Can Testosterone Replacement Therapy Harm Your Heart?

When men begin to experience signs and symptoms of low testosterone, such as loss of libido, waning muscle strength, encroaching abdominal fat, tiredness, brain fog, and erectile dysfunction, some seek out testosterone replacement therapy (TRT). After all, all those internet, television, and radio ads can’t be wrong, right? Got low T? Replacement therapy can solve your problems and make you feel like a man again.

Although TRT may seem like a great way to boost your T levels, there are some things you should know about testosterone therapy and the heart.

Use of testosterone replacement therapy

Given the high interest among aging men to take testosterone therapy, understanding the risk is important and should be discussed thoroughly between doctors and their patients. In fact, while reported rates of low testosterone among men have been static, prescriptions for TRT have climbed over the past two decades.

This rise in TRT reflects how the hormone is being increasingly prescribed and used for indications outside of the FDA approved reasons. According to the FDA, those reasons are as follows: “Testosterone is FDA-approved as replacement therapy only for men who have low testosterone levels due to disorders of the testicles, pituitary gland, or brain that cause a condition called hypogonadism. Examples of these disorders include failure of the testicles to produce testosterone because of genetic problems, or damage from chemotherapy or infection.”

Testosterone therapy and the heart

According to the findings of a new study from researchers at McGill University in Montreal, men who took testosterone therapy were at an increased risk of mini strokes (TIAs), stroke, or cardiac arrest during the first two years of taking the therapy. Data from about 15,400 British men aged 45 and older who had age-related low testosterone levels were evaluated for the study.

When compared with men who did not take testosterone replacement therapy, those who did had a 21 percent higher risk of cardiovascular events, including stroke, mini-stroke, or heart attack. This increased risk declined after two years of the hormone therapy.

One of the study’s authors, Dr. Christel Renoux, of the departments of epidemiology, biostatistics, and occupational health and the department of neurology and neurosurgery at McGill, explained that the evidence on long-term clinical benefits of using testosterone therapy in healthy men who have “modestly declining levels” of the hormone is limited. “We strongly recommend that clinicians proceed with caution when considering prescribing [testosterone therapy].”

Not all studies say TRT carries a cardiovascular risk. Some research suggests its use is associated with a lower risk of death from any cause, although past evaluations have noted an increased risk.

Between January 1, 1999 and December 31, 2010, for example, more than 44,300 men with androgen deficiency (serum testosterone less than 300 ng/dL) were evaluated. Of these, 8,808 (19.8%) had ever taken TRT and 35,527 (80.2%) had not. At a mean follow-up of 3.4 years, the risk of cardiovascular events was lower in the men who took TRT than those who did not. 

More recently, in a May 2019 article appearing in Nature Reviews Cardiology, the authors noted that the true impact of testosterone replacement therapy on cardiovascular health remains uncertain.

In fact, the experts made the following observations:

  • Some retrospective studies have shown a greater risk of cardiovascular events in men who are taking TRT, and the risk rises early after treatment begins
  • Meta-analyses of randomized, controlled trials have demonstrated conflicting findings, and this is likely due to various causes, including studies that have been too short to adequately evaluate cardiovascular events
  • The first trial (TRAVERSE) that is considered to be properly powered to evaluate cardiovascular findings among men using testosterone replacement therapy was initiated in 2018, and it will be approximately 10 years before the results become available

Until medical professionals have more information about testosterone and the impact on the heart, the authors recommend that physicians make their decisions about prescribing testosterone therapy on a case-by-case basis, especially in light of any personal or family history of cardiovascular problems. Doctors also should thoroughly discuss the risks and benefits of TRT with their patients.

Look for an alternative? Click here to read about how to find natural and effective testosterone supplements.

References

Cheetham TC et al. Association of testosterone replacement with cardiovascular outcomes among men with androgen deficiency. JAMA Internal Medicine 2017 Apr 1; 177(4): 491-99

Food and Drug Administration. FDA drug safety communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use.

Gagliano-Juca T, Basaria S. Testosterone replacement therapy and cardiovascular risk. Nature Reviews Cardiology 2019; 16: 555-74

Loo SY et al. Cardiovascular and cerebrovascular safety of testosterone replacement therapy among aging men with low testosterone levels: a cohort study. American Journal of Medicine 2019 Apr 3

Are Testosterone Supplements Effective?

We hear a lot in the media about how men should be worried about low testosterone levels, the symptoms that are attributed to them, and how they should consider taking testosterone replacement therapy to address those symptoms. Yet there are alternatives to this treatment approach, which is really supposed to be limited to men with diagnosed hypogonadism. So then one of the questions becomes, are testosterone supplements effective as an alternative?

What are testosterone supplements?

