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Is Testosterone Replacement Therapy Safe for Men With Cardiovascular Disease?

Testosterone is an anabolic hormone that promotes the growth of male genitalia. It also improves muscle mass and bone strength. In addition to the main sexual traits at birth and puberty (the changes and modifications of sexual organs such as the uterus, vagina, penis, and testes), testosterone is also engaged in secondary sexual features maintenance. 

So is testosterone replacement therapy safe for men with cardiovascular disease? A study discovered that testosterone therapy did not raise the incidence of heart disease. Further research is essential to assess the safety of utilizing testosterone therapy to treat older males with age-related low testosterone levels. In 2015, the FDA issued an advisory; testosterone labels must warn users of increased cardiovascular risk.

What Should a Patient Do About Testosterone?

Testosterone is a male hormone that is predominantly synthesized in the testicles. Normal testosterone level aids in the maintenance of men's:

  • Bone density
  • Distribution of fat
  • Muscle density and strength
  • Hair on the face and body
  • Production of red blood cells
  • Sex drive
  • Production of sperm

As a result, patients with testosterone deficiency typically have diminished libido, erectile dysfunction, exhaustion, lethargy, muscle weakness, osteoporosis, melancholy, decreased intellectual function, and regression of several secondary sexual traits. 

Testosterone flows in the body in a physiologically inactive form tied to sex hormone-binding globulin (SHBG). Its bioactive form appears as free testosterone and loosely attached to albumin. As people age, their SHBG levels rise and bond-free testosterone. 

In addition, growing aromatase enzymes promote the conversion of testosterone to estradiol. Both of which reduce the level of physiologically active testosterone. Furthermore, men should avoid certain medications like LHRH agonists. 

These are medications that decrease the quantity of testosterone released by the testicles. Because these medications suppress testosterone levels, they are referred to as medical castration.

What Happens to Patients With Low Testosterone Levels?

Sign low testosterone and book on wooden surface

Testosterone production slows with aging, and many older men exhibit symptoms of low testosterone. Low testosterone is defined by the American Urological Association as fewer than 300 nanograms (ng) of hormones per deciliter (dl) of blood. 

They also stated that approximately 2 out of every 100 males have low testosterone. The following are some of the most prevalent indications and symptoms of low testosterone in men. Women may also have some of the symptoms listed below.

1. Erection problems

Low testosterone levels might cause fatigue and mood swings. Erections can be hard to obtain or preserve when testosterone levels are low. Testosterone causes the penile tissues to create nitric oxide, which initiates a chain of events that leads to an erection. 

Other causes that can induce erectile dysfunction include:

  • high levels of cholesterol
  • diabetes
  • smoking
  • high blood pressure
  • anxiety, or stress
  • thyroid-related problems

2. Hair loss

Most males undergo hair loss as an inevitable part of aging, and women can also have age-related hair loss. Authors of a study published in 2012 discovered that testosterone injection helped in hair restoration in some females undergoing treatment for signs of sex hormone insufficiency. 

3. Bone mass decrease

Testosterone promotes the formation of bone tissue and the maintenance of bone quality. Low testosterone levels might cause a decrease in volume, making the bones more prone to fractures. 

4. Reduction in the size of testicles

A man with low testosterone may observe a decrease in testicle size and is not influenced by cold weather. The testicles may be softer than usual.

5. Sperm reduction

The semen is what makes up the majority of male ejaculation. This fluid supports sperm movement toward the egg. Testosterone stimulates the generation of sperm, and low amounts of sperm indicate a drop in testosterone. It can potentially cause fertility issues.

6. Troubles in sleeping

Men with low testosterone may have difficulty falling or staying asleep. Several men with lower testosterone experience sleep apnea. It is a deadly illness that causes a cessation of breathing for a short period. Which potentially interrupts sleep.

7. Low sex drive

People with low testosterone frequently have a decrease in sex drive. A male's sex drive usually declines with aging. However, when the problem is low testosterone, he will sense a dramatic fall in the desire to have sex. 

8. Decrease in muscle mass 

Testosterone is involved in the formation of muscle mass, and low levels of the hormone may lead to significant muscle mass loss. While low testosterone causes a decrease in muscle mass, muscular performance and strength do not deteriorate, according to a 2016 review. 

9. Body fat accumulation

A low testosterone level might lead to an increase in body fat. In some circumstances, men with a lack of hormones suffer gynecomastia or breast growth.

10. Mood swings 

According to some research, men with low testosterone levels result in difficulty in concentration, anger, and sadness.

