Proper Doses of Testosterone Reduces Heart Attack Risk
A new Veteran’s Administration study looked at records of 83,000 men, average age 66, with no evidence of heart disease or stroke and low total testosterone (TT) at the beginning of the study. Only men with confirmed low TT were included in the study. They were divided into three groups – those that achieved normal TT with treatment, those who were treated but never achieved normal TT, and those who refused treatment.
During seven years of observation, those who achieved normal testosterone levels were 47% less likely to die, had 18% fewer heart attacks, and 30% fewer strokes. Those whose TT level never rose to the normal level had the same hazard as those who had no treatment – no benefit at all. (Treatment failures are caused by lack of absorption of skin creams or lack of compliance, frequently due to cost.)
These results are not surprising. Doctors have known for 50 years that low testosterone shortens life span, increases heart attacks, strokes, and osteoporosis. Secondly, without testosterone supporting muscle function, the same men have an increased risk of obesity, type 2 diabetes, and a host of related disorders.
Two earlier studies, also from the Veterans Administration, received the headlines. They concluded that testosterone administration increased the risk of heart attack in men. However, neither study consistently checked testosterone levels prior to, or during each study. Dr. Nadelberg and I had a letter published in the Journal of the American Medical Association challenging these methods.
So identifying testosterone deficient men and carefully monitoring testosterone supplementation can have significant benefits. Please understand that the definition of a hormonal deficiency is more complicated than a single number on a lab test, and that treatment, while beneficial, is not without risks.
And now, I will discuss the limitations of this study. First, all of the subjects or patients were of the Veterans Administration hospital system. Veterans, as a group, have more chronic illnesses than the general population. Showing that testosterone works well in this group does not mean it would work well with all patients (theoretically, it could also work better in the general population, but improving on a 40% reduction in mortality is unlikely). For example, Lipitor reduces cardiac events in post heart attack patients by almost 20%, but only reduces heart attacks in the general population by about 2%. The study did not consider symptoms of hypogonadism. The study did not look at lifestyle, such as exercise. Lastly, the study tweaked its statistics by about 4% by using a manipulation called propensity scoring. The definition of “normal” testosterone level is a subject of intense scientific debate. The study did not supply any guidance, such as the percent improvement in testosterone level, so that clinicians could judge where the author stood in the debate on normal
However, you did not see a headline that read “Testosterone Replacement Therapy (TRT) is More Effective than Lipitor for Preventing Heart Attack!” One retrospective study, no matter how large, or well conducted, would be proof of such an assertion. On the other hand, we have seen recent headlines about testosterone treatment causing heart attacks, and the FDA announcing an investigation.
Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Rishi Sharma1, Olurinde A. Oni1, Kamal Gupta2, Guoqing Chen3, Mukut Sharma1, Buddhadeb Dawn2, Ram Sharma1, Deepak Parashara2,4, Virginia J. Savin5, John A. Ambrose6, and Rajat S. Barua1,2,4*
Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA 2013;310:1829–1836, Finkle WD, Greenland S, Ridgeway GK, Adams JL, Frasco MA, Cook MB, Fraumeni JF Jr, Hoover RN.
Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS ONE 2014;9:e85805. 13. Baillargeon J, Urban RJ, Kuo YF, Ottenbacher KJ, Raji MA, Du F, Lin YL, Goodwin