Testosterone-heart disease link explained

Benefits worth the risk?


In recent months, there has been a great deal of contradictory information regarding testosterone.  So much so that it is hard for any man to decipher what level is right, and whether seeking an “optimal” level is the preferred course of action.  

In 2011, 5.3 million prescriptions for testosterone were written in the United States.  The rate of prescriptions has tripled since 2000, and sales reached $1.6 billion in 2011. There has obviously been a lot of marketing for testosterone and low-T syndrome, but what exactly is testosterone is and what would are the benefits of treatment?

Testosterone is a hormone which helps regulate heart function and plays a part in sperm production, bone health, energy levels, concentration and muscle mass. This essential hormone does much more than just fuel a man’s sex drive.  The problem is, most men experience a natural decline in testosterone as they age starting at 30,  and testosterone supplementation is commonly prescribed to help these men regulate their hormone levels. The benefits and risks of the long-term use of testosterone therapy however, are not well known.

In a new study, the University of Texas looked at 9,000 male veterans who had undergone coronary angiography between 2005 and 2011, a procedure for testing the arteries when people have symptoms such as chest pain or are at high risk for heart problems.

The study found that men with signs of heart problems who take injections of testosterone or use gel containing the hormone had a 30 percent increased risk of heart attack, stroke or dying, compared with men who didn't use the hormone.  The study was stopped early due to higher rates of heart problems in the group receiving the hormone.

It is important to note that all of the men in the study more severe medical conditions including coronary artery disease, diabetes and previous heart attacks, than men in the general population.  These risk factors may have been part of the reason testosterone treatments were harmful to them, but more research is needed to know for sure.

It is not hard to see why medical professionals would also be divided when it comes to testosterone treatment. Some side effects include acne, enlarged breasts, prostate problems, testicle shrinkage and limited sperm production.  Similarly, once you start on it, you suppress your own production of testosterone and injections become a lifetime commitment.

As is the case with most hormones, testosterone needs to be kept in balance, and your physician  can decide what level is right for you since this, too, can vary from man to man, and from lab to lab.  A treatment program should be frequently monitored through lab tests, paying attention to potential side effects.

Men with prostate cancer should not receive testosterone as it could speed up cancer growth. Testosterone is not thought to cause prostate cancer, but may speed up the severity of the disease.

Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team and the chief medical correspondent for am970 in New York City. Learn more at roboticoncology.com. Visit Dr. Samadi's blog at SamadiMD.com. Follow Dr. Samadi on Twitter and Facebook.