Health & Wellness

Testosterone Medication May Boost Risk of Heart Attack, Stroke, Death?

In a recent Los Angeles Times article, one writer opened up with “..treating low testosterone may be all the rage these days among men of a certain age. But men bothered by a midlife dip in energy and sex drive may want to think twice about bumping up their “low T” with a testosterone supplement, a new study says.” Within days, we had numerous concerned patients, calling, demanding immediate answers and explanations to these suggestions…. Please, if you wish, check out this story (yes, story) and see also how Dr. Moore feels and views this complete nonsense.

Truthfully, the fact in the article that just 2.9% of all U.S. men over 40 are currently taking testosterone, is the point covered in the LA times article that stirs me up the most. It stirs me up because more than 40 to 50 % of men over 40 are suffering low or relatively low Testosterone levels, and it has been shown that men with relatively low testosterone levels suffer greater degrees of heart disease. As well, those with lower levels of testosterone suffer more prostate illness. Then, we need to consider the benefits of increase energy, mood, memory, exercise desire and response, sense of well-being, and increase in libido that comes when testosterone is optimized. Treatment of Low T in this country is becoming so popular because it helps men, and women for that matter, feel much better and overcome what were considered normal symptoms of aging in the past.

Unfortunately, the press seems to relish studies that cloud the picture and focus on negatives. And, I am afraid they are focusing on medical reasoning very similar to that surrounding the catastrophically flawed Women’s Health Initiative Study that led most primary care doctors to stop prescribing hormone treatments to their female patients. The LA Times article refers to men ignoring this screeching halt to hormone replacement for women that occurred in 2002. In that study, none of the patients were under 60 years old; yet, menopausal symptoms start in a women’s mid-thirties. In other words, the main point probably should have been that women should have their hormones monitored earlier and kept balanced earlier and we would have received the promise of hormone replacement therapy that was expected and which many women are currently gaining when hormones are properly monitored and balanced. There were multiple other flaws in the Women’s Health Initiative- such as the fact the hormones being used were not bio-identical to hormones found in females and have been found since to cause injury to artery walls and predisposing to cardiovascular events. In my opinion, a lot of women lost out on the promise of hormone replacement therapy because American Medicine and pharmaceutical companies employed and oversimplified and rationed approaches to replacing females hormones. It was a size fits all approach that over-treated many women predisposing to breast cancer.

Now, I fear, an oversimplified and rationed approach is being touted, this time to men with convenient testosterone gel products. Many millions are being spent on TV advertising convincing men that one pump of gel applied to each shoulder will carry the day for them with testosterone replacement. The family doctors are willing to oblige many times when the patient reports what they’ve learned from the TV commercials. The problem is that family doctors have not been taught all the nuances to individualizing a hormone balancing program for their male patients. Patients need to be monitored at least every six months for increases in BP. They need monitored regularly for increases in the number of red blood cells with approximately 10% of patients needing to donate blood regularly as a side effect of their needed testosterone treatment or face increased cardiovascular risks. Patients need to be monitored to make sure they are not suffering the side effects of too high of estrogen or too high of the active level of testosterone- both variable among patients based on certain enzymatic activities unique to their physiology- both imbalance of estrogen or the active form of testosterone could increase risk of cardiovascular events. I believe if there were any real increase in risks of cardiovascular events in the latest JAMA study for those on testosterone- a big part of the problem would be improper individualization and monitoring and not dealing with these certain nuances a physician specializing in hormone balancing for men would provide.

I opinion that Testosterone replacement for men and women should only be employed in conjunction with a thorough assessment of the entire hormone system along with an advanced assessment of cardiovascular risks. The new and rapidly growing field of Age Management Medicine trains physicians in these comprehensive hormone assessments in conjunction with sophisticated cardiovascular risk assessment. Furthermore, an Age Management physician will help a patient implement a number of measures that will significantly lower their cardiovascular risks- likely far outweighing any potential increase in cardiovascular events when on testosterone therapy. The Synergistic Health Approach practiced at Synergistic Health Centers, our Age Management practice, has four tenants to its philosophy of approach. The second tenant is that by implementing multiple, well-established, well-proven health steps we hope to drown out any yet to-be discovered negative of any one thing we implement. We came up with that tenant in our approach specifically to help our patients get through incitement of confusion and fear that comes when the press highlights a flawed study such as this narrowly focused JAMA study.