The People's Perspective on Medicine

Will Extra Testosterone Help or Hurt the Heart?

The FDA says that men with "Low T" due to age should avoid testosterone because of heart risks. New research suggests extra testosterone may help the heart.

The FDA has warned men that taking extra testosterone may increase the risk of heart attacks and strokes, but a new study of 755 men showed that those on testosterone were actually less prone to heart attacks, strokes or death.

Extra Testosterone is Bad for the Heart:

If you get whiplash from contradictory health headlines we wouldn’t blame you. Several years ago (July 8, 2010) we were told that older men men with low T who used topical testosterone as a gel had more mobility along with increased arm and leg strength, but the trade off was an increased risk for cardiovascular complications including heart attacks (New England Journal of Medicine, July 8, 2010). This small study was stopped early because of the negative heart and vascular problems.

No Wait, Extra Testosterone is Good for the Heart

A couple of years later we learned that testosterone replacement therapy (TRT) was helpful for patients with heart failure (Circulation Heart Failure, May 1, 2012). We learned that extra testosterone improves exercise capacity and “appears to be a promising therapy to improve functional capacity in patients with HF [heart failure].”

Stop…More Testosterone is Actually Bad for Heart:

After a few more years the answer seemed clear: testosterone replacement therapy was really bad for the heart. Researchers assessed heart attack risks in large groups of men. Veterans who underwent cardiac catheterization and had received a prescription for testosterone were seemingly more likely to die or end up in the hospital from a heart attack or stroke over the following three years (Journal of the American Medical Association, Nov. 6, 2013).

Another study followed 55,000 men who had received TRT. The investigators compared the number of non-fatal heart attacks this group experienced before and after they received a prescription for testosterone (PLOS One, Jan. 29, 2014). Older men on TRT were roughly twice as likely to have a heart attack.

Never Mind: Testosterone Does NOT Boost Heart Attacks:

Is your brain turning somersaults? We’re not surprised. On July 9, 2014 a study was published online in the journal Annals of Pharmacotherapy. Over 25,000 older men eligible for Medicare were studied over an eight-year timespan. More than 6,000 received a prescription for testosterone over that length of time. These gentlemen were compared with roughly 19,000 men who did not get T. There was no increased risk of heat attacks in the men getting extra testosterone. If anything, men who were at especially high risks of heart problems seemed to have a reduced risk for suffering a heart attack if they got TRT.

The FDA Says Extra Testosterone is Off Limits to Most Men:

Despite conflicting data the FDA has made it very clear that taking testosterone for “low T” is verboten unless a man has a serious medical condition such as a disorder of the testicles, pituitary gland or brain. If, and only if a man cannot produce adequate testosterone because of such a serious condition should he be allowed to get a prescription for TRT. The FDA states that low T caused by aging is not a reasonable cause for such a prescription. The FDA also warns that TRT poses cardiovascular risks such as “an increased risk of heart attack, stroke, or death.”

But Wait, There’s More Good News About Extra Testosterone:

Another study published in the New England Journal of Medicine (Feb. 18, 2016) suggested that testosterone supplementation with the prescription drug AndroGel improved sexual function as well as mood. And research in the European Heart Journal (Oct. 21, 2015) concluded that normalizing hormone levels with extra testosterone lowered the risk for heart attacks, strokes and premature death.

The Latest Update on Extra Testosterone:

Okay, we know that your head is spinning. Does TRT help or hurt the heart? Well, the final word is not in but a study was presented at the American College of Cardiology meetings April 2-4, 2016 in Chicago that offered additional good news to the pro-T perspective.

Investigators at the Intermountain Medical Center randomized 755 men with serious heart disease to receive different doses of testosterone or placebo. The men on placebo had more cardiovascular events than those on testosterone. We find it even more interesting that the men getting higher doses of T had the lowest likelihood of having a heart attack or stroke.

Bottom Line:

The latest research suggests that when testosterone is given to normalize hormone levels in men that it will not increase the risk for heart attacks and strokes and might even lower the risk for such cardiovascular events.

Now one might anticipate that the FDA would be very interested in the new research and might consider softening its warning. Perhaps that will happen, but we would not hold our breath. In the meantime, we suggest that men work with their health care professionals to find the safest and most appropriate path forward if they have low levels of testosterone. You can listen to our streaming audio podcast “Boosting Testosterone Naturally” for free at this link.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I wonder if the form the testosterone is in makes a difference. Gel, vs pill vs DHEA. And what about T for women? Any studies there?

I had a surgical menopause when I was 49, followed immediately by a bad mood and hot flashes. I yelled at the doctor when he came in to see me the next day and he went running for a nurse to give me an estrogen shot. At his office followup he gave me a small T shot, a script for a more natural estrogen patch, and I felt a lot better for a while. Increased libido, increased ability to achieve orgasm, stronger – just more alive. I had several small shots in the years following. He called them half strength. Then new doctor/insurance, no more shots.

Now I am taking small amounts of DHEA as blood tests have shown cortisol difficulties combined with low hormones, even considering my age. The hope is that by raising my estrogen hormones, I will correct my cortisol imbalances. And sleep better.

Could age at time of supplementation be a factor in the various results from testosterone studies – just as HRT begun well after menopause has adverse effects but HRT begun at or slightly before menopause has many positive effects?

would like to see comments by readers. thanks.

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