booking an initial consultation with Physicians Rejuvenation Centers.
Call us at 561-783-5153 for a faster transaction!