Unlike testosterone replacement therapy (TRT), which provides individuals with the hormone directly, testosterone supplements, which are sometimes referred to as testosterone boosters, work by increasing testosterone or related hormones. In some cases, they prevent testosterone from being transformed into estrogen. In this latter case, prevention of the conversion helps maintain T levels.

Natural testosterone supplements

Numerous herbs and nutrients have been shown to be effective as testosterone supplements. Here are those that have provided some positive research results.

D-aspartic acid

This natural amino acid has been shown to boost testosterone levels by increasing the amount of follicle-stimulating hormone and luteinizing hormone. Both of these hormones have an impact on testosterone levels. 

Other research has suggested the amino acid may play boost testosterone in certain groups of men but not others. An Australian team noted that while d-aspartic acid was associated with increases in total testosterone, it did not result in changes in resistance-trained men.

Fenugreek

You may be familiar with this herb because of its abilities to ease digestive problems, but it also can boost testosterone. Here are two studies that have demonstrated this benefit.

Sixty healthy men took either 600 mg of fenugreek or placebo daily for six week. At the study’s end, those who took fenugreek experienced an improvement in strength. The majority of men also showed increased sex drive (81% of the group), better sexual performance (66%), greater energy (81%), improved well-being (55%).

In another study of 30 college-age men, all the participants performed resistance training four times a week. Half of the men took fenugreek and the others took a placebo. Levels of both free and total testosterone rose in the fenugreek group but declined slightly in the placebo group. Men in the fenugreek group also showed a greater increase in strength and fat loss.

Ginger

Ginger has a reputation for reducing inflammation and aiding digestion, but it also has an impact on testosterone. Both animal and human studies have demonstrated this ability.

For example, several animal studies have shown that ginger increased luteinizing hormone levels in diabetic rats and can nearly double T levels. Human study results showed a 17 percent increase in testosterone levels and a nearly twofold rise in luteinizing levels in 75 infertile men who took ginger daily for three months.

Tribulus terrestris

This herb has been used for centuries by several cultures to improve sex drive and enhance testosterone levels. Research concerning the ability of the herb to boost T levels is mixed, and much of the data comes from animal studies.

However, one three-month study of men with erectile dysfunction found that the herb improved self-reported ratings of sexual health and boosted testosterone levels by 16 percent. Thus far the research indicates that tribulus can help increase testosterone in individuals who have low T or impaired sexual function, but it does not seem to increase testosterone in individuals with normal levels.

Vitamin D

A significant percentage of adults are deficient or low in vitamin D, which can have a significant impact on health. One of those effects is associated with testosterone levels. Research indicates that increasing your body’s levels of vitamin D can result in higher testosterone levels and improvements in associated symptoms.

In a year-long study of 65 men, half took 3,300 International Units of vitamin D daily, while the others took placebo. Vitamin D levels doubled in the vitamin D group and testosterone levels climbed about 20 percent when compared with the placebo group.

Zinc

Zinc is a very active mineral, involved in more than 100 chemical processes. Although the relationship between zinc and testosterone is not fully understood, what experts have shown is that men who restrict zinc intake have lower testosterone levels than do healthy men. At the same time, men deficient in zinc who take supplements show a rise in T levels.

In a 2019 study appearing in Aging Male, researchers pointed out that “medicinal doses of zinc may increase total testosterone and improve sperm count,” even though “the current body of evidene does not suggest broad recommendations regarding the use of zinc for all types of hypogonadism.”

Are testosterone supplements effective?

There are arguments on both sides of this question. In a recent study from the Keck School of Medicine of the University of Southern California, experts evaluated 150 testosterone supplements and reported that 90 percent claims to boost testosterone. However, less than 25 percent had data to support their claims.

Testosterone supplements that have scientific data to support their claims can be effective. Men need to look for products that provide such references and talk to a medical professional about how these supplements can best help them.

References

Clemesha CG et al. Testosterone boosting supplements composition and claims are not supported by the academic literature. World Journal of Men’s Health 2019 Jun 14; 37:e34

Ghlissi Z et al. Antioxidant and androgenic effects of dietary ginger on reproductive function of male diabetic rats. International Journal of Food Science and Nutrition 2013 Dec; 64(8): 974-78

Melville GW et al. The effects of d-aspartic acid supplementation in resistance-trained men over a three month training period: a randomized controlled trial. PLoS One 2017 Aug 25; 12(8): e0182630

Prasad AS. Zinc status and serum testosterone levels of healthy adults. Nutrition 1996 May; 12(5): 344-48

Santos HO, Teixeira FJ. Use of medicinal doses of zinc as a safe and efficient coadjutant in the treatment of male hypogonadism. Aging Male 2019 Feb 15:1-10

