A famous cardiac study was published about 10 years ago. It soon became on ongoing study known as the Multiple Risk Factor Intervention Trial (MRFIT). The present study examined changes in Testosterone over 13 years in 66 men aged 41 to 61 years. The researchers determined if changes in total Testosterone are related to cardiovascular disease risk factors.
The average Testosterone levels at the beginning of the study were 751 ng/dl and decreased by 41 ng/dl. Men who smoked or exhibited Type A behavior were found to have even greater decreases in T levels. The change in Testosterone was also associated with an increase in triglyceride levels and a decrease in the good cholesterol (HDL).
The authors concluded that decreases in Testosterone levels as observed in men over time are associated with unfavorable heart disease risk. (2) Sounds to me like a good reason to get T support/replacement therapy in the middle age years!
In a similar study, researchers in Poland examined if Testosterone replacement therapy in aging men positively effected heart disease risk factors. Twenty-two men with low T levels received 200 mg of Testosterone enanthate every other week for one year. Throughout treatment, Testosterone, estradiol, total cholesterol, HDL and LDL were measured.
The researchers determined that T replacement returned both Testosterone and estradiol levels back to normal and acceptable levels. They also found that T replacement lowered cholesterol and LDL (the bad cholesterol) without altering HDL (the good cholesterol). Furthermore, there was no change in prostate function or size.
The take home message from this study is that T replacement doesn't appear to raise heart disease risk and it may actually lower your risk. (3) It appears that more physicians should be prescribing low dose Testosterone to middle age and aging men for both libido, muscle tone and for cardiac reasons.
What about younger men?
It's been long established that men have a higher risk of heart disease. One of the risk factors implicated is Testosterone. Reportedly, the recreational use of Testosterone can alter lipoprotein levels and, in fact, case reports exist describing bodybuilders who've abused steroids and have experienced heart disease or even sudden death. But the question remains, is the causal association one of truth or just an association?
To answer this, researchers at the University of North Texas recruited twelve competitive bodybuilders for a comprehensive evaluation of the cardiovascular effects of steroids. Six heavyweight steroid-using bodybuilders were compared with six heavyweight drug-free bodybuilders.
As expected, the heavy steroid users had lower total cholesterol and HDL levels as compared to the drug-free athletes. What was unexpected was that the steroid users also had significantly lower LDL (the bad cholesterol) and triglyceride levels as compared to the non-steroid users. In addition, the juicers also had lower apolipoprotein B levels (a marker for heart disease risk). Thus, the authors concluded that androgens do not appear to raise the risk of cardiovascular disease. (4) The take home message from this study is that the negative cardiac side effects of steroids are most likely overstated.
In a little more progressive study, researchers at the Albert Einstein College of Medicine in the Boogie Down Bronx (the BDB to those in the know) examined Testosterone as a possible therapy for cardiovascular disease. (5) The researchers note that T can be given in oral, injectable, pellet and transdermal delivery forms. It's noted that injections of Testosterone (100 to 200 mg every two weeks) in men with low levels of T will decrease total cholesterol and LDL while raising the HDL.
In fact, Testosterone therapy has been found to have antianginal effects (reduces chest pain). Low levels of Testosterone are also correlated with high blood pressure, specifically high systolic pressure. The researchers determined that returning T levels back to normal and even high-normal levels have positive cardiovascular effects and should be considered as an adjunctive treatment for maintaining muscle mass when someone has congestive heart failure.
Putting it all together
Strong research demonstrates that the risks of negative cardiovascular effects of steroids are overstated. In fact, a recent paper published in the Canadian Journal of Applied Physiology questioned the whole risk of using steroids. (6) Joey Antonio, Ph.D. and Chris Street MS, CSCS published strong data showing that the risks of steroid use are largely exaggerated, much like scare tactics used by your parents while you were a kid. Of course, it goes unsaid that abuse of anything will lead to unwanted consequences.
We know that as we age, circulating Testosterone levels naturally decrease. For most people the Testosterone decrease goes from high-normal to mid to low normal. Data shows that there's an inverse relationship between T levels and blood pressure as well as abdominal obesity (that paunch we see on so many middle age males).
Testosterone replacement lowers abdominal obesity and restores Testosterone back to normal levels. Restored Testosterone is correlated with better mood, better muscle tone, stronger sex drive, lower cardiovascular disease risks, stronger bones and better memory. It's important to note that while conservative use gives a pronounced positive health benefit, higher doses may not necessarily lead to further health benefits.
What to do
If you see your body composition changing (your gut starts looking like your Uncle Lester's), your strength or muscle tone diminishing despite your hard training and good diet, and your sex drive not matching up to TC's columns, have your Testosterone levels checked. The acceptable normal range for Testosterone to physicians is 300 mg/dl to 1100 mg/dl. Yes, that's a pretty wide range.
In the clinic, we see people with the complaints consistent with "andropause" (a term for male menopause) and/or increased cardiovascular risk having Testosterone levels between 300 mg/dl and 550 mg/dl. Bringing it up to the mid to high-normal level is what gives the health and "youthful" benefits. Traditionally 200 mg/dl of supplemental Testosterone given every one to two weeks improves body composition, lowers total cholesterol and LDL, while raising HDL.
It appears that supplemental T is a healthier and safer way to go than many of the drugs used to treat poor lipid profiles. The data presented in this article applies for males over 35, not those who are 18. If you think that you can benefit from Testosterone therapy look for physicians who market themselves as "anti-aging" or "longevity physicians" as well as the more progressive endocrinologists or cardiologists.
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