11. Hot flashes 

Many individuals link hot flashes with fluctuating estrogen levels during menopause; low testosterone levels can also trigger this symptom.

12. A drop in energy levels

Low testosterone levels might result in decreased energy and weariness. A patient may feel exhausted or lose interest in activity and movements even after having enough rest. In women, testosterone is quite essential. 

Women's levels, on the other hand, are generally lower than men's. Low hormone levels in women are usually not a concern. However, high testosterone levels may induce undesirable effects. 

These are some examples:

  • irregular or non-existent menstrual cycles
  • growth of face and body hair
  • infertility
  • lowered voice

High testosterone levels in women can be triggered by the following factors:

  • ovarian cancer 
  • adrenal tumor
  • congenital adrenocortical hyperplasia
  • polycystic ovarian syndrome

Men Testosterone Replacement and Cardiovascular Risk Factors

Modern androgen therapy began in 1935, testosterone was extracted from bulls' testes and artificially produced separately. Since then, several different types of prescriptions have been developed. Over the last decade, hypogonadal men have been commonly recognized and treated in older men. 

Based on a study, 2.4 million men aged 40 to 69 years old in the United States (US) struggle with hypogonadism. Approximately 481,000 new instances of hypogonadism are diagnosed each year in males of the same age group. Testosterone levels typically peak around the age of 30 and would fall at 1-2 percent annually. 

Findings suggest that as men get older, their testosterone levels fall. Patients with low testosterone should be treated with testosterone replacement therapy (TRT). If testosterone contributes to the dilation of blood vessels, it may be able to alleviate angina in men with coronary artery disease. 

In a 2000 experiment, 46 males with stable angina and lower serum testosterone levels were assigned randomly to either a testosterone supplement or a placebo for twelve weeks. Before and post-therapy, each individual conducted a conventional physical stress test. 

Men on testosterone had better exercise tolerance than placebo-treated patients at the end of the experiment. Although the difference was minor, amounting to an average gain of only 26 seconds. The benefits of TRT must be considered as against the risks of replacements. 

Particularly in patients with documented CV illness or those with higher CV risk factors. In recent years, the FDA has ruled that there is no proof of considerable CV risk for any particular group of patients given by hormone replacement therapy

However, further research is needed to determine the dangers of TRT in patients with strong CV risk factors and a history of coronary heart disease. As a previously reported study, the FDA authorized testosterone undecanoate in March 2019. It is an oral pill to treat males with specific types of hypogonadism, making it the first latest oral testosterone pellets medication in over six decades. 

The American College of Cardiology (ACC) and the American Endocrine Society recommend that men with adversely managed heart failure (HF), recent myocardial infarction (MI), revascularization, or stroke in the preceding six months should avoid TRT. 

Normal testosterone levels are helpful to the male cardiovascular system, and testosterone insufficiency is linked to an adverse metabolic profile and an increased risk of vascular disease. 

Ways to Boost Low Testosterone Naturally

Fit people doing deadlift exercise in gym

Healthy levels are critical in adults for overall health, illness risk, sexual function, body composition, and everything else. Furthermore, boosting testosterone levels might result in rapid improvements in muscular mass and vitality in just a few weeks. Surprisingly, it also has a significant impact on female health and sexual health.

The science is very conclusive: both genders should maintain appropriate testosterone levels, specifically as they age. Here are some tested methods for naturally increasing hormone levels. 

1. Weight lifting and Exercise

Exercise is among the most efficient ways to avoid a variety of health problems. Surprisingly, it can also increase testosterone levels. A meta-analysis study discovered that men who exercise regularly had greater testosterone. 

Exercise improves testosterone levels, endurance, and response time in older men. According to a new study, a good workout is even more effective for obese males than a weight loss plan in boosting testosterone levels. 

2. Consume protein, fat, and carbohydrates.

What people consume has a significant impact on testosterone and other hormone production. As a result, men must be mindful of the long-term calorie consumption and diet plan. 

Overeating or dieting constantly may cause testosterone levels to drop.

Eating adequate protein can maintain normal levels and help in fat loss, which is linked to testosterone. Carbohydrate consumption also plays its part, with studies demonstrating that carbs can enhance testosterone levels throughout resistance training. 

3. Avoid estrogen therapy or medication and maintain a healthier lifestyle.

There is a vast array of factors that can have an impact on hormone levels. Healthy sex life is essential for controlling the sex hormone and testosterone levels. The high estrogen-like compound may also alter the levels. 