Sellandi TM et al. Clinical study of Tribulus terrestris Linn in oligozoospermia: a double blind study. Ayu 2012 Jul; 33(3): 356-64

Steels E et al. Physiological aspects of male libido enhanced by standardized Trigonella foenum-graecum extract and mineral formulation. Phytotherapy Research 2011 Sep; 25(9): 1294-300

Topo E et al. The role and molecular mechanism of D-aspartic acid in the release and synthesis of LH and testosterone in humans and rats. Reproductive Biology and Endocrinology 2009 Oct 27; 7:120

Wehr E et al. Association of vitamin D status with serum androgen levels in men. Clinical Endocrinology (Oxford) 2010 Aug; 73(2): 243-48

Wilborn C et al. Effects of a purported aromatase and 5a-reductase inhibitor on hormone profiles in college-age men. International Journal of Sports Nutrition and Exercise Medicine 2010 Dec; 20(6): 457-65

The Impact of Testosterone on Male Physique & Health

As young males progress through adolescence into young adulthood, they experience the tell-tale signs of hormonal changes. Testosterone’s impact on male physique and other characteristics becomes quite evident: growth of body hair, deepening voice, maturation of the penis and testicles, increased muscle mass, and quickening libido, among others.

During those early years, testosterone levels are peaking, but as the saying goes, what goes up must come down. Around age 30, testosterone levels begin a slow and gradual decline, approximately 1 percent per year. That decline has varying effects on a man’s physique, depending on a number of factors.

Testosterone impacts male physique: what gives?

As guys get older and T levels decline, the impact of the hormone on male physique changes. A small amount of circulating testosterone transforms into a form of estrogen called estradiol. As T levels decline, men also produce less estradiol. Therefore, changes and symptoms experienced by men who have falling testosterone levels may be partly or entirely due to the drop in estradiol levels.

Of course, testosterone levels in any given man may be low, within normal range, or high. Although there are guidelines physicians and patients follow to help them determine where a guy falls on the T spectrum, testosterone levels are highly individual, as are each man’s response to them. Here we are concerned with the two extremes, and this is how low and high testosterone levels may affect you.

Low testosterone

Perhaps you are already experiencing some of the symptoms that are commonly associated with low testosterone: lack of sex drive, erectile dysfunction, loss of muscle tone and mass, accumulation of body fat (especially around the abdomen), hair loss, mood changes, trouble sleeping, decrease in testicle size, fatigue, bone loss, and mood changes.

All of these changes associated with low testosterone, even those not directly linked to physique, have an impact on a man’s physical, emotional, and mental health. Yet enhancing your testosterone levels naturally is highly recommended over taking testosterone replacement therapy, which is medically recommended only for men who have a medical condition that causes excessively low testosterone levels (hypogonadism).

High testosterone

Men who artificially pump up their testosterone levels by using anabolic steroids, testosterone, or related hormones to improve their athletic performance or muscle mass may experience some significant problems associated with excessive testosterone, such as:

  • Low sperm counts
  • An enlarged prostate
  • Acne or other skin problems
  • Fluid retention (swelling of the feet, ankles and legs)
  • Weight gain
  • High cholesterol and blood pressure
  • Insomnia
  • Increased risk of heart attack
  • Increased muscle mass
  • Headaches
  • Liver disease

However, you also can help boost your testosterone levels naturally by adhering to certain lifestyle modifications, such as following a healthy all-natural diet, exercising and lifting weights (even light ones can help), reducing stress, getting sufficient vitamin D, sleeping at least 7 hours per night (which is when testosterone replenishes itself), and taking natural supplements that may help boost testosterone levels. These approaches are not associated with the side effects found with other ways to raise T levels. 

What the research says

In a study appearing in the Journal of Clinical Endocrinology and Metabolism, researchers looked at the effect of taking testosterone enanthate (200 mg/week) for six months in13 nonathletic men. Eight healthy men served as controls. Factors considered were bone turnover fat-free mass, bone density, muscle strength, serum testosterone, among others.

Concerning male physique, use of testosterone resulted in an increase in fat-free mass, a decrease in fat mass, changes in muscle strength, and a rise in testosterone levels. The authors concluded that “these changes do not support the use of androgens for enhancing athletic performance.”

Bottom line

It’s well known that testosterone impacts male physique, as demonstrated here. Testosterone’s effect on male health can depend on many factors, ranging from what a man’s “normal” testosterone levels is, to his age, diet, exercise habits , and other lifestyle factors. If you talk to a doctor about symptoms of low testosterone, be sure to ask about the benefits and side effects of any suggested treatment plan and to discuss the impact of lifestyle changes and the use of natural supplements, a combination that can help balance a man’s testosterone levels without the use of medical intervention.

References

Harvard Health Publishing. Testosterone—what it does and doesn’t do. 2015 July

Young NR et al. Body composition and muscle strength in healthy men receiving testosterone enanthate for contraception. Journal of Clinical Endocrinology and Metabolism 1993 Oct; 77(4): 1028-32

Low Energy and Low Testosterone – What’s the Deal and How to Beat It?

Do you feel tired all the time, lack motivation, experience brain fog, and get sleepy during the day? Many medical and lifestyle factors can cause these symptoms, but when we are talking about men, one of those factors can be low testosterone. In fact, low energy and low testosterone can be a significant problem for men as they grow older and their T levels decline.

The hormone testosterone is responsible for many processes, during adolescence and throughout adult life, including maintaining muscle, producing sperm cells, libido, and generating energy. Although declining testosterone levels can have an impact on these and other factors as a part of normal aging, it’s not normal for testosterone to drop so low that fatigue becomes a way of life.

Symptoms of low testosterone
Low energy or fatigue is just one of the symptoms of having low testosterone. Others include:
• Depression
• Irritability
• Anemia
• Hot flushes
• Erectile dysfunction
• Decline in body hair growth
• Decrease in muscle mass
• Development of gynecomastia (man boobs)
• Trouble concentrating
• Loss of bone mass (osteoporosis)

If you are experiencing symptoms of low testosterone, talk to your doctor about having your T levels checked. All it takes is a simple blood test.

How to remedy low energy and low testosterone
If you want to boost your testosterone levels and your energy along with it, you may be tempted to listen to the commercials telling you to jump on board the testosterone replacement therapy (TRT) train. However, testosterone replacement therapy is FDA approved only for men who have low T levels associated with disorders of the pituitary gland, testicles, or brain that cause hypogonadism. The safety and benefits of using TRT for symptoms of low T for aging reasons has not been established. TRT also may increase a man’s risk of suffering a heart attack or stroke.

Instead, you can help battle low energy and low testosterone with natural options. It is recommended you adopt all of these lifestyle tips because they can work in synergy and improve your results.

Get checked out. Talk to your doctor about any medical conditions or medications that could be causing your low energy and low testosterone. Thyroid disease, sleep apnea, depression, insomnia, heart disease, diabetes, and anemia are associated with fatigue and/or low T, as are the following medications: opioids, some antidepressants, statins, ketoconazole, cimetidine, spironolactone, and chemotherapy. Discuss with your doctor lifestyle changes and alternative medications, if needed, to help you overcome the low energy and low testosterone that is affecting your quality of life.

Try natural testosterone supplements. Numerous herbs and nutrients have been shown to help boost testosterone levels naturally on various levels. Those ingredients include L-arginine, avena sativa, beetroot, beta-sitosterol, L-carnitine, L-citrulline, fenugreek, ginkgo biloba, green tea extract, pygeum africanum, resveratrol, tribulus terrestris, vitamin D, and zinc. Rather than take these substances individual, your best bet is to take one supplement that contains all or nearly all of them.

Improve your diet. Kick up your energy and T levels by keeping saturated fat intake low and fruits, vegetables, and other whole natural foods high on your menu. Alcohol consumption should be kept to a minimum: two drinks daily is considered moderation, but less is even better.

Stay hydrated. This is a simple tip that many men overlook, especially if they are exercising, working outdoors, or are elderly. Dehydration can cause fatigue and lower your energy levels. Carry a stainless steel water bottle and drink from it frequently.

Get quality sleep. Seven to eight hours every night is highly recommended. You need sleep to produce testosterone. If you are experiencing sleep apnea, get it treated. Your doctor can order a sleep study if sleep apnea is indicated.

Get help for depression. Depression, low energy and low testosterone often go hand-in-hand, so it’s important to address depression. If you are treated medically for depression, talk to your doctor about medications that are not in the selective serotonin reuptake inhibitor class, as these can interfere with libido and sexual performance.

Exercise. Regular physical activity raises testosterone levels. Be sure to choose activities you enjoy so you’ll be more likely to stick with it. You’ll feel more energized, improve your overall health, enhance muscle strength, and even drop some weight.

Bottom line
If you’re experiencing low energy or fatigue, low testosterone may be a reason. These natural testosterone and energy boosters can alter your life for the better if you’re willing to commit to change. The challenge is out!

References
Bergh SJ, Giraldi A. Sexual dysfunction associated with antidepressant agents. Ugeskr Laeger 2014 May 26; 176(22).
Food and Drug Administration. FDA drug safety communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. 2018 Feb 26
McHenry J et al. Sex differences in anxiety and depression: role of testosterone. Frontiers in Neuroendocrinology 2014 Jan 35(1): 42-57
Metcalf E. Does working out affect testosterone levels? WebMD 2015