Limit the regular exposure to BPA, paraben, or other substances found in some plastics. It should come as no surprise that excessive alcohol or drug usage, whether medicinal or recreational, can cause testosterone deficiency. Laughter, achievement, and enjoyment may assist raise the health and testosterone levels - make them a part of the daily routine. 

4. Reduce the cortisol levels and stress

Long-term stress, which raises levels of cortisol, is constantly highlighted in studies. Abnormally high cortisol levels might quickly lower testosterone levels. These hormones function in a seesaw way: as one rises, the other falls. 

Stress and elevated cortisol levels can also lead to a surge in food consumption, weight gain, and the accumulation of toxic body fat around internal organs. As a result, these alterations may have a detrimental effect on testosterone levels. Aim to reduce recurrent stressful circumstances in life for healthy living and hormones.

5. Get plenty of deep, restful sleep.

Getting enough sleep is just as crucial for health as eating right and exercising. It may also have a significant impact on testosterone levels. The appropriate quantity of sleep differs from person to person. 

However, one study discovered that getting only 5 hours of sleep each night was associated with a 15% decrease in testosterone. Other lengthy investigations back this up. According to one report, every extra hour of sleep results in a 15% increase in testosterone levels.

Benefits of Testosterone Treatment

Portrait of a smiling man

Although testosterone therapy helps reverse the consequences of hypogonadism, it is uncertain if testosterone therapy would assist healthy older men. Some men believe that taking testosterone medicines makes them feel younger and more energetic. 

There is little evidence to support testosterone use in healthy men. According to the American College of Physicians, testosterone therapy may improve sexual performance in certain men. But, there is limited data that it benefits other functions such as energy and vitality.

Men with low baseline total testosterone concentrations, a subsequent testosterone level, and over three years of follow-up were evaluated. The usage of testosterone products was associated with a higher level.

The successful testosterone treatment that results in significant increases in testosterone levels lowers the risk of atrial fibrillation by 21%. Another study discovered that testosterone supplementation helps certain men prevent heart attacks, but the findings were ultimately unclear. 

The old belief that rising testosterone was accountable for the formation of prostate cancer was based on sophisticated but limited studies from the 1940s and anecdotal case studies. According to current research, high endogenous androgen levels do not enhance the chance of developing prostate cancer. 

Moreover, testosterone therapy has not been shown to raise prostate cancer risk or the probability of more severe disease at prostate cancer diagnosis in men with testosterone insufficiency. This behavior appears to be explained by androgen receptor saturation.

There is no evidence that testosterone therapy raises the risk of breast cancer, heart failure, or thromboembolic events. There is little data on the safety and effectiveness of testosterone therapy in women who do not utilize concurrent estrogen therapy or who use testosterone therapy for more than six months. 

Earlier research has indicated that subcutaneous testosterone administration in a menopausal woman may alleviate various menopausal symptoms, including hot flashes, sleep issues, irritability, and exhaustion. 

While testosterone is regarded as a male hormone, since men have significantly larger quantities, it is also present in females. A postmenopausal woman with diminished sexual desire due to personal despair and no other identified cause may benefit from testosterone therapy. 

Additional Risks

Another component of testosterone therapy that impacts cardiovascular health is a higher risk of sleep apnea. Sleep apnea occurs when a patient repeatedly stops breathing while sleeping. 

Sleep apnea can cause an increase in blood pressure, which raises the risk of stroke. It is also linked to an increased risk of heart valve dysfunction and severe cardiac rhythms known as arrhythmia.

Testosterone replacement therapy may raise cholesterol levels. A cardiac arrest can be caused by cholesterol buildup in the veins that carry blood to the heart.  Other adverse effects involve oily skin, fluid retention, and a reduction in testicular size.

Higher endogenous testosterone concentrations in males are related to a more favorable health risk profile for heart failure, involving high-density lipoprotein (HDL) lower blood pressure, triglyceride, cholesterol concentrations, and glucose concentration. If the hormone levels are normal, testosterone therapy may affect natural testosterone production.

Discover the Customized Hormone Replacement Plans at Revitalize You MD

Here at Revitalize You MD, we strive to provide excellent hormone therapy for you and your health. Aside from testosterone replacement therapy, we also offer various medical and aesthetic treatments tailored to your specific needs and preferences. 

End your pain and low self-esteem; restore wellness to your body with the help of our professional and registered medical experts. Book an appointment with Revitalize You MD today.


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